Sally Koch Kubetin

Phase III data from the DEFINE trial confirming that oral BG-12 (dimethyl fumarate) effectively prevents relapse in patients with relapsing remitting multiple sclerosis have been published (N. Engl. J. Med. 2012;367:1098-107). The drug was almost equally effective regardless of whether it was given two or three times daily, and the benefits were seen at 2 years. These data were originally reported at the Fourth Cooperative Meeting on Multiple Sclerosis and published in Clinical Neurology News.

Also published this week were other phase II trial data from the CONFIRM trial showing the same thing – that when given at a dose of 240 mg two or three times daily, oral BG-12 significantly reduced the rate of relapse, the proportion of patients with a relapse, and disease activity as measured by a range of MRI end points as compared with placebo (N. Engl. J. Med. 2012;367:1087-97). These data were originally reported at the Joint Congress of ECTRIMS/ACTRIMS and were published in Clinical Neurology News as part of the DEFINE trial story.

Phase III data from the DEFINE trial confirming that oral BG-12 (dimethyl fumarate) effectively prevents relapse in patients with relapsing remitting multiple sclerosis have been published (N. Engl. J. Med. 2012;367:1098-107). The drug was almost equally effective regardless of whether it was given two or three times daily, and the benefits were seen at 2 years. These data were originally reported at the Fourth Cooperative Meeting on Multiple Sclerosis and published in Clinical Neurology News.

Also published this week were other phase II trial data from the CONFIRM trial showing the same thing – that when given at a dose of 240 mg two or three times daily, oral BG-12 significantly reduced the rate of relapse, the proportion of patients with a relapse, and disease activity as measured by a range of MRI end points as compared with placebo (N. Engl. J. Med. 2012;367:1087-97). These data were originally reported at the Joint Congress of ECTRIMS/ACTRIMS and were published in Clinical Neurology News as part of the DEFINE trial story.

Phase III data from the DEFINE trial confirming that oral BG-12 (dimethyl fumarate) effectively prevents relapse in patients with relapsing remitting multiple sclerosis have been published (N. Engl. J. Med. 2012;367:1098-107). The drug was almost equally effective regardless of whether it was given two or three times daily, and the benefits were seen at 2 years. These data were originally reported at the Fourth Cooperative Meeting on Multiple Sclerosis and published in Clinical Neurology News.

Also published this week were other phase II trial data from the CONFIRM trial showing the same thing – that when given at a dose of 240 mg two or three times daily, oral BG-12 significantly reduced the rate of relapse, the proportion of patients with a relapse, and disease activity as measured by a range of MRI end points as compared with placebo (N. Engl. J. Med. 2012;367:1087-97). These data were originally reported at the Joint Congress of ECTRIMS/ACTRIMS and were published in Clinical Neurology News as part of the DEFINE trial story.

BERLIN – "Near remission," which is based on joint counts and acute phase reactants, predicts disease status at 3 years in patients with early inflammatory arthritis as well as the definition of remission that was proposed by the American College of Rheumatology/European League Against Rheumatism in 2011. The ACR/EULAR definition includes patient global assessment of status, according to Dr. Laure Gossec, who presented findings from the ESPOIR trial at the annual European Congress of Rheumatology.

"Near-remission is much more frequent than ACR/EULAR remission in early arthritis. It appears from this analysis that near-remission (not taking into account patient global) predicts radiographic progression over 3 years in early arthritis, as well as ACR/EULAR remission, or as the definition of remission that takes into account patient-reported fatigue. Near-remission may be a valid predictive outcome in early arthritis," said Dr. Gossec, associate professor of rheumatology at Descartes University, Paris, who currently is a visiting scholar at Manchester (England) University Arthritis Epidemiology Unit.

The 2011 ACR/EULAR proposed definition of Boolean remission of early rheumatoid arthritis comprises one or no tender joints; one or no swollen joints; C-reactive protein (CRP) level equal to or less than 1 mg/dL; and a patient global assessment score of no higher than 1 (Ann. Rheum. Dis. 2011;70:404-13). However, last year at the 2011 Annual European Congress of Rheumatology, some authors noted that patient global assessment was often a limiting factor to reach this remission, and proposed near-remission as an alternative outcome (Arthritis Rheum. 2011, ACR Congress, abstract 2459). "The question is would we lose predictive information, by not taking into account the patient’s point of view? And reversely, should we be assessing fatigue; would that add to predictive information?" Dr. Gossec noted in an interview.

Dr. Gossec and her associates undertook the ESPOIR observational study to assess if patient reported outcomes, particularly patient global and fatigue, predict radiologic joint destruction at 3 years, in patients already in near remission as judged by their joint counts and levels of acute phase reactants. Specifically, the investigators assessed the predictive value of both the ACR/EULAR proposed definition of remission at 6 and 12 months after diagnosis as well as the definition of "near remission," which included three of the four proposed ACR/EULAR end points but did not include patient global assessment of status, and "fatigue-remission" in which patient’s self-report of fatigue substitutes for the patient global.

Dr. Gossec and her associates followed 776 patients with early arthritis. The patients underwent swollen and tender joint counts and CRP measurements at 6 and 12 months after diagnosis. In addition, they completed a patient global assessment of their status at those times and a fatigue visual analog scale assessment. The outcome was change in the total Sharp-van der Heijde score between baseline and at 3 years.

Of the 776 patients, 57 patients (7.4%) met the proposed ACR/EULAR definition of remission both at 6 and 12 months, whereas 145 patients (18.7%) reached near-remission, and only 24 patients (3.1%) reached fatigue-remission. Agreement between ACR/EULAR remission and the other definitions was moderate: kappa, 0.51 (95% confidence interval, 0.43-0.60) and 0.39 (95% CI, 0.26-0.53), respectively. Prediction of radiographic progression was similar no matter which definition of remission was used.

However, the relation between radiographic progression and remission was strongest for the definition of near remission and the proposed ACR/EULAR remission. In stepwise selection only the variables in near-remission were predictive. Thus, it appears that the strongest drivers of radiographic progression are joint counts and acute phase reactants, and that for patients already in remission for those criteria, patient-reported outcomes add little to the prediction of radiographic progression. Dr. Gossec concluded that "assessing patient-reported outcomes is important to understand the patient’s perspective, but have only some added value to predict radiographic outcomes if objective criteria are already well controlled."

Dr. Gossec reported that she has no conflicts of interest that are relevant to this project.

BERLIN – "Near remission," which is based on joint counts and acute phase reactants, predicts disease status at 3 years in patients with early inflammatory arthritis as well as the definition of remission that was proposed by the American College of Rheumatology/European League Against Rheumatism in 2011. The ACR/EULAR definition includes patient global assessment of status, according to Dr. Laure Gossec, who presented findings from the ESPOIR trial at the annual European Congress of Rheumatology.

"Near-remission is much more frequent than ACR/EULAR remission in early arthritis. It appears from this analysis that near-remission (not taking into account patient global) predicts radiographic progression over 3 years in early arthritis, as well as ACR/EULAR remission, or as the definition of remission that takes into account patient-reported fatigue. Near-remission may be a valid predictive outcome in early arthritis," said Dr. Gossec, associate professor of rheumatology at Descartes University, Paris, who currently is a visiting scholar at Manchester (England) University Arthritis Epidemiology Unit.

The 2011 ACR/EULAR proposed definition of Boolean remission of early rheumatoid arthritis comprises one or no tender joints; one or no swollen joints; C-reactive protein (CRP) level equal to or less than 1 mg/dL; and a patient global assessment score of no higher than 1 (Ann. Rheum. Dis. 2011;70:404-13). However, last year at the 2011 Annual European Congress of Rheumatology, some authors noted that patient global assessment was often a limiting factor to reach this remission, and proposed near-remission as an alternative outcome (Arthritis Rheum. 2011, ACR Congress, abstract 2459). "The question is would we lose predictive information, by not taking into account the patient’s point of view? And reversely, should we be assessing fatigue; would that add to predictive information?" Dr. Gossec noted in an interview.

Dr. Gossec and her associates undertook the ESPOIR observational study to assess if patient reported outcomes, particularly patient global and fatigue, predict radiologic joint destruction at 3 years, in patients already in near remission as judged by their joint counts and levels of acute phase reactants. Specifically, the investigators assessed the predictive value of both the ACR/EULAR proposed definition of remission at 6 and 12 months after diagnosis as well as the definition of "near remission," which included three of the four proposed ACR/EULAR end points but did not include patient global assessment of status, and "fatigue-remission" in which patient’s self-report of fatigue substitutes for the patient global.

Dr. Gossec and her associates followed 776 patients with early arthritis. The patients underwent swollen and tender joint counts and CRP measurements at 6 and 12 months after diagnosis. In addition, they completed a patient global assessment of their status at those times and a fatigue visual analog scale assessment. The outcome was change in the total Sharp-van der Heijde score between baseline and at 3 years.

Of the 776 patients, 57 patients (7.4%) met the proposed ACR/EULAR definition of remission both at 6 and 12 months, whereas 145 patients (18.7%) reached near-remission, and only 24 patients (3.1%) reached fatigue-remission. Agreement between ACR/EULAR remission and the other definitions was moderate: kappa, 0.51 (95% confidence interval, 0.43-0.60) and 0.39 (95% CI, 0.26-0.53), respectively. Prediction of radiographic progression was similar no matter which definition of remission was used.

However, the relation between radiographic progression and remission was strongest for the definition of near remission and the proposed ACR/EULAR remission. In stepwise selection only the variables in near-remission were predictive. Thus, it appears that the strongest drivers of radiographic progression are joint counts and acute phase reactants, and that for patients already in remission for those criteria, patient-reported outcomes add little to the prediction of radiographic progression. Dr. Gossec concluded that "assessing patient-reported outcomes is important to understand the patient’s perspective, but have only some added value to predict radiographic outcomes if objective criteria are already well controlled."

Dr. Gossec reported that she has no conflicts of interest that are relevant to this project.

BERLIN – "Near remission," which is based on joint counts and acute phase reactants, predicts disease status at 3 years in patients with early inflammatory arthritis as well as the definition of remission that was proposed by the American College of Rheumatology/European League Against Rheumatism in 2011. The ACR/EULAR definition includes patient global assessment of status, according to Dr. Laure Gossec, who presented findings from the ESPOIR trial at the annual European Congress of Rheumatology.

"Near-remission is much more frequent than ACR/EULAR remission in early arthritis. It appears from this analysis that near-remission (not taking into account patient global) predicts radiographic progression over 3 years in early arthritis, as well as ACR/EULAR remission, or as the definition of remission that takes into account patient-reported fatigue. Near-remission may be a valid predictive outcome in early arthritis," said Dr. Gossec, associate professor of rheumatology at Descartes University, Paris, who currently is a visiting scholar at Manchester (England) University Arthritis Epidemiology Unit.

