What Can 30 Years of Rheumatic Disease Research Tell Us About the Future? Save

As a practicing rheumatologist for more than 30 years, I can recall a time – just a couple of decades ago – when waiting rooms were full of patients in wheelchairs, debilitated and in pain from rheumatoid arthritis (RA) and other related conditions. My colleagues and I did our best to treat and relieve the suffering the best we could, knowing all too well that we were limited to the few therapies available at the time.

Fast forward to today: The progress we've made in all realms of science and healthcare boggles the mind. From mapping the human genome to space-aged diagnostic tools and technologies, never in my lifetime could I have expected to see such tremendous and life-changing advances that are transforming care and the way it's delivered.

This is especially true in the field of rheumatology, where in just a few decades, innovation and research have provided relief, mobility, comfort and hope where there had previously been little.

Gone are the days where the vast majority of my patients with RA were wheelchair-bound and suffering from disabling joint damage and systemic disease complications. Thanks to the perseverance and hard-nosed commitment of experts in the field – along with private and public investment in medical research – we've seen an explosion of new therapeutics and ways to treat rheumatic disease.

For example, disease-modifying anti-rheumatic drugs (DMARDs) can now slow or stop the inflammatory processes that damage the body's joints and internal organs. More recently, the advent of biologics and biosimilar therapies – genetically engineered proteins originating from human genes – have allowed rheumatologists to target the specific parts of the immune system that fuel inflammation. These and other therapeutic advances have helped millions of Americans living with RA, psoriatic arthritis, juvenile idiopathic arthritis, ankylosing spondylitis and other chronic diseases to manage pain and avoid severe disability.

With all of this astounding progress, it can be difficult to accept that we still have a long way to go before we have mastered these diseases, even curing or ultimately, preventing them. As we look to the future of rheumatic disease care, there are many questions that remain unanswered: Why are rheumatic diseases increasing in frequency and prevalence? Are there genetic or environmental causes? How close are we to finding a cure?

We're nowhere close to the finish line, and these questions may never be answered if we fail to address a host of new challenges facing rheumatology care providers and researchers.

Among those challenges are critical workforce shortages which will be upon us in less than a generation. According to a 2015 workforce study from the American College of Rheumatology (ACR), approximately half of the current rheumatology workforce is expected to retire in the next 15 years. This is particularly troubling when you consider that our workforce is aging and retiring at the same time our patient population is aging and growing. In fact, demand for rheumatologic services will grow by more than 130 percent over the next 14 years – leading to a healthcare crisis whereby patients with rheumatic diseases will have dramatically less access to specialty care.

To make matters worse, public funding for rheumatology research continues to wane. An overall reduction in NIH funding levels for rheumatologic diseases in recent years is breeding a fiercely competitive environment among researchers, leaving few opportunities for scientists in their early and mid-careers. A dearth of new researchers can have lasting and negative consequences on the future of rheumatology care: without fostering research scientists early on, these bright young minds are often compelled toward different paths – meaning lost opportunities for potential groundbreaking discoveries in our field.

If we are truly invested in finding cures, eliminating disparities, understanding the biology and pathogenesis, improving outcomes, and making clinical improvements for patients living with rheumatic diseases, we must find ways to invest in medical research, cultivate physician scientists, and expand the clinical workforce.

One solution is to increasingly look toward private efforts, such as the Rheumatology Research Foundation, to meet future goals in today's environment. As the largest private funding source of rheumatology research and training in the U.S., the Foundation supports a number of remarkable research projects that show great promise for the future of care. Below are just a few examples of studies they have funded:

• Alice Chan of the University of California, San Francisco is studying a novel candidate gene, known as Mosaic, which has been identified as responsible for causing early and severe multi-organ autoimmunity in a unique breed of dog. Also present in humans, the Mosaic gene is linked to early onset of Addison's disease, arthritis, autoimmune cytopenias, hepatitis, and uveitis. Like other important ongoing research, Dr. Chan's work will shed light on the role of genetics in these diseases, and possibly lead to new therapeutic targets in treating autoimmune diseases.
• New York University researchers are investigating a new measurement tool that will allow doctors to measure the immunologic defects that are the actual cause of a patient's RA and evaluate the effectiveness of treatment. Rather than evaluate arthritis by symptoms alone, researchers are finding ways to measure the number of autoimmune cells in a patient's immunologic memory – looking at the underlying cause of the disease that is responsible for symptoms and joint destruction.
• At Johns Hopkins University, the Foundation is funding tools to cultivate the next generation of rheumatologists in the face of the dwindling workforce. An interactive, web-based rheumatology curriculum will expose internal medicine residents to rheumatology during their training, helping more doctors learn how to better diagnose and treat patients with rheumatic diseases and encourage more students to pursue rheumatology as a specialty.
• Similarly, at Drexel University, Foundation-supported researchers are developing an online tool that teaches better examination techniques for patients with RA – with the goal of decreasing misdiagnoses, shortening the gap between symptom onset and treatment, and also encouraging more students to join the subspecialty.

These are just a few of the exciting projects that underscore the importance of rheumatology research and training. The future of our specialty – our ability to treat patients and to conquer rheumatic diseases – depends on a vibrant, well-trained workforce and continued investment in research.

Years ago, as a young rheumatologist, I never thought I would see the types of treatments that are the standard of care for patients today. Today, I know that tomorrow brings even greater promise and – hopefully – a cure. Making it so means relying on what we know to be true: that with adequate support for researchers and their hard work and innovation, the sky truly is the limit.

Eric L. Matteson, MD, MPH, is a practicing rheumatologist and professor of medicine at Mayo Clinic in Rochester, Minn., and president of the Rheumatology Research Foundation of the American College of Rheumatology.