Speak Out Rheum: Musings on Our Past & Rheumatology

Rheumatologists have said goodbye to our jewelers’ rings to measure changes in joint structure. Today, we use musculoskeletal ultrasound and magnetic resonance imaging to show very precise images of joint pathology and monitor disease activity.

In this brief moment in our time of practice—just the past 40–50 years, a blink of an eye in the long history of our species—we and our patients have enjoyed the apparent miraculous discoveries of the many causes of rheumatic diseases. Our current biologic therapies have been life changing for millions of our patients and have given them their lives back. Intravenous pegloticase can eliminate golf-ball sized tophi with a Drano action in weeks. Collagenase clostridium injections provide a meat tenderizer-like softening effect, and within a few days a Dupuytren contracture is gone and the finger is straightened.

Many patients today extend and grasp our hands with a firm grip and a glint in their eye of thanks.

Rheumatology is at the beginning of adopting precision medicine, and I can only imagine what new discoveries and treatments there will be in the next 40 years for our patients and future rheumatologists. Perhaps, thousands of years from now, a physician will examine an old picture of a hand with severe arthritis from a digital archive and, like us today, find themselves bemused by how far we have progressed and yet how similar we remain.

David R. Mandel, MD, FACR, has been providing care to patients with rheumatic diseases in Northeast Ohio since 1982. He is a member of the medical staffs of University Hospitals, Lake and Hillcrest Hospitals. He is a past president of the Ohio Association of Rheumatology.