The 2011 ACR/EULAR proposed definition of Boolean remission of early rheumatoid arthritis comprises one or no tender joints; one or no swollen joints; C-reactive protein (CRP) level equal to or less than 1 mg/dL; and a patient global assessment score of no higher than 1 (Ann. Rheum. Dis. 2011;70:404-13). However, last year at the 2011 Annual European Congress of Rheumatology, some authors noted that patient global assessment was often a limiting factor to reach this remission, and proposed near-remission as an alternative outcome (Arthritis Rheum. 2011, ACR Congress, abstract 2459). "The question is would we lose predictive information, by not taking into account the patient’s point of view? And reversely, should we be assessing fatigue; would that add to predictive information?" Dr. Gossec noted in an interview.

Dr. Gossec and her associates undertook the ESPOIR observational study to assess if patient reported outcomes, particularly patient global and fatigue, predict radiologic joint destruction at 3 years, in patients already in near remission as judged by their joint counts and levels of acute phase reactants. Specifically, the investigators assessed the predictive value of both the ACR/EULAR proposed definition of remission at 6 and 12 months after diagnosis as well as the definition of "near remission," which included three of the four proposed ACR/EULAR end points but did not include patient global assessment of status, and "fatigue-remission" in which patient’s self-report of fatigue substitutes for the patient global.

Dr. Gossec and her associates followed 776 patients with early arthritis. The patients underwent swollen and tender joint counts and CRP measurements at 6 and 12 months after diagnosis. In addition, they completed a patient global assessment of their status at those times and a fatigue visual analog scale assessment. The outcome was change in the total Sharp-van der Heijde score between baseline and at 3 years.

Of the 776 patients, 57 patients (7.4%) met the proposed ACR/EULAR definition of remission both at 6 and 12 months, whereas 145 patients (18.7%) reached near-remission, and only 24 patients (3.1%) reached fatigue-remission. Agreement between ACR/EULAR remission and the other definitions was moderate: kappa, 0.51 (95% confidence interval, 0.43-0.60) and 0.39 (95% CI, 0.26-0.53), respectively. Prediction of radiographic progression was similar no matter which definition of remission was used.

However, the relation between radiographic progression and remission was strongest for the definition of near remission and the proposed ACR/EULAR remission. In stepwise selection only the variables in near-remission were predictive. Thus, it appears that the strongest drivers of radiographic progression are joint counts and acute phase reactants, and that for patients already in remission for those criteria, patient-reported outcomes add little to the prediction of radiographic progression. Dr. Gossec concluded that "assessing patient-reported outcomes is important to understand the patient’s perspective, but have only some added value to predict radiographic outcomes if objective criteria are already well controlled."

Dr. Gossec reported that she has no conflicts of interest that are relevant to this project.

Dr. Ellen M. Gravallese has had a trail-blazing and award-winning career in which she has straddled rheumatology to make contributions both to the bench and the bedside. Her accomplishments owe much to her joint abilities to focus on basic research that bears fruit in the form of meaningful clinical improvements in patient management and to foster the next generation of rheumatology investigators. But there has also been a place for serendipity in her trajectory.

As director for translational research at the Musculoskeletal Center of Excellence, University of Massachusetts Memorial Medical Center, Worcester, Dr. Gravallese’s research focuses on study of the pathogenesis of rheumatoid arthritis, with particular interest in the fundamental mechanisms of bone and cartilage destruction.

Photos courtesy Dr. Ellen Gravallese

According to Dr. Michael Weinblatt, her longtime colleague, "Her research has changed our understanding of the disease, leading to a rethinking of the interaction of inflammation and erosion.

"Some of the erosive process in RA may not all be due to inflammation. It also results from the effect of osteoclasts on bone. The insight that treatment can reduce erosion even when it does not [affect] inflammation may lead to treatment advances," said Dr. Weinblatt, who is the John R. and Eileen K. Riedman professor of medicine at Harvard Medical School, Boston.

Specifically, research done in Dr. Gravallese’s lab has "definitively identified osteoclasts as the cell type responsible for bone destruction in RA, and RANKL as a critical cytokine produced by RA synovial tissues that drive osteoclastogenesis. Anti-RANKL antibodies, recently approved for clinical use, have already been shown to be effective in the prevention of bone destruction in osteoporosis and cancer," according to some biographic material."

"In addition, however, Dr. Gravallese is well known as an outstanding clinician and teacher. Physician-scientists who teach, see patients, and do research are often referred to as ‘triple threats,’ according to Dr. Robert W. Finberg, who was among those who recruited her to the University of Massachusetts 6 years ago.

Indeed, Dr. Gravallese is known to her colleagues as a triple threat plus a little something extra, "Ellen came highly recommended as a creative scientist who had made major discoveries in the area of bone research and the pathogenesis of joint destruction as a result of rheumatoid arthritis. She is internationally known for her contributions to the field of rheumatology," he said. Dr. Gravallese’s achievements prompted one of her colleagues to refer to her as a ‘quadruple threat,’ with expertise in research, clinical medicine, teaching, and service to her profession," said Dr. Finberg, who is chair of the department of medicine at University of Massachusetts where Dr. Gravallese is also professor of medicine and cell biology.

Dr. Gravallese began to test the waters and to challenge the status quo in the patriarchal education system when she was a young student, according to Dr. Katherine Upchurch.

"While in the eighth grade, she sought to single-handedly overturn single-sex education at the then all-male Phillips Academy, in Andover, Mass., where her brothers had gone. She met with the director of admissions at PA to advocate for herself, but it was not to be. I surmise that this may be her only academic failure to date," Dr. Upchurch told an audience the night that Dr. Gravallese won the Marion Ropes Physician Achievement Award from the Arthritis Foundation in 2011.

Dr. Gravallese, the daughter and sister of physicians, was not thinking about a career in rheumatology, much less leading research that may change the management of RA, when she was in medical school. "While in my fourth year of medical school, I had the opportunity to spend a 1-month rotation in Cooperstown, N.Y., at the Mary Imogene Bassett Hospital, which is a community hospital closely associated with Columbia University, N.Y. I had only 1 month open in my schedule for a rotation there, and because I signed up late, there was only one rotation available, which was rheumatology. I must admit it was not my top choice at the time for a clinical rotation."

On such matters of chance an entire professional life can be based.

"However, I was fortunate to work with Dr. Gary Hoffman, who at that time was a young rheumatologist in community practice. I worked side by side with Dr. Hoffman for the entire month, and was fascinated by the patients I saw and was struck by the fact that so little was known about the pathogenesis of their diseases. Dr. Hoffman was such an inspiring mentor," she said in an interview.

Despite that early and rewarding exposure to rheumatology, Dr. Gravallese chose pathology as her specialty. In pathology, "there was a deep understanding of pathophysiologic disease mechanisms, and I felt that this was the area in which I might make the greatest impact in studying disease at the basic level. I first did an internship in internal medicine for 1 year at the Brigham and Women’s Hospital in Boston. Once I moved to pathology, I found that there was a keen appreciation for disease mechanism and a huge opportunity for basic investigation into disease mechanism."

But an unmet need for contact with patients continued to pique her. "I desperately missed the contact with patients and the ability to interact closely with other physicians in the treatment of these patients." After her internal medicine internship from 1981 to 1982 at Brigham and Women’s Hospital in Boston, she undertook a residency in pathology from 1982 to 1984, where she worked with Dr. Joseph Corson, among others. The chief of surgical pathology, Dr. Corson had a special interest in "in the pathologic changes that occurred in the synovium in the rheumatic diseases and had been collecting interesting cases of synovial pathology for his entire career. I was able to work with him in a one-on-one fashion for several months, studying these cases and coming to an understanding of what was and what was not known about the pathogenesis of rheumatic diseases involving the synovium." This was the "eureka" moment that led her to choose rheumatology. From 1984 to 1986, she did 2 more years of internal medicine residency, followed by a rheumatology/immunology fellowship from 1986 to 1988 also at Brigham and Women’s.

Dr. Mittie K. Doyle, a researcher in Dr. Gravallese’s lab in 1994-1996 at the Harvard School of Public Health, also in Boston, noted that her long-time mentor "is actually triple boarded in pathology, internal medicine, and rheumatology."

Dr. Doyle noted that while she worked in Dr. Gravallese’s lab at the Harvard, the focus of her research was a "murine model of Lyme carditis.

"She has made major scientific contributions to the field of rheumatology, specifically in her pursuit to understand the pathogenesis of bone erosion and remodeling in inflammatory arthritis. Along the way, she continues to find the time to mentor young medical students, graduate students, and fellows," said Dr. Doyle, who is director of clinical development in immunology at Johnson & Johnson in Spring House, Penn.

"We met in 1993, when I began my rheumatology fellowship at the Brigham. I was immediately impressed by her superior clinical skills, particularly given her dedication to her innovative basic laboratory work. Ellen’s background in pathology, combined with her clinical expertise, makes her a quintessential translational medicine scientist," Dr. Doyle noted.

But wait, there is another side to Dr. Gravallese. With her husband, Dr. M. Timothy Hresko, she has raised two sons of whom she is immensely proud.

To her young mentors who sometimes lived with Dr. Gravallese’s family while between apartments, the business of parenting while maintaining a cutting-edge research career may have looked easy. But it was not.

"My husband had just left on a trip to a European meeting ... very early the next morning my older son, who was about 7 at the time, woke up short of breath and announced that he was ‘having a heart attack.’ It was croup, and I had to take him urgently to the ER. He was treated, and when we arrived home, I found that our hot-water heater had burst and flooded the basement and our power was out. Just as I had arranged for all of the repairs, my younger son also developed croup."

She survived such back-to-back challenges on the home front with aplomb, even though Dr. Gravallese would be the last person to say so.

Perhaps it is the knowledge that she has survived domestic catastrophes that gave her the pluck needed for her current administrative duties.

Dr. Weinblatt called Dr. Gravallese someone who "remains optimistic about the future of academic medicine." Perhaps, it was that optimism that motivated her to become chief of the rheumatology division at UMass Medical School in 2006, which increased the demands of administration on her time. Since moving to her duties as the chief of rheumatology, "I now focus on the administration of the division but continue to spend much of my time in basic and translational research efforts in RA and bone, and in the study and treatment of patients with rheumatoid arthritis. I see patients with our rheumatology fellows and am involved in the training of medical students, graduate students, and postdoctoral fellows in multiple venues."

Dr. Gravallese has touched the lives and careers of many young rheumatologists in training and they still recall the experience as being fundamental to shaping their lives.

The guys in her family have done more than prepare her for departmental uproar. They have opened her eyes to a pleasure she had been unaware of, at least in a meaningful way, even though she spent most of her life in the greater Boston area. These days, "I am indeed a Red Sox fan. Before I had my two boys I paid no attention to sports. But, as the years went on, I found that the more I heard about baseball from them, the more fascinating it became. Both of my boys are avid sports fans, as is my husband – and all three played baseball."

And speaking of sports metaphors, Dr. Upchurch, clinical chief in her UMass lab, noted that as the result of one of Dr. Gravallese’s innovations in the 6 years since she became rheumatology chief, "We were the first departmental division to develop and implement a scorecard devoted to productivity and quality.

"Our annual outpatient visits are projected to number over 14,000 this fiscal year, a staggering 96% increase, compared with 2006. ... And perhaps most important to us, we consistently are among the top performers in the systemwide Press Ganey patient satisfaction survey. We are where we are in large part because of Dr. Gravallese’s leadership.

