By 2034, new medications will finish their journey to the pipeline. They will have names that are utterly unpronounceable to human beings, but they will exist. And these medications will enable us to treat patients by uniquely targeting the steps in such pathways that we do not know today. In the ideal setup for the rheumatology clinic for tomorrow, we won’t need to guess whether a patient will respond to a medication or not, but rather can counsel patients how soon a given medication will work based on basic lab work and other investigations.
In the same way that we look at gold injections or thalidomide as ancient remedies, I feel that rheumatologists in 2034 will look at prednisone as an historical artifact. Even in 2024, prednisone seems to be on its way out, with urgent appeals to reduce prednisone to its lowest possible dose for as little time as possible. In 2034, my hope is that it will require a compounding pharmacy to synthesize a dose of prednisone to the patient because prednisone will be replaced by cheaper and more effective medications with less adverse effects.
More optimistically, I believe there will be cures—truly cures—to many of the chronic inflammatory conditions that we consider today to be stubbornly unresponsive. We’re at the infancy of CAR-T therapy for such conditions as systemic lupus erythematosus and systemic sclerosis. And although there have been setbacks and concerns about the risks of therapy, including malignancies, exist, I feel confident the technology will continue to advance so the benefits will unambiguously outweigh risks.3
Rheumatologists Will Unite with Other Specialists
With the proliferation of knowledge and skills, rheumatologists are going to study a very different field than our forebears. Rheumatologists of 2034 are going to be part hematologists, part clinical immunologists and part infectious disease specialists, among other hybrids. I anticipate there will be a lot more cross-training during fellowship and more interdisciplinary involvement so we can learn from our colleagues. This will include primary care, and I am eager to see the burgeoning field of preventive rheumatology grow into its own over the next 10 years.
To the newest members of the rheumatology community, fellowship will be the ideal point to have elective clinical experiences and research projects, so the academic rheumatologists in 2034 can have deep and meaningful relationships with our colleagues. The private practice rheumatologists of 2034 will obviously have a different sphere that they inhabit, but having knowledge that transcends what is traditionally rheumatology will be just as essential.
