Partly because treatment options were so limited for rheumatic diseases, rehabilitation via hospitalization was seen as a key mode of management. Early studies of these units documented that, on average, patients with rheumatoid arthritis were hospitalized for two to three months, with some staying a year or longer.3
Dr. Matteson notes that on the whole, the shift reflects a change for the best. People do not have to stay in the hospital as much, & he believes the model generally fosters good patient outcomes.
Inpatient Rheumatic Disease Units
Jonathan Scott Coblyn, MD, is the director of clinical rheumatology at Brigham and Women’s Hospital, Boston, and an associate professor at Harvard Medical School. He completed his fellowship in the late 1970s at Robert Breck Brigham Hospital (RBBH; which became Brigham and Women’s Hospital in 1980, after merging with the Boston Hospital for Women and the Peter Bent Brigham Hospital). He notes that, at the time, RBBH was filled with people with rheumatic disease or people who were there for orthopedic surgery. “There were no hospitalists at that time, so we would all take our turn, like you do in a general medical service, but it would be on the inpatient rheumatology service. We had hospital-employed doctors, and we had private practice doctors who admitted there as well.”
“When I was a fellow,” Dr. Coblyn says, “the indication for someone with rheumatoid arthritis to be admitted to the hospital was new-onset rheumatoid arthritis or a flare of their rheumatoid arthritis. That’s inconceivable now. People were admitted, and they stayed in for almost two weeks—three weeks or more. We gave them aspirin and paraffin wax and Hubbard tubs and physical therapy and started them on gold shots. The service was covered by housestaff.”
The patients would often have quite severe symptoms. As Dr. Coblyn remembers, “You would see people who would come in—they would have both hips, both knees, maybe their neck fused, and they’d be in there for months and see the rheumatologists, orthopedists and therapists. It is now a totally different patient population and almost a different disease than it was then.”
When Dr. Matteson came to the Mayo Clinic in the late 1980s, it had an inpatient rheumatology service, as well as a consulting service that went to different hospitals. “This was for patients with rheumatic diseases—for example, rheumatoid arthritis flares or lupus flares—and we would have them hospitalized on the rheumatology service. And in fact there were three inpatient services, because frankly we didn’t have very effective treatments. Patients would be in the hospital for extended periods of time for physical therapy, to receive steroids, maybe to get started on a drug like sulfasalazine or Plaquenil.”