"Additionally, she has established a growing clinical research program in our Center, through the recruitment of Dr. Jon Kay, its director. The program now has two dedicated research associates who oversee a growing number of active clinical research projects. Finally, through her leadership and that of Dr. Nancy Liu, our fellowship program director, our fellowship has received a 5-year unconditional accreditation from the Accreditation Council for Graduate Medical Education and receives a record and increasing number of outstanding applications each year," according to Dr. Upchurch. Dr. Lisa Criscione-Schreiber, rheumatology training program director at Duke University, Durham, N.C., was second-year medical student when she applied for an immunology research project in Boston. She joined Dr. Gravallese’s lab for 15 months. "I never would have become a rheumatologist were it not for Ellen. In her lab, I worked with a lupus mouse model, and then she encouraged me to attend some of the rheumatology fellows’ clinical case conferences, which were fascinating and led me to consider a career in rheumatology. Throughout my career, I’ve consulted with her on many matters regarding my career’s trajectory."

One of Dr. Gravallese’s current researchers at the UMass, cell biology doctoral candidate Melissa Matzelle, said that Dr. Gravallese respects her students’ autonomy. "Unlike other principal investigators, who often force a student to work on a narrow project, Ellen has given me the freedom to pursue my passions and interests in my research, often taking my work in new directions.

"She is also cognizant of the importance of a strong professional network for the advancement of my career. While many PIs give their students the opportunity to present research at national and international forums, she has not only done that, but also has gone above and beyond and made a concerted effort to introduce me to many other leading rheumatologists. These new relationships have allowed me to initiate novel collaborative projects."

Ms. Matzelle reported one other aspect of her mentor’s character that impressed her: "I had the opportunity to meet a husband and wife who had both been patients of Ellen’s in the past. They spoke at length about how she worked tirelessly to diagnose and treat their conditions. They raved at how dedicated she was with their care and how she had made the extra effort where other doctors had not."

One of the greatest challenges facing rheumatology is the very nature of the specialty, Dr. Gravallese said. "We are an ‘evaluation and management’ specialty and as such, our revenues are low, compared with more procedural-based specialties. This puts us at a disadvantage in academic centers where resources for divisional growth are limited. It requires some ingenuity and hard work to develop new programs and to continue with innovation. The administrative work that I have done as division chief has opened my eyes to some of the challenges facing academic rheumatology that will be important to solve going forward." But, even with those challenges in mind, Dr. Gravallese said she would do it all over again, with "no regrets."

Dr. Gravallese has served the American College of Rheumatology in multiple capacities, including as chair of the publications committee and a member of the ACR Board of Directors and the ACR Research and Education Foundation Board of Directors. She has made numerous contributions to the rheumatology literature both an as author and member of the editorial advisory boards of Arthritis and Rheumatism, Current Opinion in Rheumatology, and Annals of the Rheumatic Diseases.

The titles on Dr. Gravallese’s bedside table give a clue to her personal taste in reading:"The Innovators Prescription" by Clayton M. Christensen; "The Paris Wife" by Paula McLain; and "The Lost Symbol," Dan Brown’s most recent novel.

Dr. Ellen M. Gravallese has had a trail-blazing and award-winning career in which she has straddled rheumatology to make contributions both to the bench and the bedside. Her accomplishments owe much to her joint abilities to focus on basic research that bears fruit in the form of meaningful clinical improvements in patient management and to foster the next generation of rheumatology investigators. But there has also been a place for serendipity in her trajectory.

As director for translational research at the Musculoskeletal Center of Excellence, University of Massachusetts Memorial Medical Center, Worcester, Dr. Gravallese’s research focuses on study of the pathogenesis of rheumatoid arthritis, with particular interest in the fundamental mechanisms of bone and cartilage destruction.

Photos courtesy Dr. Ellen Gravallese

According to Dr. Michael Weinblatt, her longtime colleague, "Her research has changed our understanding of the disease, leading to a rethinking of the interaction of inflammation and erosion.

"Some of the erosive process in RA may not all be due to inflammation. It also results from the effect of osteoclasts on bone. The insight that treatment can reduce erosion even when it does not [affect] inflammation may lead to treatment advances," said Dr. Weinblatt, who is the John R. and Eileen K. Riedman professor of medicine at Harvard Medical School, Boston.

Specifically, research done in Dr. Gravallese’s lab has "definitively identified osteoclasts as the cell type responsible for bone destruction in RA, and RANKL as a critical cytokine produced by RA synovial tissues that drive osteoclastogenesis. Anti-RANKL antibodies, recently approved for clinical use, have already been shown to be effective in the prevention of bone destruction in osteoporosis and cancer," according to some biographic material."

"In addition, however, Dr. Gravallese is well known as an outstanding clinician and teacher. Physician-scientists who teach, see patients, and do research are often referred to as ‘triple threats,’ according to Dr. Robert W. Finberg, who was among those who recruited her to the University of Massachusetts 6 years ago.

Indeed, Dr. Gravallese is known to her colleagues as a triple threat plus a little something extra, "Ellen came highly recommended as a creative scientist who had made major discoveries in the area of bone research and the pathogenesis of joint destruction as a result of rheumatoid arthritis. She is internationally known for her contributions to the field of rheumatology," he said. Dr. Gravallese’s achievements prompted one of her colleagues to refer to her as a ‘quadruple threat,’ with expertise in research, clinical medicine, teaching, and service to her profession," said Dr. Finberg, who is chair of the department of medicine at University of Massachusetts where Dr. Gravallese is also professor of medicine and cell biology.

Dr. Gravallese began to test the waters and to challenge the status quo in the patriarchal education system when she was a young student, according to Dr. Katherine Upchurch.

"While in the eighth grade, she sought to single-handedly overturn single-sex education at the then all-male Phillips Academy, in Andover, Mass., where her brothers had gone. She met with the director of admissions at PA to advocate for herself, but it was not to be. I surmise that this may be her only academic failure to date," Dr. Upchurch told an audience the night that Dr. Gravallese won the Marion Ropes Physician Achievement Award from the Arthritis Foundation in 2011.

Dr. Gravallese, the daughter and sister of physicians, was not thinking about a career in rheumatology, much less leading research that may change the management of RA, when she was in medical school. "While in my fourth year of medical school, I had the opportunity to spend a 1-month rotation in Cooperstown, N.Y., at the Mary Imogene Bassett Hospital, which is a community hospital closely associated with Columbia University, N.Y. I had only 1 month open in my schedule for a rotation there, and because I signed up late, there was only one rotation available, which was rheumatology. I must admit it was not my top choice at the time for a clinical rotation."

On such matters of chance an entire professional life can be based.

"However, I was fortunate to work with Dr. Gary Hoffman, who at that time was a young rheumatologist in community practice. I worked side by side with Dr. Hoffman for the entire month, and was fascinated by the patients I saw and was struck by the fact that so little was known about the pathogenesis of their diseases. Dr. Hoffman was such an inspiring mentor," she said in an interview.

Despite that early and rewarding exposure to rheumatology, Dr. Gravallese chose pathology as her specialty. In pathology, "there was a deep understanding of pathophysiologic disease mechanisms, and I felt that this was the area in which I might make the greatest impact in studying disease at the basic level. I first did an internship in internal medicine for 1 year at the Brigham and Women’s Hospital in Boston. Once I moved to pathology, I found that there was a keen appreciation for disease mechanism and a huge opportunity for basic investigation into disease mechanism."

But an unmet need for contact with patients continued to pique her. "I desperately missed the contact with patients and the ability to interact closely with other physicians in the treatment of these patients." After her internal medicine internship from 1981 to 1982 at Brigham and Women’s Hospital in Boston, she undertook a residency in pathology from 1982 to 1984, where she worked with Dr. Joseph Corson, among others. The chief of surgical pathology, Dr. Corson had a special interest in "in the pathologic changes that occurred in the synovium in the rheumatic diseases and had been collecting interesting cases of synovial pathology for his entire career. I was able to work with him in a one-on-one fashion for several months, studying these cases and coming to an understanding of what was and what was not known about the pathogenesis of rheumatic diseases involving the synovium." This was the "eureka" moment that led her to choose rheumatology. From 1984 to 1986, she did 2 more years of internal medicine residency, followed by a rheumatology/immunology fellowship from 1986 to 1988 also at Brigham and Women’s.

Dr. Mittie K. Doyle, a researcher in Dr. Gravallese’s lab in 1994-1996 at the Harvard School of Public Health, also in Boston, noted that her long-time mentor "is actually triple boarded in pathology, internal medicine, and rheumatology."

Dr. Doyle noted that while she worked in Dr. Gravallese’s lab at the Harvard, the focus of her research was a "murine model of Lyme carditis.

"She has made major scientific contributions to the field of rheumatology, specifically in her pursuit to understand the pathogenesis of bone erosion and remodeling in inflammatory arthritis. Along the way, she continues to find the time to mentor young medical students, graduate students, and fellows," said Dr. Doyle, who is director of clinical development in immunology at Johnson & Johnson in Spring House, Penn.

"We met in 1993, when I began my rheumatology fellowship at the Brigham. I was immediately impressed by her superior clinical skills, particularly given her dedication to her innovative basic laboratory work. Ellen’s background in pathology, combined with her clinical expertise, makes her a quintessential translational medicine scientist," Dr. Doyle noted.

But wait, there is another side to Dr. Gravallese. With her husband, Dr. M. Timothy Hresko, she has raised two sons of whom she is immensely proud.

To her young mentors who sometimes lived with Dr. Gravallese’s family while between apartments, the business of parenting while maintaining a cutting-edge research career may have looked easy. But it was not.

"My husband had just left on a trip to a European meeting ... very early the next morning my older son, who was about 7 at the time, woke up short of breath and announced that he was ‘having a heart attack.’ It was croup, and I had to take him urgently to the ER. He was treated, and when we arrived home, I found that our hot-water heater had burst and flooded the basement and our power was out. Just as I had arranged for all of the repairs, my younger son also developed croup."

She survived such back-to-back challenges on the home front with aplomb, even though Dr. Gravallese would be the last person to say so.

Perhaps it is the knowledge that she has survived domestic catastrophes that gave her the pluck needed for her current administrative duties.

Dr. Weinblatt called Dr. Gravallese someone who "remains optimistic about the future of academic medicine." Perhaps, it was that optimism that motivated her to become chief of the rheumatology division at UMass Medical School in 2006, which increased the demands of administration on her time. Since moving to her duties as the chief of rheumatology, "I now focus on the administration of the division but continue to spend much of my time in basic and translational research efforts in RA and bone, and in the study and treatment of patients with rheumatoid arthritis. I see patients with our rheumatology fellows and am involved in the training of medical students, graduate students, and postdoctoral fellows in multiple venues."

Dr. Gravallese has touched the lives and careers of many young rheumatologists in training and they still recall the experience as being fundamental to shaping their lives.

The guys in her family have done more than prepare her for departmental uproar. They have opened her eyes to a pleasure she had been unaware of, at least in a meaningful way, even though she spent most of her life in the greater Boston area. These days, "I am indeed a Red Sox fan. Before I had my two boys I paid no attention to sports. But, as the years went on, I found that the more I heard about baseball from them, the more fascinating it became. Both of my boys are avid sports fans, as is my husband – and all three played baseball."

