Not all illnesses leave visible marks. For millions of people living with autoimmune and chronic conditions like lupus, rheumatoid arthritis, fibromyalgia, or Sjögren’s syndrome, the pain is real—even when it can’t be seen. These are known as invisible illnesses: complex, often misunderstood medical conditions that don’t always show up on the outside but profoundly impact a person’s daily life. 

While they may not draw attention the way a cast or a scar might, their effects just as life-altering. In this article, Dr. Manan Dhingra, rheumatologist at Riverside Healthcare, discusses what it means to live with an invisible illness, the challenges of diagnosis and treatment, and how rheumatologists are at the forefront of care for these often-overlooked conditions.

What Constitutes an Invisible Illness—And How Are They Diagnosed?

Invisible illnesses in rheumatology fall into two main categories. The first includes conditions like fibromyalgia, where symptoms such as pain and fatigue are significant but lack visible physical signs such as joint swelling or rashes. 

The second category involves autoimmune diseases that may have outward signs (e.g. joint swelling or mouth sores) but are still considered “invisible” because they affect multiple organ systems, fluctuate over time, and can be difficult to diagnose. This complexity often makes these illnesses hard to recognize or understand, both for patients and providers.

“A lot of the conditions we see in rheumatology can be difficult to diagnose because they often have overlapping symptoms. So, almost all of patients will have joint pain and almost all of them will have fatigue. So, to specify what exactly is going on, we try to determine a pattern,” explains Dr. Dhingra. “We look at the pattern of the affected joints, the time of day symptoms occur, if there’s swelling.”

The diagnostic process also often involves blood work and sometimes imaging. Certain antibodies in the blood can reveal important information about what is going on—particularly for a condition like rheumatoid arthritis. 

“If all of the workup tends to be negative, and on the outside there aren't obvious signs and we've ruled out other possibilities, then we think about the other kind of invisible illness, which would be something like fibromyalgia,” he adds. “Generally, that's the way we proceed.”

The Role of Rheumatologists in Diagnosis and Treatment

Rheumatologists play a key role in identifying and managing invisible illnesses. They begin by evaluating whether a patient’s symptoms point to a rheumatologic, inflammatory, or autoimmune condition versus something like an infection. Once a diagnosis is made, rheumatologists have a wide range of treatments available to help manage the illness, slow its progression, and prevent long-term damage.

“Once we make the diagnosis of something like rheumatoid arthritis or lupus that has often gone undiagnosed or untreated, we can really make a huge impact in helping people feel remarkably better. We also prevent future damage down the road to joints and to other parts of the body,” assures Dr. Dhingra.

How Are Invisible Illnesses Treated?

There have been significant advances in treatment options for invisible illnesses, particularly in rheumatology. Alongside long-standing medications like NSAIDs and steroids, doctors also use conventional disease-modifying drugs such as methotrexate and hydroxychloroquine, which are typically taken orally. More recently, biologic therapies—administered through injections or infusions—have transformed care, leading to major improvements in symptoms and quality of life for many patients.

Dr. Dhingra urges individuals to visit with a rheumatologist if they’re having issues like pain that's not getting better, swelling in the joints, stiffness in the morning that lasts several hours, or unexplained symptoms such as fever, rashes, or mouth sores.

“In many cases, the result of seeing a rheumatologist is that we rule out certain issues. That's the most important thing we do, and that actually can be a very important step,” he shares. “It can give you a lot of clarity and confidence in managing your symptoms.”
 

For more information on Riverside's Rheumatology services click here.