As a rheumatologist, I often get the question, “What do you do?” According to my kids, their mom does “something with joints.” At the conclusion of patient visits, when I propose a diagnosis such as polymyalgia rheumatica or PMR, I often hear, “What is that?” The fact is most people do not think about rheumatology until they need a rheumatologist. And then, learning the lingo about disease, medications, and lab monitoring can be a challenge.
Rheumatology is a relatively new specialty in the world of medicine. Focus on the disease in America began in the early 1920s with initial definition and discovery, followed by the famous breakthrough of cortisone at Mayo Clinic in 1950, and grew to a deeper scientific understanding of arthritis diseases today. Treatments have progressed from cortisone and aspirin to immune system modification with biologic medications. Future therapies will involve genetics, engineering new cartilage, and creating cells that rheumatologists will command to do our bidding upon the immune system.
Today we work to manage autoimmune diseases such as rheumatoid arthritis or lupus with medications that adjust the immune system response. Symptoms that can occur in association with some of these diseases are rashes, joint swelling, fevers, lung problems, and kidney issues. By adjusting the immune system, we can change the symptoms, hopefully lessening their impact on the patient.
In our fast-paced world, we often want answers and quick solutions to our problems. However, rheumatology cases require persistence. There are no blood tests that specifically diagnose the problem. Rheumatologists must take time to talk with and examine the patient. We gather additional information from labs tests, studies, and x-rays. Once all the data is available, sometimes the condition is clear. But other times, the case is more challenging and requires several visits before making a firm diagnosis.
Like most health providers, I enjoy solving patient problems and making a diagnosis. We get satisfaction from figuring things out and our reward comes when a treatment improves a patient’s function or quality of life. Our goal in rheumatology is to help patients achieve remission, or better yet, to predict who is likely to get rheumatoid arthritis in hopes of preventing it from starting in the first place.
So, when patients look at me with that expression that asks “rheuma-what?”, they don’t necessarily want to hear about the science of what I do. Instead, I assure them that we will keep working together with the same goal: To get the immune system to quiet down, and help the patient feel better so they can get back to life.
Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc®. For free and easy access to the entire Prairie Doc® ® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook. Jennifer May, M.D. is a contributing Prairie Doc® columnist. She practices rheumatology in Rapid City, South Dakota.