And speaking of sports metaphors, Dr. Upchurch, clinical chief in her UMass lab, noted that as the result of one of Dr. Gravallese’s innovations in the 6 years since she became rheumatology chief, "We were the first departmental division to develop and implement a scorecard devoted to productivity and quality.

"Our annual outpatient visits are projected to number over 14,000 this fiscal year, a staggering 96% increase, compared with 2006. ... And perhaps most important to us, we consistently are among the top performers in the systemwide Press Ganey patient satisfaction survey. We are where we are in large part because of Dr. Gravallese’s leadership.

"Additionally, she has established a growing clinical research program in our Center, through the recruitment of Dr. Jon Kay, its director. The program now has two dedicated research associates who oversee a growing number of active clinical research projects. Finally, through her leadership and that of Dr. Nancy Liu, our fellowship program director, our fellowship has received a 5-year unconditional accreditation from the Accreditation Council for Graduate Medical Education and receives a record and increasing number of outstanding applications each year," according to Dr. Upchurch. Dr. Lisa Criscione-Schreiber, rheumatology training program director at Duke University, Durham, N.C., was second-year medical student when she applied for an immunology research project in Boston. She joined Dr. Gravallese’s lab for 15 months. "I never would have become a rheumatologist were it not for Ellen. In her lab, I worked with a lupus mouse model, and then she encouraged me to attend some of the rheumatology fellows’ clinical case conferences, which were fascinating and led me to consider a career in rheumatology. Throughout my career, I’ve consulted with her on many matters regarding my career’s trajectory."

One of Dr. Gravallese’s current researchers at the UMass, cell biology doctoral candidate Melissa Matzelle, said that Dr. Gravallese respects her students’ autonomy. "Unlike other principal investigators, who often force a student to work on a narrow project, Ellen has given me the freedom to pursue my passions and interests in my research, often taking my work in new directions.

"She is also cognizant of the importance of a strong professional network for the advancement of my career. While many PIs give their students the opportunity to present research at national and international forums, she has not only done that, but also has gone above and beyond and made a concerted effort to introduce me to many other leading rheumatologists. These new relationships have allowed me to initiate novel collaborative projects."

Ms. Matzelle reported one other aspect of her mentor’s character that impressed her: "I had the opportunity to meet a husband and wife who had both been patients of Ellen’s in the past. They spoke at length about how she worked tirelessly to diagnose and treat their conditions. They raved at how dedicated she was with their care and how she had made the extra effort where other doctors had not."

One of the greatest challenges facing rheumatology is the very nature of the specialty, Dr. Gravallese said. "We are an ‘evaluation and management’ specialty and as such, our revenues are low, compared with more procedural-based specialties. This puts us at a disadvantage in academic centers where resources for divisional growth are limited. It requires some ingenuity and hard work to develop new programs and to continue with innovation. The administrative work that I have done as division chief has opened my eyes to some of the challenges facing academic rheumatology that will be important to solve going forward." But, even with those challenges in mind, Dr. Gravallese said she would do it all over again, with "no regrets."

Dr. Gravallese has served the American College of Rheumatology in multiple capacities, including as chair of the publications committee and a member of the ACR Board of Directors and the ACR Research and Education Foundation Board of Directors. She has made numerous contributions to the rheumatology literature both an as author and member of the editorial advisory boards of Arthritis and Rheumatism, Current Opinion in Rheumatology, and Annals of the Rheumatic Diseases.

The titles on Dr. Gravallese’s bedside table give a clue to her personal taste in reading:"The Innovators Prescription" by Clayton M. Christensen; "The Paris Wife" by Paula McLain; and "The Lost Symbol," Dan Brown’s most recent novel.

Dr. Ellen M. Gravallese has had a trail-blazing and award-winning career in which she has straddled rheumatology to make contributions both to the bench and the bedside. Her accomplishments owe much to her joint abilities to focus on basic research that bears fruit in the form of meaningful clinical improvements in patient management and to foster the next generation of rheumatology investigators. But there has also been a place for serendipity in her trajectory.

As director for translational research at the Musculoskeletal Center of Excellence, University of Massachusetts Memorial Medical Center, Worcester, Dr. Gravallese’s research focuses on study of the pathogenesis of rheumatoid arthritis, with particular interest in the fundamental mechanisms of bone and cartilage destruction.

Photos courtesy Dr. Ellen Gravallese

According to Dr. Michael Weinblatt, her longtime colleague, "Her research has changed our understanding of the disease, leading to a rethinking of the interaction of inflammation and erosion.

"Some of the erosive process in RA may not all be due to inflammation. It also results from the effect of osteoclasts on bone. The insight that treatment can reduce erosion even when it does not [affect] inflammation may lead to treatment advances," said Dr. Weinblatt, who is the John R. and Eileen K. Riedman professor of medicine at Harvard Medical School, Boston.

Specifically, research done in Dr. Gravallese’s lab has "definitively identified osteoclasts as the cell type responsible for bone destruction in RA, and RANKL as a critical cytokine produced by RA synovial tissues that drive osteoclastogenesis. Anti-RANKL antibodies, recently approved for clinical use, have already been shown to be effective in the prevention of bone destruction in osteoporosis and cancer," according to some biographic material."

"In addition, however, Dr. Gravallese is well known as an outstanding clinician and teacher. Physician-scientists who teach, see patients, and do research are often referred to as ‘triple threats,’ according to Dr. Robert W. Finberg, who was among those who recruited her to the University of Massachusetts 6 years ago.

Indeed, Dr. Gravallese is known to her colleagues as a triple threat plus a little something extra, "Ellen came highly recommended as a creative scientist who had made major discoveries in the area of bone research and the pathogenesis of joint destruction as a result of rheumatoid arthritis. She is internationally known for her contributions to the field of rheumatology," he said. Dr. Gravallese’s achievements prompted one of her colleagues to refer to her as a ‘quadruple threat,’ with expertise in research, clinical medicine, teaching, and service to her profession," said Dr. Finberg, who is chair of the department of medicine at University of Massachusetts where Dr. Gravallese is also professor of medicine and cell biology.

Dr. Gravallese began to test the waters and to challenge the status quo in the patriarchal education system when she was a young student, according to Dr. Katherine Upchurch.

"While in the eighth grade, she sought to single-handedly overturn single-sex education at the then all-male Phillips Academy, in Andover, Mass., where her brothers had gone. She met with the director of admissions at PA to advocate for herself, but it was not to be. I surmise that this may be her only academic failure to date," Dr. Upchurch told an audience the night that Dr. Gravallese won the Marion Ropes Physician Achievement Award from the Arthritis Foundation in 2011.

Dr. Gravallese, the daughter and sister of physicians, was not thinking about a career in rheumatology, much less leading research that may change the management of RA, when she was in medical school. "While in my fourth year of medical school, I had the opportunity to spend a 1-month rotation in Cooperstown, N.Y., at the Mary Imogene Bassett Hospital, which is a community hospital closely associated with Columbia University, N.Y. I had only 1 month open in my schedule for a rotation there, and because I signed up late, there was only one rotation available, which was rheumatology. I must admit it was not my top choice at the time for a clinical rotation."

On such matters of chance an entire professional life can be based.

"However, I was fortunate to work with Dr. Gary Hoffman, who at that time was a young rheumatologist in community practice. I worked side by side with Dr. Hoffman for the entire month, and was fascinated by the patients I saw and was struck by the fact that so little was known about the pathogenesis of their diseases. Dr. Hoffman was such an inspiring mentor," she said in an interview.

Despite that early and rewarding exposure to rheumatology, Dr. Gravallese chose pathology as her specialty. In pathology, "there was a deep understanding of pathophysiologic disease mechanisms, and I felt that this was the area in which I might make the greatest impact in studying disease at the basic level. I first did an internship in internal medicine for 1 year at the Brigham and Women’s Hospital in Boston. Once I moved to pathology, I found that there was a keen appreciation for disease mechanism and a huge opportunity for basic investigation into disease mechanism."

But an unmet need for contact with patients continued to pique her. "I desperately missed the contact with patients and the ability to interact closely with other physicians in the treatment of these patients." After her internal medicine internship from 1981 to 1982 at Brigham and Women’s Hospital in Boston, she undertook a residency in pathology from 1982 to 1984, where she worked with Dr. Joseph Corson, among others. The chief of surgical pathology, Dr. Corson had a special interest in "in the pathologic changes that occurred in the synovium in the rheumatic diseases and had been collecting interesting cases of synovial pathology for his entire career. I was able to work with him in a one-on-one fashion for several months, studying these cases and coming to an understanding of what was and what was not known about the pathogenesis of rheumatic diseases involving the synovium." This was the "eureka" moment that led her to choose rheumatology. From 1984 to 1986, she did 2 more years of internal medicine residency, followed by a rheumatology/immunology fellowship from 1986 to 1988 also at Brigham and Women’s.

Dr. Mittie K. Doyle, a researcher in Dr. Gravallese’s lab in 1994-1996 at the Harvard School of Public Health, also in Boston, noted that her long-time mentor "is actually triple boarded in pathology, internal medicine, and rheumatology."

Dr. Doyle noted that while she worked in Dr. Gravallese’s lab at the Harvard, the focus of her research was a "murine model of Lyme carditis.

"She has made major scientific contributions to the field of rheumatology, specifically in her pursuit to understand the pathogenesis of bone erosion and remodeling in inflammatory arthritis. Along the way, she continues to find the time to mentor young medical students, graduate students, and fellows," said Dr. Doyle, who is director of clinical development in immunology at Johnson & Johnson in Spring House, Penn.

"We met in 1993, when I began my rheumatology fellowship at the Brigham. I was immediately impressed by her superior clinical skills, particularly given her dedication to her innovative basic laboratory work. Ellen’s background in pathology, combined with her clinical expertise, makes her a quintessential translational medicine scientist," Dr. Doyle noted.

But wait, there is another side to Dr. Gravallese. With her husband, Dr. M. Timothy Hresko, she has raised two sons of whom she is immensely proud.

To her young mentors who sometimes lived with Dr. Gravallese’s family while between apartments, the business of parenting while maintaining a cutting-edge research career may have looked easy. But it was not.

"My husband had just left on a trip to a European meeting ... very early the next morning my older son, who was about 7 at the time, woke up short of breath and announced that he was ‘having a heart attack.’ It was croup, and I had to take him urgently to the ER. He was treated, and when we arrived home, I found that our hot-water heater had burst and flooded the basement and our power was out. Just as I had arranged for all of the repairs, my younger son also developed croup."

She survived such back-to-back challenges on the home front with aplomb, even though Dr. Gravallese would be the last person to say so.

Perhaps it is the knowledge that she has survived domestic catastrophes that gave her the pluck needed for her current administrative duties.

Dr. Weinblatt called Dr. Gravallese someone who "remains optimistic about the future of academic medicine." Perhaps, it was that optimism that motivated her to become chief of the rheumatology division at UMass Medical School in 2006, which increased the demands of administration on her time. Since moving to her duties as the chief of rheumatology, "I now focus on the administration of the division but continue to spend much of my time in basic and translational research efforts in RA and bone, and in the study and treatment of patients with rheumatoid arthritis. I see patients with our rheumatology fellows and am involved in the training of medical students, graduate students, and postdoctoral fellows in multiple venues."

