Rheumatology News is celebrating its 10th anniversary of publication. Over those years, the practice of rheumatology has undergone a sea change, with the advent of biologic agents and approval of the first new agents for management of both gout and lupus in half a century. Some of the members of Rheumatology News’ Editorial Advisory Board have reflected on these and other memorable developments in the specialty as we launch into our next decade.
As a publication, Rheumatology News came into being 10 years ago in a print-driven world and now deals out news of use to clinicians via www.rheumatologynews.com, Facebook, and Twitter, as well as in enduring print. Stories now take the form of videos and podcasts, as well as investigations of developments of interest to practicing rheumatologists.
These enormous changes in both rheumatology and publishing tempt one to imagine what surprises await us during the next 10 years. Let’s meet back here in 2022 to discuss them. Meanwhile, thank you for your loyalty, and please accept warm wishes for the New Year from Rheumatology News.
Sally Koch Kubetin, Managing Editor
Rheumatology Was ‘Almost Extinct’
Having practiced rheumatology for 30 years, my first thought is "can it really be that long," and my second thought is "I wish I could do it all over again."
Norman B. Gaylis
I think, without a doubt, most of my colleagues who have practiced rheumatology during this time frame would agree that the advent of biologic therapy for the treatment of rheumatoid arthritis has been the single biggest game changer in our specialty. From a specialty that was almost extinct, closing down fellowship programs and being advised by its key opinion leaders to consider blending the practice of rheumatology and internal medicine in order to survive, we have seen the resurrection and emergence of rheumatology as a leading cutting-edge specialty in internal medicine
Our RA patients have multiple options that provide them outcomes that range from low disease activity to remission. Gone are all of the poor cushingoid patients with compression fractures of the spine who would haunt our waiting rooms during their weekly visits for gold injections.
As part of the biologic era, we have seen the economics of practicing rheumatology become far more complex and challenging. Both the patients and the rheumatologists are facing economic obstacles in the form of either providing the care or affording the care. In addition to RA, we now see many other diagnoses coming into line for treatment with different biologic therapies. Even osteoarthritis, which affects the majority of our patients, is emerging from the dark ages. A number of new cartilage sparing/repairing molecules are either available or close to reaching the marketplace
I think we should not forget the advances we have made in the diagnosis, management, and prevention of osteoporosis, which was truly an epidemic in my early career. The advent of bone-density testing has been responsible for the recognition and use of newer medications that together with a lower need for steroid usage in RA, have helped to reduce dramatically the incidence of osteoporosis-related fractures.
A bittersweet emotion for me is the progressive but somewhat slow recognition and evolution of the value of imaging tools such as MRI and ultrasound in the diagnosis and management of RA and other rheumatic diseases. These tools give us the ability – much like the oncology model – to make early diagnoses of inflammatory arthritis; determine the appropriateness of using biologic therapy when the damage is still reversible; and ultimately to measure whether the structural benefits of these expensive medications are justified, can be discontinued, or should be switched.
The good news is that we seem to have overcome this resistance, and I believe we are at the beginning of another new era, in which the combination of biomarkers, imaging tools, and outcome measurements of disease activity are contributing to results that – at the beginning of my career – I never have believed I would see.
One final note is that the rheumatologist is still the best physician choice for any patient with musculoskeletal or rheumatic complaints.
Norman Gaylis, M.D.
Private practice, Aventura, Fla.
Resetting the Inflammatory Rheostat
As I look back at the past 10 years in rheumatology, I think, in the absence of a cure, that the most important change in the therapy of rheumatoid arthritis, and collagen-vascular diseases in general, has been clinical acceptance of the concept that early therapy to control the inflammatory process can prevent tissue damage.