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Two kinds of joint disease
Inflammatory arthritis — rheumatoid arthritis, psoriatic arthritis, lupus, gout — is a medical disease: the immune system inflames the joint lining, and the primary treatment is medication that calms the immune attack. That's rheumatology. Mechanical problems — osteoarthritis, meniscus tears, ligament injuries, AVN — are structural: cartilage worn, tissue torn, bone compromised. That's orthopedics.
Read your own symptoms
Signals that point toward each specialist:
- Rheumatology signals: many joints at once (especially small joints of hands/feet), symmetric involvement both sides, prolonged morning stiffness (over an hour), fatigue or fevers, family history of autoimmune disease
- Orthopedic signals: one or two large joints (knee, hip), pain that worsens with activity and eases with rest, brief morning stiffness that loosens quickly, a clear injury history, locking/catching/instability
- Either way: a hot, red, exquisitely painful single joint with fever is urgent — same-day care
Where the two teams meet
The paths cross constantly. Rheumatoid patients whose knees are structurally destroyed after years of disease need an orthopedic surgeon for replacement — coordinated with rheumatology on medication timing around surgery. Gout patients get flare management medically but may need a surgeon when tophi damage a joint. And plenty of patients arrive at orthopedics labeled "arthritis" whose blood work belongs in rheumatology — or arrive at rheumatology with what turns out to be a mechanical tear. Good specialists redirect without wasting your months.
Practical advice for Hawai‘i patients
If your pattern reads mechanical — one big joint, activity-related, injury history — start with an orthopedic evaluation; exam plus weight-bearing X-rays answer most of it in a visit, and anything inflammatory-looking gets appropriate labs and a rheumatology referral. If your pattern reads inflammatory, ask your primary care physician for rheumatology labs first. And when inflammatory disease has already wrecked a hip or knee's structure, the two specialties team up: medicine controls the disease, surgery restores the joint.
Medically reviewed by Paul Norio Morton, MD, FAAOS, FAAHKS. Last reviewed: . This article is for education only and isn’t a substitute for an exam and personalized advice — schedule a consultation to discuss your situation.