Dr. Gravallese has touched the lives and careers of many young rheumatologists in training and they still recall the experience as being fundamental to shaping their lives.

The guys in her family have done more than prepare her for departmental uproar. They have opened her eyes to a pleasure she had been unaware of, at least in a meaningful way, even though she spent most of her life in the greater Boston area. These days, "I am indeed a Red Sox fan. Before I had my two boys I paid no attention to sports. But, as the years went on, I found that the more I heard about baseball from them, the more fascinating it became. Both of my boys are avid sports fans, as is my husband – and all three played baseball."

And speaking of sports metaphors, Dr. Upchurch, clinical chief in her UMass lab, noted that as the result of one of Dr. Gravallese’s innovations in the 6 years since she became rheumatology chief, "We were the first departmental division to develop and implement a scorecard devoted to productivity and quality.

"Our annual outpatient visits are projected to number over 14,000 this fiscal year, a staggering 96% increase, compared with 2006. ... And perhaps most important to us, we consistently are among the top performers in the systemwide Press Ganey patient satisfaction survey. We are where we are in large part because of Dr. Gravallese’s leadership.

"Additionally, she has established a growing clinical research program in our Center, through the recruitment of Dr. Jon Kay, its director. The program now has two dedicated research associates who oversee a growing number of active clinical research projects. Finally, through her leadership and that of Dr. Nancy Liu, our fellowship program director, our fellowship has received a 5-year unconditional accreditation from the Accreditation Council for Graduate Medical Education and receives a record and increasing number of outstanding applications each year," according to Dr. Upchurch. Dr. Lisa Criscione-Schreiber, rheumatology training program director at Duke University, Durham, N.C., was second-year medical student when she applied for an immunology research project in Boston. She joined Dr. Gravallese’s lab for 15 months. "I never would have become a rheumatologist were it not for Ellen. In her lab, I worked with a lupus mouse model, and then she encouraged me to attend some of the rheumatology fellows’ clinical case conferences, which were fascinating and led me to consider a career in rheumatology. Throughout my career, I’ve consulted with her on many matters regarding my career’s trajectory."

One of Dr. Gravallese’s current researchers at the UMass, cell biology doctoral candidate Melissa Matzelle, said that Dr. Gravallese respects her students’ autonomy. "Unlike other principal investigators, who often force a student to work on a narrow project, Ellen has given me the freedom to pursue my passions and interests in my research, often taking my work in new directions.

"She is also cognizant of the importance of a strong professional network for the advancement of my career. While many PIs give their students the opportunity to present research at national and international forums, she has not only done that, but also has gone above and beyond and made a concerted effort to introduce me to many other leading rheumatologists. These new relationships have allowed me to initiate novel collaborative projects."

Ms. Matzelle reported one other aspect of her mentor’s character that impressed her: "I had the opportunity to meet a husband and wife who had both been patients of Ellen’s in the past. They spoke at length about how she worked tirelessly to diagnose and treat their conditions. They raved at how dedicated she was with their care and how she had made the extra effort where other doctors had not."

One of the greatest challenges facing rheumatology is the very nature of the specialty, Dr. Gravallese said. "We are an ‘evaluation and management’ specialty and as such, our revenues are low, compared with more procedural-based specialties. This puts us at a disadvantage in academic centers where resources for divisional growth are limited. It requires some ingenuity and hard work to develop new programs and to continue with innovation. The administrative work that I have done as division chief has opened my eyes to some of the challenges facing academic rheumatology that will be important to solve going forward." But, even with those challenges in mind, Dr. Gravallese said she would do it all over again, with "no regrets."

Dr. Gravallese has served the American College of Rheumatology in multiple capacities, including as chair of the publications committee and a member of the ACR Board of Directors and the ACR Research and Education Foundation Board of Directors. She has made numerous contributions to the rheumatology literature both an as author and member of the editorial advisory boards of Arthritis and Rheumatism, Current Opinion in Rheumatology, and Annals of the Rheumatic Diseases.

The titles on Dr. Gravallese’s bedside table give a clue to her personal taste in reading:"The Innovators Prescription" by Clayton M. Christensen; "The Paris Wife" by Paula McLain; and "The Lost Symbol," Dan Brown’s most recent novel.

They met in a medical school biochemistry class in which the professor arranged the students alphabetically, so that Woodward sat next to Wortmann. In the beginning, their teamwork as study partners earned them excellent grades. But when romance distracted them, they had to study apart. By the second year of medical school Dorothy Woodward and Robert Wortmann were married. That was 42 years ago.

"In college, she was chemistry major and I was biology major. So she did the experiments and I cleaned up afterward. I still do the dishes after meals," according to Dr. Robert Wortmann, who explained that his dish duty originated from a bet over a ski race. "I lost a bet wagering ‘dishes for the year’ when we were in a ski race 35 years ago. She won and has refused a rematch."

Photos courtesy Dr. Dorothy Wortmann

Asked to reflect back on his greatest achievement to date, Dr. Robert Wortmann said: "My part in our balancing family and career. We have been married for more than 42 years, we raised two sons who continue make us very proud, and, overall, we have had very satisfying careers. I won’t say it has been easy, but I will say it has been rewarding." Despite that still-lamented ski match, the Wortmanns seem to have had a marriage that has been far more collaborative than competitive, even as they moved several times before arriving in Hanover, New Hampshire, where Robert Wortmann is professor of medicine at Dartmouth and Dorothy Wortmann is a pediatric rheumatologist on the faculty.

Each Wortmann arrived at medical school through a different process. For Robert, becoming a physician may have been a matter of medicine being the family business. "Other than playing professional football, which would have been a goal if I had been bigger, faster, stronger and had any talent (I did play football at Carleton [College, Northfield, Minn.]), I guess I never really considered any alternative to medical school. I don’t think I knew very much about other occupations or professions. My father was a physician and most of our family friends were physicians’ families. Also, I was pretty comfortable in the hospital environment. As I was growing up, my father was in a solo ob.gyn. practice. That meant if I was with him, and he got called to the hospital, I would have to go with him. In those days, they would page doctors at baseball games and come find them in movie theaters. My father used an answering service that he would call hourly whenever he was away from a phone. During the daytime, I usually got to go into the pathology department and always got to see some organs or look at slides. Other times, I would hang out in the doctors’ lounge."

For Dorothy, getting on the road to medical school took imagination, the support of her grandmother, and the enthusiasm of her undergraduate advisers. "I had always expected to go to nursing school. My grandmother, who was my college scholarship, wanted me to get a BA, so I went to Mount Holyoke [College, South Hadley, Mass.], and then my advisers in college encouraged me to go to medical school. My sister was in college and my brother was in graduate school. My father had not planned on sending his daughters to graduate school. He said I could apply for scholarships back East or come to K.U. Medical School, in Kansas City." So the University of Kansas it was, for them both.

After graduation, Robert Wortmann recalled: "We were in one of the first years of the ‘couples match’ for residencies and ended up at the University of Michigan, Ann Arbor, me in medicine and she in pediatrics." Then his obligatory military service reared its head and the couple set off for Korea. If the call had come 5 months earlier, his tour would have been as a medical officer in Vietnam.

From 1973-1974, he served as a general medical officer for the U.S. Army in what was to be the last MASH (mobile army surgical hospital) in Korea. Together, that medical staff of two surgeons, one internist, one anesthesiologist, and 10 nurses cared for 12 helicopter pilots and about 90 enlisted men assigned with them to Camp Mosier, which included the 43rd MASH unit. They also cared for civilians, including residents of a nearby leper colony, as time allowed. Dr. Robert Wortmann’s duties were broad and included "doing sick call and seeing inpatients. I was also No. 3 surgeon, the radiologist, the lab officer, the blood bank officer, the rabies control officer, the VD control officer, the person in charge of doing physical exams on Korean women who were going to marry GIs, and the nuclear holocaust control officer."

Although pregnant with their son, Jon, Dorothy also went to Korea. Conditions were harsh, and the Army made no accommodations for this military wife, even though she came in handy as a pediatrician at the underserved hospital in Seoul. With Robert stationed in "north of the tank wall in a tactical zone at the MASH hospital," he had no car and she could not live on the base there. Instead, she lived in an apartment in Seoul without a car. There was an oil shortage that winter and all water had to be boiled before drinking. Until their son was born, he would visit her in Seoul on weekends when he was free, and she would visit the base on weekends when he was on duty. "The 2½ of us slept in a single bed in a Quonset hut," she recalled in an interview.

The first season of the television show "M*A*S*H" aired the year before Robert arrived in Korea. While he was there, the show’s coproducers visited his MASH unit searching for ideas for the series, which had become wildly popular despite their expectations. "The show was based on a book. They had used up all the material from the book, and they needed fodder for future shows. They did everything we did and interviewed everyone individually. Thus, I can recognize something in every episode beginning in year 3 that was based on our reality. My name was used as a character in one episode [spelled Wortman]. In another episode, they were collecting money for a pool to bet on when Colonel Potter would become a grandfather. At the time of their visit, there was just such a pool at our hospital for when Jon would be born," Robert recalled.

Once Robert was discharged from the U.S. Army, the two doctors moved to Ann Arbor, where Robert was chief resident in internal medicine. Considering how difficult it can be for two physicians to juggle a growing family around their training, the Wortmanns have made it look almost easy. Robert did his rheumatology fellowship from 1977-1979 at Michigan while Dorothy finished her pediatrics residency there, followed by her pediatric rheumatology fellowship at the same institution.

At the time Dorothy was in her fellowship, pediatric rheumatology was not a recognized subspecialty. "I did not do any research, and I was not sure I would be offered academic positions, but I have been fortunate in each of the places we have lived," she noted.

Over the years, the Wortmanns have been at the Medical College of Wisconsin in Milwaukee, where Robert eventually became professor of medicine in the division of rheumatology while Dorothy was on the faculty of the pediatrics department. From there, they moved to East Carolina University, Greenville, where Robert was professor and chairman of the department of medicine. Onward they went to the University of Oklahoma, Tulsa, where Robert was professor and C.S. Lewis Jr. Chair of Internal Medicine. And finally, they went to Dartmouth University, Hanover, N. H., where he is professor of medicine.

His colleague at Dartmouth, Dr. Christopher M. Burns, noted in an interview that: "Bob and Dottie have worked at a number of institutions over the years. Although it’s true that most of their moves were driven by Bob’s career, it’s also true that no matter where she went, Dottie had a big impact. She actually established pediatric rheumatology in Wisconsin, and dramatically improved the pediatric rheumatology programs at all the institutions she’s traveled to with Bob."

