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Adult rheumatology is a subspecialty field in Internal Medicine that deals with connective tissue disorders involving the musculoskeletal and immunological systems. Rheumatologists are responsible for investigating, diagnosing, treating, and managing patients’ chronic rheumatological conditions, including osteoarthritis, rheumatoid arthritis, and lupus, among many others. To enter the field, one must complete three years of internal medicine residency and apply for the 2-year fellowship in rheumatology at various programs in Canada. The pediatric rheumatology subspecialty requires entry from a pediatrics core residency.

Rheumatologists must have appropriate knowledge of all body systems, as rheumatological conditions can affect many organs and tissues. Heavy emphasis is put on knowledge of the musculoskeletal system as well as immune system manifestations, especially in treating systemic auto-immune conditions such as rheumatoid arthritis or lupus. Rheumatologists must also act as effective collaborators with other health professionals (family physicians, other internists, physiatrists, physiotherapists, occupational therapists, nurses, etc.) for chronic disease management of their patients. Common proficiencies expected of rheumatologists are performing a complete patient history and physical examination, joint inspections and injections, and treatment with DMARDs (disease-modifying anti-rheumatic drugs) and anti-inflammatory medications. Rheumatologists also have important roles in the interpretation of laboratory tests for autoimmune serum markers or markers of inflammation (e.g. ANA – anti-nuclear antibodies, ESR – erythrocyte sedimentation rate), and interpreting imaging and fluid pathological findings of the affected joints or tissues. Because rheumatological conditions can heavily affect a patient’s quality of life, rheumatologists must be sensitive to psychosocial aspects of their patients’ diseases.

Common Disease and Disorders

Osteoarthritis (OA)
The most common form of arthritis. It involves the degeneration and low-grade inflammation of cartilage and bone, especially in fingers, wrists, knees, hips, and lower back. Rheumatologists diagnose OA from signs and symptoms, as well as from utilizing imaging modalities to help distinguish OA from other causes of joint pain and discomfort. Through treatment and lifestyle change recommendations, rheumatologists help patients manage the pain and function of the affected joints.

Rheumatoid Arthritis (RA)
Thickening and inflammation of the joints, especially in the hands, caused by an auto-immune reaction. The disease may also affect other parts of the body such as the lungs or the heart. Rheumatologists play a large role in diagnosing RA from the signs and symptoms of the patient, as well as through blood tests looking for rheumatoid factor, an autoantibody. The treatment for RA involves restoring or maintaining function while minimizing inflammation and discomfort. This can be achieved with assistive devices or with medications. Rheumatologists play an important role in managing the disease and work with patients to find an optimum treatment.

Systemic Lupus Erythematosus (SLE)
Autoimmune reaction against a variety of organs and tissues with widely variable signs and symptoms, and hence is referred to as “The Great Imitator” for mimicking other diseases. The autoantibodies in SLE are directed against nuclear proteins. There is no known cause of the disease, but there may be an unknown environmental factor that affects people with a higher genetic predisposition to autoimmune diseases. Rheumatologists play an important role in differentiating SLE from other possible diagnoses, and developing an appropriate treatment plan to prevent severe or long-lasting SLE flares.

Systemic Sclerosis (Scleroderma)
A hardening and tightening of the skin and underlying connective tissues. In more severe cases, internal organs are affected and the condition can be fatal. This is a rare autoimmune disease with unknown causes, but strong links with environmental and genetic factors have been found. Rheumatologists diagnose, treat, and monitor patients with scleroderma for complications like scleroderma renal crisis, pulmonary hypertension, or pulmonary fibrosis.

Further Advanced Training Opportunities

Once the core 3-year internal medicine residency and subsequent 2-year rheumatology fellowship are completed, practicing physicians may choose to practice rheumatology in the community, or can pursue advanced training opportunities throughout the country and abroad. These include Canadian Arthritis Society Research fellowships, the Geoff Carr Lupus Fellowship designed to train rheumatologists to be experts in the management of patients with lupus, the GSK-CaNIOS-CRA-TAS Lupus fellowship Research fellowship, or Master’s degrees such as Master’s of Public Health (MPH) or MBA (Master’s of Business Administration). Further training may afford the opportunity to practice in more specialized academic or tertiary centers.

Gender Breakdown
50 responses (2014 National Survey Results)

Age Breakdown
50 responses (2014 National Survey Results)
Hours Breakdown (Excluding on-call activities)
50 responses (2014 National Survey Results)

Activity Hours Worked (mean)
Direct patient care without a teaching component 19.67
Direct patient care with a teaching component 10.31
Teaching/ educating without direct patient care 3.09
Indirect patient care 8.59
Health facility committees 1.14
Administration 1.77
Research 4.58
Managing your practice 1.52
CME/ CPD (Continuing Professional Development) 3.22
Other actvities .70
Total Hours 54.58

Average number of on-call work hours per month: 104.77
34 responses; reported as mean (2014 National Survey Results)

Adult Rheumatology Residency Programs in Canada

Contact information for Program Directors can be accessed on the Royal College’s website here: Open in new tab

University of British Columbia
Vancouver, British Columbia

Queen’s University
Kingston, Ontario

University of Calgary
Calgary, Alberta

University of Ottawa
Ottawa, Ontario

University of Alberta
Edmonton, Alberta

McGill University
Montréal, Quebec

University of Saskatchewan
Saskatoon, Saskatchewan

Université de Montréal
Montréal, Quebec

University of Manitoba
Manitoba, Winnipeg

Université de Sherbrooke
Sherbrooke, Quebec

Université Laval
Laval, Québec

Western University
London, Ontario

Dalhousie University
Halifax, Nova Scotia

McMaster University
Hamilton, Ontario

University of Toronto
Toronto, Ontario

Page Author(s): Ramona Neferu (2018)
© 2021 Internal Medicine Interest Group (IMIG) - Schulich School of Medicine and Dentistry