Rheumatology represents a subspecialty in internal medicine and pediatrics, which is devoted to adequate diagnosis and therapy of rheumatic diseases (including clinical problems in joints, soft tissues, heritable connective tissue disorders, vasculitis and autoimmune diseases). This field is multidisciplinary in nature, which means it relies on close relationships with other medical specialties.
The specialty of rheumatology has undergone a myriad of noteworthy advances in recent years, especially if we consider the development of state-of-the-art biological drugs with novel targets, made possible by rapid advances in the basic science of musculoskeletal diseases and improved imaging techniques.
History of rheumatology
The term “rheuma” can be dated back to the 1st century A.D., when it had a meaning akin to the Hippocratic term “catarrhos”. Both of these terms are derived from the term phlegm and refer to substances which flow, which was one of the four primary humors. The first known use in English is recorded in the late 14th century.
Thomas Sydenham was an English physician from the 17th century, often called “the English Hippocrates”. He introduced the value of clinical observation in the practice of medicine, basing his treatment endeavors on practical experience rather than upon the theories of Galen. He suffered from gout, a complex form of arthritis, which he managed to describe in detail.
The first clinical description of rheumatoid arthritis is credited to Landré-Beauvais in 1880. Although the disease appeared similar to gout, Landré-Beauvais pointed out that this disease shows several distinctive features – namely a chronic course, predominance in women, involvement of multiple joints from the onset, and a significant decline in general health.
Interestingly, some important advances in the history of rheumatology occurred during war periods. Arthritis associated with conjunctivitis and urethritis (following dysenteric episodes) has been described during the First World War by the German Hans Reiter and, more recently, French Nöel Fiessinger and Edgar Leroy.
Several other war episodes have been pivotal for the development of drugs that are now abundantly used to treat rheumatic diseases. In fact, the discovery of effects of immunosuppressive agents was an indirect consequence of the poison gas usage (so-called mustard gas), already during the First World War.
Furthermore, the history of the cortisone has a direct link to the Second World War, when Germany imported large quantities of bovine adrenal glands from Argentina for the purpose of producing gland extracts to increase the performance ability of their aviators. Since then, rheumatology has come a long way, and today there is virtually no branch of internal medicine that does not interact with rheumatology.
Key aspects of modern rheumatology
Rheumatology has changed significantly over the last twenty years from a largely inpatient based specialty with poorly effective treatment modalities, to an outpatient based specialty with targeted and science-based therapies. Still, one fundamental problem remains, and that is the difficulty of defining the range of illnesses included in this field.
The adequate understanding of pathophysiological processes underlying rheumatic diseases prompted the development of new drugs. Today, physicians have access not only to novel biologic drugs, but also to specific registries established to evaluate real-life usage of these agents and their optimal role in treatment protocols.
In addition, rheumatology offers diverse prospects for both clinical and scientific research. This field is undoubtedly set to develop even further in the future, as better assessment of disease, improved science, the development of new biomarkers and optimization of drug usage will help address many challenges ahead.