Dorothy’s area of particular expertise as a pediatric rheumatologist has been Kawasaki syndrome, a disease she first encountered as a resident: "As senior pediatric residents, we each had to do a Clinical Pathology Conference. Mine was a 3-year-old child who had been admitted for diarrhea and dehydration and who died in the waiting room while waiting for the car to be brought around on discharge. Fortunately, a medical student had taken a very detailed history, and I had read a recent article from Hawaii about a new disease reported in Japan now being seen in Hawaii. That child had Kawasaki syndrome. The cardiac sequelae were just being recognized. As rheumatology fellows at Michigan, we saw these children because it is a vasculitis. When we moved to Milwaukee, there was an outbreak with 20 children in the hospital over a several-week period. In fact, if I remember correctly, there were 13 children in the hospital at one time. This was very unusual. It was reported to the CDC and investigated. I then followed these and subsequent children with one of our cardiologists in a total of about 150 children. This was a large clinical experience at that time and led to those papers."

The stars had to align in a very precise pattern for Robert to become a rheumatologist. First, because his training was interrupted by military service, he had time to reconsider his choice of general internal medicine. Then, he was struck by how sad the general internists he met all seemed, which gave Robert another reason to rethink that specialty. Robert felt strongly that he should experience work in a research lab so he would not later regret never having done it. Going into general internal medicine would have meant no time in a research lab. Finally, Dorothy was given a pediatric rheumatology fellowship position at the University of Michigan where he would do a rheumatology fellowship. Dr. William N. Kelley asked him "what I thought of rheumatology. It turns out Dr. Irving Fox, a rheumatologist on the faculty, had just received a new grant with a post doc position. So after interviewing, it was decided that I would do 1 year of research as a rheumatology fellow.

"... I did struggle in the lab at first but found I really like rheumatology. So in April, I met with Irv and requested a second year of fellowship and told him I wanted to become an academic rheumatologist, but with a clinical, not research, position. Only 2 weeks later, I was sitting in a small library with graph paper and three different colored pencils plotting the results of an experiment (we did not have computers then). The red line went up and the blue line went down and that was my "eureka moment." Those results told me the definite answer to a question we were asking and told me what the next step was. I experienced what others had told me about, about what it is like when you know something for the first time, even if it is trivial, and you are the only one in the world to know it. But I was hooked on research. It was definitely an acquired taste," Dr. Wortmann said.

When asked to identify the largest changes in rheumatology since he was certified in 1979, Dr. Robert Wortmann cited a long list: "We have gone from salicylates and gold to methotrexate and biologics for rheumatoid arthritis. Because of these advances and earlier diagnosis, we hardly ever see crippling disease and patients in wheelchairs. I don’t know if trainees today ever see patients with swan neck or boutonniere deformities of their hands.

"The life expectancy of knee replacements has improved from 5 to 25 years (thank goodness)! Wegener’s granulomatosis has gone from a universally and rapidly fatal disease to very treatable one, and scleroderma renal crisis is almost unheard of. Fibromyalgia has become epidemic. The percentage of adults in this country with hyperuricemia has risen from 5% to 21.4% with a proportionate increase in the number of patients with gout, now 8.3 million. One of my interests is metabolic myopathies. In 1979, only 4 had been described; now we know of more than 25. The "Primer on the Rheumatic Diseases" has quadrupled in size."

Over the course of her career, Dr. Dorothy Wortmann has seen her specialty blossom: "Pediatric rheumatology was in its infancy as I started. There were not many of us, we had few medications, and there were little if any data on which to base treatment. We didn’t have a textbook until 1992 with the "Textbook of Pediatric Rheumatology," which is now in its sixth edition. At about the same time, we were a recognized as a subspecialty in pediatrics and the first Pediatric Rheumatology Board exam was given. The Pediatric Collaborative Study Group was first and now we have CARRA and PRINTO as well. We have objective outcome measures, data on which to base our decision for treatment and an array of more effective medications."

They met in a medical school biochemistry class in which the professor arranged the students alphabetically, so that Woodward sat next to Wortmann. In the beginning, their teamwork as study partners earned them excellent grades. But when romance distracted them, they had to study apart. By the second year of medical school Dorothy Woodward and Robert Wortmann were married. That was 42 years ago.

"In college, she was chemistry major and I was biology major. So she did the experiments and I cleaned up afterward. I still do the dishes after meals," according to Dr. Robert Wortmann, who explained that his dish duty originated from a bet over a ski race. "I lost a bet wagering ‘dishes for the year’ when we were in a ski race 35 years ago. She won and has refused a rematch."

Photos courtesy Dr. Dorothy Wortmann

Asked to reflect back on his greatest achievement to date, Dr. Robert Wortmann said: "My part in our balancing family and career. We have been married for more than 42 years, we raised two sons who continue make us very proud, and, overall, we have had very satisfying careers. I won’t say it has been easy, but I will say it has been rewarding." Despite that still-lamented ski match, the Wortmanns seem to have had a marriage that has been far more collaborative than competitive, even as they moved several times before arriving in Hanover, New Hampshire, where Robert Wortmann is professor of medicine at Dartmouth and Dorothy Wortmann is a pediatric rheumatologist on the faculty.

Each Wortmann arrived at medical school through a different process. For Robert, becoming a physician may have been a matter of medicine being the family business. "Other than playing professional football, which would have been a goal if I had been bigger, faster, stronger and had any talent (I did play football at Carleton [College, Northfield, Minn.]), I guess I never really considered any alternative to medical school. I don’t think I knew very much about other occupations or professions. My father was a physician and most of our family friends were physicians’ families. Also, I was pretty comfortable in the hospital environment. As I was growing up, my father was in a solo ob.gyn. practice. That meant if I was with him, and he got called to the hospital, I would have to go with him. In those days, they would page doctors at baseball games and come find them in movie theaters. My father used an answering service that he would call hourly whenever he was away from a phone. During the daytime, I usually got to go into the pathology department and always got to see some organs or look at slides. Other times, I would hang out in the doctors’ lounge."

For Dorothy, getting on the road to medical school took imagination, the support of her grandmother, and the enthusiasm of her undergraduate advisers. "I had always expected to go to nursing school. My grandmother, who was my college scholarship, wanted me to get a BA, so I went to Mount Holyoke [College, South Hadley, Mass.], and then my advisers in college encouraged me to go to medical school. My sister was in college and my brother was in graduate school. My father had not planned on sending his daughters to graduate school. He said I could apply for scholarships back East or come to K.U. Medical School, in Kansas City." So the University of Kansas it was, for them both.

After graduation, Robert Wortmann recalled: "We were in one of the first years of the ‘couples match’ for residencies and ended up at the University of Michigan, Ann Arbor, me in medicine and she in pediatrics." Then his obligatory military service reared its head and the couple set off for Korea. If the call had come 5 months earlier, his tour would have been as a medical officer in Vietnam.

From 1973-1974, he served as a general medical officer for the U.S. Army in what was to be the last MASH (mobile army surgical hospital) in Korea. Together, that medical staff of two surgeons, one internist, one anesthesiologist, and 10 nurses cared for 12 helicopter pilots and about 90 enlisted men assigned with them to Camp Mosier, which included the 43rd MASH unit. They also cared for civilians, including residents of a nearby leper colony, as time allowed. Dr. Robert Wortmann’s duties were broad and included "doing sick call and seeing inpatients. I was also No. 3 surgeon, the radiologist, the lab officer, the blood bank officer, the rabies control officer, the VD control officer, the person in charge of doing physical exams on Korean women who were going to marry GIs, and the nuclear holocaust control officer."

Although pregnant with their son, Jon, Dorothy also went to Korea. Conditions were harsh, and the Army made no accommodations for this military wife, even though she came in handy as a pediatrician at the underserved hospital in Seoul. With Robert stationed in "north of the tank wall in a tactical zone at the MASH hospital," he had no car and she could not live on the base there. Instead, she lived in an apartment in Seoul without a car. There was an oil shortage that winter and all water had to be boiled before drinking. Until their son was born, he would visit her in Seoul on weekends when he was free, and she would visit the base on weekends when he was on duty. "The 2½ of us slept in a single bed in a Quonset hut," she recalled in an interview.

The first season of the television show "M*A*S*H" aired the year before Robert arrived in Korea. While he was there, the show’s coproducers visited his MASH unit searching for ideas for the series, which had become wildly popular despite their expectations. "The show was based on a book. They had used up all the material from the book, and they needed fodder for future shows. They did everything we did and interviewed everyone individually. Thus, I can recognize something in every episode beginning in year 3 that was based on our reality. My name was used as a character in one episode [spelled Wortman]. In another episode, they were collecting money for a pool to bet on when Colonel Potter would become a grandfather. At the time of their visit, there was just such a pool at our hospital for when Jon would be born," Robert recalled.

Once Robert was discharged from the U.S. Army, the two doctors moved to Ann Arbor, where Robert was chief resident in internal medicine. Considering how difficult it can be for two physicians to juggle a growing family around their training, the Wortmanns have made it look almost easy. Robert did his rheumatology fellowship from 1977-1979 at Michigan while Dorothy finished her pediatrics residency there, followed by her pediatric rheumatology fellowship at the same institution.

At the time Dorothy was in her fellowship, pediatric rheumatology was not a recognized subspecialty. "I did not do any research, and I was not sure I would be offered academic positions, but I have been fortunate in each of the places we have lived," she noted.

Over the years, the Wortmanns have been at the Medical College of Wisconsin in Milwaukee, where Robert eventually became professor of medicine in the division of rheumatology while Dorothy was on the faculty of the pediatrics department. From there, they moved to East Carolina University, Greenville, where Robert was professor and chairman of the department of medicine. Onward they went to the University of Oklahoma, Tulsa, where Robert was professor and C.S. Lewis Jr. Chair of Internal Medicine. And finally, they went to Dartmouth University, Hanover, N. H., where he is professor of medicine.

His colleague at Dartmouth, Dr. Christopher M. Burns, noted in an interview that: "Bob and Dottie have worked at a number of institutions over the years. Although it’s true that most of their moves were driven by Bob’s career, it’s also true that no matter where she went, Dottie had a big impact. She actually established pediatric rheumatology in Wisconsin, and dramatically improved the pediatric rheumatology programs at all the institutions she’s traveled to with Bob."

Dorothy’s area of particular expertise as a pediatric rheumatologist has been Kawasaki syndrome, a disease she first encountered as a resident: "As senior pediatric residents, we each had to do a Clinical Pathology Conference. Mine was a 3-year-old child who had been admitted for diarrhea and dehydration and who died in the waiting room while waiting for the car to be brought around on discharge. Fortunately, a medical student had taken a very detailed history, and I had read a recent article from Hawaii about a new disease reported in Japan now being seen in Hawaii. That child had Kawasaki syndrome. The cardiac sequelae were just being recognized. As rheumatology fellows at Michigan, we saw these children because it is a vasculitis. When we moved to Milwaukee, there was an outbreak with 20 children in the hospital over a several-week period. In fact, if I remember correctly, there were 13 children in the hospital at one time. This was very unusual. It was reported to the CDC and investigated. I then followed these and subsequent children with one of our cardiologists in a total of about 150 children. This was a large clinical experience at that time and led to those papers."

