(upbeat music)
My first exposure to rheumatology
occurred in medical school.
I was fortunate, actually, to have mentors,
who were both rheumatologists,
through my medical school experience.
So, I was exposed early.
This was at the time when we were just beginning
to understand and decipher things about the immune system,
largely as a results of HIV infection and AIDS,
where we began to understand the role,
the critical role, of lymphocytes in causing diseases
and how their absence was leading to immunodeficiency.
It was really an important time in our specialty.
We began to understand that immune system
and how it worked in very explicit detail.
What was happening when I was in medical school
in residency, was that the first biological agents
for the treatment of rheumatic diseases were be tested.
And this was really fascinating to me,
to be able to develop targeted molecules
to knock out a specific part of the immune system.
In this case, it was looking at down-regulating T cells.
But over time,
I really was attracted to rheumatology as a specialty.
At that time, in terms of clinical ability,
we were limited in our capacity to be able to help patients
in the ways that we are now.
We didn't understand so much about the diseases,
and we had limited therapies
except for very, very potent immune-suppressing agents
that caused tremendous side effects for people.
But there was great opportunity.
And what I saw in the rheumatologists that I worked with
was their incredible compassion
for the patients that they took care of.
And what I saw was the opportunity
to be a real doctor for patients,
to understand them as individuals,
and to understand these very complicated diseases
that affect so many parts of the body
and so many aspects of someone's health.
My training in rheumatology was really at a perfect time
because I saw rheumatoid arthritis, for instance,
before and after.
And when I say that, I mean
rheumatoid arthritis before we had biologics
and before we used aggressively-dosed therapies.
Our waiting rooms in our rheumatology clinic,
when I started my fellowship,
were filled with people in wheelchairs.
And we had these special built-up chairs
for people to be able to sit into.
And we spent a lot of time,
working with our orthopedic colleagues
and working with rehabilitation specialists,
in how to try to fix the damage that had been done.
But at this time, we were doing the first trials
of drugs, biological therapies for rheumatoid arthritis,
and we began to see changes that were really dramatic.
We had previously been using things like gold
to treat patients, where not a lot of people responded,
and they had significant side effects.
And then we started using these biological medications,
first in clinical trials and then in clinical practice,
that made immediate and important differences
for many people treated with the diseases.
And this, I think, was one
of the most gratifying things to see,
was actually to see the transformation of our specialty
and the focus on rheumatic diseases
as something that we could treat,
and for which we could make real differences
in the lives of patients.
What's happened over time, as these biologics
have become really part of our armamentarium
and part of the routine treatment for people with RA
is the disease itself has changed.
RA is not the disease it used to be.
We don't have waiting rooms
that are filled with people in wheelchair anymore.
And the reason is because we introduce
more aggressive therapies early,
and we're able to prevent the damage
that otherwise used to occur.
So, the specialty now is not about rehabilitating people
and trying to live with disability,
but trying to prevent disability
from occurring in the first place.
The therapies that we have, have really made this possible.
As I look beyond rheumatoid arthritis,
I see the same types of developments
that are happening in other rheumatic diseases.
Most proximately with psoriatic arthritis
and with ankylosing spondylitis,
but also, as we look across other diseases,
like lupus, or vasculitis, or scleroderma.
Many of these conditions are where we were
with rheumatoid arthritis a decade ago.
The science is beginning to catch up,
and the targeted therapies are being able to be used.
And I think this is where we're going to be heading
in the future to really make a huge impact
on these illnesses that affect so many people
in such significant ways.
(upbeat music)