The stars had to align in a very precise pattern for Robert to become a rheumatologist. First, because his training was interrupted by military service, he had time to reconsider his choice of general internal medicine. Then, he was struck by how sad the general internists he met all seemed, which gave Robert another reason to rethink that specialty. Robert felt strongly that he should experience work in a research lab so he would not later regret never having done it. Going into general internal medicine would have meant no time in a research lab. Finally, Dorothy was given a pediatric rheumatology fellowship position at the University of Michigan where he would do a rheumatology fellowship. Dr. William N. Kelley asked him "what I thought of rheumatology. It turns out Dr. Irving Fox, a rheumatologist on the faculty, had just received a new grant with a post doc position. So after interviewing, it was decided that I would do 1 year of research as a rheumatology fellow.

"... I did struggle in the lab at first but found I really like rheumatology. So in April, I met with Irv and requested a second year of fellowship and told him I wanted to become an academic rheumatologist, but with a clinical, not research, position. Only 2 weeks later, I was sitting in a small library with graph paper and three different colored pencils plotting the results of an experiment (we did not have computers then). The red line went up and the blue line went down and that was my "eureka moment." Those results told me the definite answer to a question we were asking and told me what the next step was. I experienced what others had told me about, about what it is like when you know something for the first time, even if it is trivial, and you are the only one in the world to know it. But I was hooked on research. It was definitely an acquired taste," Dr. Wortmann said.

When asked to identify the largest changes in rheumatology since he was certified in 1979, Dr. Robert Wortmann cited a long list: "We have gone from salicylates and gold to methotrexate and biologics for rheumatoid arthritis. Because of these advances and earlier diagnosis, we hardly ever see crippling disease and patients in wheelchairs. I don’t know if trainees today ever see patients with swan neck or boutonniere deformities of their hands.

"The life expectancy of knee replacements has improved from 5 to 25 years (thank goodness)! Wegener’s granulomatosis has gone from a universally and rapidly fatal disease to very treatable one, and scleroderma renal crisis is almost unheard of. Fibromyalgia has become epidemic. The percentage of adults in this country with hyperuricemia has risen from 5% to 21.4% with a proportionate increase in the number of patients with gout, now 8.3 million. One of my interests is metabolic myopathies. In 1979, only 4 had been described; now we know of more than 25. The "Primer on the Rheumatic Diseases" has quadrupled in size."

Over the course of her career, Dr. Dorothy Wortmann has seen her specialty blossom: "Pediatric rheumatology was in its infancy as I started. There were not many of us, we had few medications, and there were little if any data on which to base treatment. We didn’t have a textbook until 1992 with the "Textbook of Pediatric Rheumatology," which is now in its sixth edition. At about the same time, we were a recognized as a subspecialty in pediatrics and the first Pediatric Rheumatology Board exam was given. The Pediatric Collaborative Study Group was first and now we have CARRA and PRINTO as well. We have objective outcome measures, data on which to base our decision for treatment and an array of more effective medications."

They met in a medical school biochemistry class in which the professor arranged the students alphabetically, so that Woodward sat next to Wortmann. In the beginning, their teamwork as study partners earned them excellent grades. But when romance distracted them, they had to study apart. By the second year of medical school Dorothy Woodward and Robert Wortmann were married. That was 42 years ago.

"In college, she was chemistry major and I was biology major. So she did the experiments and I cleaned up afterward. I still do the dishes after meals," according to Dr. Robert Wortmann, who explained that his dish duty originated from a bet over a ski race. "I lost a bet wagering ‘dishes for the year’ when we were in a ski race 35 years ago. She won and has refused a rematch."

Photos courtesy Dr. Dorothy Wortmann

Asked to reflect back on his greatest achievement to date, Dr. Robert Wortmann said: "My part in our balancing family and career. We have been married for more than 42 years, we raised two sons who continue make us very proud, and, overall, we have had very satisfying careers. I won’t say it has been easy, but I will say it has been rewarding." Despite that still-lamented ski match, the Wortmanns seem to have had a marriage that has been far more collaborative than competitive, even as they moved several times before arriving in Hanover, New Hampshire, where Robert Wortmann is professor of medicine at Dartmouth and Dorothy Wortmann is a pediatric rheumatologist on the faculty.

Each Wortmann arrived at medical school through a different process. For Robert, becoming a physician may have been a matter of medicine being the family business. "Other than playing professional football, which would have been a goal if I had been bigger, faster, stronger and had any talent (I did play football at Carleton [College, Northfield, Minn.]), I guess I never really considered any alternative to medical school. I don’t think I knew very much about other occupations or professions. My father was a physician and most of our family friends were physicians’ families. Also, I was pretty comfortable in the hospital environment. As I was growing up, my father was in a solo ob.gyn. practice. That meant if I was with him, and he got called to the hospital, I would have to go with him. In those days, they would page doctors at baseball games and come find them in movie theaters. My father used an answering service that he would call hourly whenever he was away from a phone. During the daytime, I usually got to go into the pathology department and always got to see some organs or look at slides. Other times, I would hang out in the doctors’ lounge."

For Dorothy, getting on the road to medical school took imagination, the support of her grandmother, and the enthusiasm of her undergraduate advisers. "I had always expected to go to nursing school. My grandmother, who was my college scholarship, wanted me to get a BA, so I went to Mount Holyoke [College, South Hadley, Mass.], and then my advisers in college encouraged me to go to medical school. My sister was in college and my brother was in graduate school. My father had not planned on sending his daughters to graduate school. He said I could apply for scholarships back East or come to K.U. Medical School, in Kansas City." So the University of Kansas it was, for them both.

After graduation, Robert Wortmann recalled: "We were in one of the first years of the ‘couples match’ for residencies and ended up at the University of Michigan, Ann Arbor, me in medicine and she in pediatrics." Then his obligatory military service reared its head and the couple set off for Korea. If the call had come 5 months earlier, his tour would have been as a medical officer in Vietnam.

From 1973-1974, he served as a general medical officer for the U.S. Army in what was to be the last MASH (mobile army surgical hospital) in Korea. Together, that medical staff of two surgeons, one internist, one anesthesiologist, and 10 nurses cared for 12 helicopter pilots and about 90 enlisted men assigned with them to Camp Mosier, which included the 43rd MASH unit. They also cared for civilians, including residents of a nearby leper colony, as time allowed. Dr. Robert Wortmann’s duties were broad and included "doing sick call and seeing inpatients. I was also No. 3 surgeon, the radiologist, the lab officer, the blood bank officer, the rabies control officer, the VD control officer, the person in charge of doing physical exams on Korean women who were going to marry GIs, and the nuclear holocaust control officer."

Although pregnant with their son, Jon, Dorothy also went to Korea. Conditions were harsh, and the Army made no accommodations for this military wife, even though she came in handy as a pediatrician at the underserved hospital in Seoul. With Robert stationed in "north of the tank wall in a tactical zone at the MASH hospital," he had no car and she could not live on the base there. Instead, she lived in an apartment in Seoul without a car. There was an oil shortage that winter and all water had to be boiled before drinking. Until their son was born, he would visit her in Seoul on weekends when he was free, and she would visit the base on weekends when he was on duty. "The 2½ of us slept in a single bed in a Quonset hut," she recalled in an interview.

The first season of the television show "M*A*S*H" aired the year before Robert arrived in Korea. While he was there, the show’s coproducers visited his MASH unit searching for ideas for the series, which had become wildly popular despite their expectations. "The show was based on a book. They had used up all the material from the book, and they needed fodder for future shows. They did everything we did and interviewed everyone individually. Thus, I can recognize something in every episode beginning in year 3 that was based on our reality. My name was used as a character in one episode [spelled Wortman]. In another episode, they were collecting money for a pool to bet on when Colonel Potter would become a grandfather. At the time of their visit, there was just such a pool at our hospital for when Jon would be born," Robert recalled.

Once Robert was discharged from the U.S. Army, the two doctors moved to Ann Arbor, where Robert was chief resident in internal medicine. Considering how difficult it can be for two physicians to juggle a growing family around their training, the Wortmanns have made it look almost easy. Robert did his rheumatology fellowship from 1977-1979 at Michigan while Dorothy finished her pediatrics residency there, followed by her pediatric rheumatology fellowship at the same institution.

At the time Dorothy was in her fellowship, pediatric rheumatology was not a recognized subspecialty. "I did not do any research, and I was not sure I would be offered academic positions, but I have been fortunate in each of the places we have lived," she noted.

Over the years, the Wortmanns have been at the Medical College of Wisconsin in Milwaukee, where Robert eventually became professor of medicine in the division of rheumatology while Dorothy was on the faculty of the pediatrics department. From there, they moved to East Carolina University, Greenville, where Robert was professor and chairman of the department of medicine. Onward they went to the University of Oklahoma, Tulsa, where Robert was professor and C.S. Lewis Jr. Chair of Internal Medicine. And finally, they went to Dartmouth University, Hanover, N. H., where he is professor of medicine.

His colleague at Dartmouth, Dr. Christopher M. Burns, noted in an interview that: "Bob and Dottie have worked at a number of institutions over the years. Although it’s true that most of their moves were driven by Bob’s career, it’s also true that no matter where she went, Dottie had a big impact. She actually established pediatric rheumatology in Wisconsin, and dramatically improved the pediatric rheumatology programs at all the institutions she’s traveled to with Bob."

Dorothy’s area of particular expertise as a pediatric rheumatologist has been Kawasaki syndrome, a disease she first encountered as a resident: "As senior pediatric residents, we each had to do a Clinical Pathology Conference. Mine was a 3-year-old child who had been admitted for diarrhea and dehydration and who died in the waiting room while waiting for the car to be brought around on discharge. Fortunately, a medical student had taken a very detailed history, and I had read a recent article from Hawaii about a new disease reported in Japan now being seen in Hawaii. That child had Kawasaki syndrome. The cardiac sequelae were just being recognized. As rheumatology fellows at Michigan, we saw these children because it is a vasculitis. When we moved to Milwaukee, there was an outbreak with 20 children in the hospital over a several-week period. In fact, if I remember correctly, there were 13 children in the hospital at one time. This was very unusual. It was reported to the CDC and investigated. I then followed these and subsequent children with one of our cardiologists in a total of about 150 children. This was a large clinical experience at that time and led to those papers."

The stars had to align in a very precise pattern for Robert to become a rheumatologist. First, because his training was interrupted by military service, he had time to reconsider his choice of general internal medicine. Then, he was struck by how sad the general internists he met all seemed, which gave Robert another reason to rethink that specialty. Robert felt strongly that he should experience work in a research lab so he would not later regret never having done it. Going into general internal medicine would have meant no time in a research lab. Finally, Dorothy was given a pediatric rheumatology fellowship position at the University of Michigan where he would do a rheumatology fellowship. Dr. William N. Kelley asked him "what I thought of rheumatology. It turns out Dr. Irving Fox, a rheumatologist on the faculty, had just received a new grant with a post doc position. So after interviewing, it was decided that I would do 1 year of research as a rheumatology fellow.

"... I did struggle in the lab at first but found I really like rheumatology. So in April, I met with Irv and requested a second year of fellowship and told him I wanted to become an academic rheumatologist, but with a clinical, not research, position. Only 2 weeks later, I was sitting in a small library with graph paper and three different colored pencils plotting the results of an experiment (we did not have computers then). The red line went up and the blue line went down and that was my "eureka moment." Those results told me the definite answer to a question we were asking and told me what the next step was. I experienced what others had told me about, about what it is like when you know something for the first time, even if it is trivial, and you are the only one in the world to know it. But I was hooked on research. It was definitely an acquired taste," Dr. Wortmann said.

When asked to identify the largest changes in rheumatology since he was certified in 1979, Dr. Robert Wortmann cited a long list: "We have gone from salicylates and gold to methotrexate and biologics for rheumatoid arthritis. Because of these advances and earlier diagnosis, we hardly ever see crippling disease and patients in wheelchairs. I don’t know if trainees today ever see patients with swan neck or boutonniere deformities of their hands.

"The life expectancy of knee replacements has improved from 5 to 25 years (thank goodness)! Wegener’s granulomatosis has gone from a universally and rapidly fatal disease to very treatable one, and scleroderma renal crisis is almost unheard of. Fibromyalgia has become epidemic. The percentage of adults in this country with hyperuricemia has risen from 5% to 21.4% with a proportionate increase in the number of patients with gout, now 8.3 million. One of my interests is metabolic myopathies. In 1979, only 4 had been described; now we know of more than 25. The "Primer on the Rheumatic Diseases" has quadrupled in size."

Over the course of her career, Dr. Dorothy Wortmann has seen her specialty blossom: "Pediatric rheumatology was in its infancy as I started. There were not many of us, we had few medications, and there were little if any data on which to base treatment. We didn’t have a textbook until 1992 with the "Textbook of Pediatric Rheumatology," which is now in its sixth edition. At about the same time, we were a recognized as a subspecialty in pediatrics and the first Pediatric Rheumatology Board exam was given. The Pediatric Collaborative Study Group was first and now we have CARRA and PRINTO as well. We have objective outcome measures, data on which to base our decision for treatment and an array of more effective medications."

Countless rheumatologists who look back on their training count Dr. James O’Dell as being among their mentors who mattered.

Such has been Dr. O’Dell’s enthusiasm for rheumatology and teaching that many young physicians in their internal medicine residency opted to leave their home states and come to Omaha to focus on rheumatology in a fellowship at the University of Nebraska with him.

One such former resident and then fellow Dr. Steve Craig tells a typical story of inspiration at the hand of Dr. O’Dell: "In my second year of [internal medicine] residency, I stumbled upon my rheumatology rotation.

"Through the course of the rotation, Dr. O’Dell spent no less than 3.5 hours each week in didactic training of the students and residents. Most of these sessions were early in the morning, so as not to interfere with typical resident duties on the rotation. He did this month after month, and has done so year after year.

"He never tires of teaching the residents, and his work shows in the results of national testing scores of his residents. In any case, I found myself not wanting to leave the rotation when the calendar turned," said Dr. Craig, now a rheumatologist in Des Moines, Iowa.

Above all else, Dr. O’Dell "believed firmly that a good rheumatologist must first be a good internist," said Dr. Craig, who noted that during his "intern year, I was impressed to discover that he and other faculty members in the rheumatology department took a month or two a year to act as the staff physician on one of the inpatient internal medicine teams."

Another former resident and then fellow, Dr. Ted R. Mikuls, of the University of Nebraska, noted of Dr. O’Dell: "Like all great mentors, Jim had a much bigger impact on the next generation of rheumatologists and internists than he could possibly imagine. Seldom a day goes by that I don’t hear echoes of lessons I’ve learned from Jim reflected in my approach to training and patient care."

Over the course of his 27 years and counting of running the Internal Medicine Residence Training Program at the University of Nebraska Medical Center in Omaha, Dr. O’Dell has directed the training of more than 600 residents.

Dr. O’Dell followed an unlikely path to a career in medicine in that his undergraduate degree from the University of Nebraska is in electrical engineering. It is difficult to imagine that such a personable man as Dr. O’Dell would be fulfilled living his life among engineers. And indeed, Dr. O’Dell saw that the path to happiness lay elsewhere. "I started college in the school of engineering and worked summers with an engineering firm and realized that I wanted and needed more direct interactions with people on a day-to-day basis. I finished my engineering degree so I would have something to fall back on if medical school didn’t go so well – as soon as I got into the clinical years I have never looked back. The engineering background is very helpful in organization and working through things logically – I think this has been particularly true for some of the research that I have done.

"In medical school I thought I would be a family physician or a surgeon and interviewed for residence in those two areas. During January of my senior year after interviewing was over I had a clear epiphany that I was cut out to be an internist! I was able to switch to an IM residence.

"The choice of rheumatology was harder – ultimately I wanted to know one area really well but at the same time continue to take care of the whole patient and not just an organ. I also wanted to follow my patients for the long-term and not just come in and out of their lives. Rheumatology gave me the opportunity to do all of this. After seeing this modeled by Dr. Art Weaver in Lincoln, Nebraska, I was sold, and as they say, the rest is history," said Dr. O’Dell, who is now the Bruce Professor of Internal Medicine, vice-chair of internal medicine, and chief of the division of rheumatology at the University of Nebraska Medical Center in Omaha as well as president of the American College of Rheumatology.

One of his mentors during his rheumatology fellowship at the University of Colorado at Denver was Dr. Herbert Kaplan, now retired. "When [Dr. O’Dell] trained there was a 30-bed rheumatology unit in the hospital. When he made rounds with me, his enthusiasm and ability to relate to patients was unusual as was his ability to soak up knowledge and work cooperatively with the nurses and myself to the patients’ benefit."

Dr. O’Dell has not regretted his decision to become a rheumatologist. He still recalls clearly some of the patients he met during his fellowship at the University of Colorado and what they taught him about the specialty. One such patient was "[a] delightful elderly gentleman from Bolivia who had just come to Denver to live with his daughter. He suffered greatly from what had been diagnosed as rheumatoid arthritis but what was really chronic gout. When we figured this out and got him on the right therapy, it was, at least to him, a miracle," recalled Dr. O’Dell.

"I remember many of my heroic RA patients who suffered greatly from their disease without much in the way of complaints at a time when we did not have much to offer them. These people and their unbelievably positive attitudes are a big reason why I have worked the last 30 years to help understand vastly superior ways to treat them," he said.

Research has long been an important priority for Dr. O’Dell. Among his research projects are studies that compare active treatments in patients whose RA remains active despite methotrexate therapy; genetics of RA; treatment of early aggressive RA; and combination disease-modifying antirheumatic drug therapy for RA.

Dr. Arthur L. Weaver noted of Dr. O’Dell’s research: "He created and continues to manage the RAIN [Rheumatoid Arthritis Investigational Network], which is a unique research consortium of academic and practicing rheumatologists whose primary mission has been to answer everyday questions via investigator initiated research. The RAIN network was responsible for multiple innovative studies including the initial trial and subsequent worldwide prominence of ‘Triple Therapy,’ " said Dr. Weaver, who is clinical professor of medicine at the University of Nebraska and has known Dr. O’Dell since his days as chief resident at the University of Nebraska.

Dr. Kaplan, past president of ACR from 1993-1994, remembers that he mentioned Dr. O’Dell and the RAIN network during his presidential speech as a singular example of research that assessed data gathering from both academic and practice settings. "Most researchers do all one or all the other. [Dr. O’Dell] set the precedent of gathering data from both sources."

Installed as president of the American College of Rheumatology at the annual meeting in November, Dr. O’Dell has a long record of involvement with the ACR, serving in many leadership positions both within the college and its Research and Education Foundation (REF) for the past 20 years. He was president of the REF from 2005-2007, secretary of ACR in 2009, and ACR president-elect in 2011. He served as chair of Patient Giving for the REF’s Within Our Reach campaign, chair of the ACR Registry Task Force, and first chair of the ACR Registry and Health Information Technology Committee.

Some of his earlier committee leadership roles include serving as chair of the Annual Scientific Meeting Abstract Selection Committee in 1998 and 1999, serving on the committee that developed the ACR Guidelines for the Management of Rheumatoid Arthritis in 1996 and 2008, and serving on the Blue Ribbon Committee on Access to Care in 1999. Recently, Dr. O’Dell chaired the association’s Rheumatoid Arthritis Clinical Trial Investigators Ad Hoc Task Force, whose findings were published in the August 2011 issue of Arthritis & Rheumatism.

While he may have been the first physician in his family, Dr. O’Dell’s family is making medicine a family tradition. "[M]y younger brother is an academic general internist and educator at the U. of Nebraska (UNMC). I also now have a son-in-law who is an internist at UNMC, a nephew in residence at UNMC, and a daughter-in-law who is in her first year of medical school also at UNMC," he said.

Dr. O’Dell is not only a rheumatologist, he has been an arthritis patient. His two new knees attest to the fact that he has walked a mile in the shoes of patients with knee pain, and he has followed rheumatologic advice regarding exercise: "I swim 3 to 4 miles per week. I started this 30 years ago when I started having knee arthritis problems. Now even though I have two new knees, I still swim," he said.

When asked to imagine what he will be doing in 5 years, Dr. O’Dell imagines that he will be "[d]oing much the same things I’m doing now – teaching and working to find better ways to treat RA. Also I hope to slow down enough to enjoy my two grand children."

Countless rheumatologists who look back on their training count Dr. James O’Dell as being among their mentors who mattered.

Such has been Dr. O’Dell’s enthusiasm for rheumatology and teaching that many young physicians in their internal medicine residency opted to leave their home states and come to Omaha to focus on rheumatology in a fellowship at the University of Nebraska with him.

One such former resident and then fellow Dr. Steve Craig tells a typical story of inspiration at the hand of Dr. O’Dell: "In my second year of [internal medicine] residency, I stumbled upon my rheumatology rotation.

"Through the course of the rotation, Dr. O’Dell spent no less than 3.5 hours each week in didactic training of the students and residents. Most of these sessions were early in the morning, so as not to interfere with typical resident duties on the rotation. He did this month after month, and has done so year after year.

"He never tires of teaching the residents, and his work shows in the results of national testing scores of his residents. In any case, I found myself not wanting to leave the rotation when the calendar turned," said Dr. Craig, now a rheumatologist in Des Moines, Iowa.

Above all else, Dr. O’Dell "believed firmly that a good rheumatologist must first be a good internist," said Dr. Craig, who noted that during his "intern year, I was impressed to discover that he and other faculty members in the rheumatology department took a month or two a year to act as the staff physician on one of the inpatient internal medicine teams."

Another former resident and then fellow, Dr. Ted R. Mikuls, of the University of Nebraska, noted of Dr. O’Dell: "Like all great mentors, Jim had a much bigger impact on the next generation of rheumatologists and internists than he could possibly imagine. Seldom a day goes by that I don’t hear echoes of lessons I’ve learned from Jim reflected in my approach to training and patient care."

Over the course of his 27 years and counting of running the Internal Medicine Residence Training Program at the University of Nebraska Medical Center in Omaha, Dr. O’Dell has directed the training of more than 600 residents.

Dr. O’Dell followed an unlikely path to a career in medicine in that his undergraduate degree from the University of Nebraska is in electrical engineering. It is difficult to imagine that such a personable man as Dr. O’Dell would be fulfilled living his life among engineers. And indeed, Dr. O’Dell saw that the path to happiness lay elsewhere. "I started college in the school of engineering and worked summers with an engineering firm and realized that I wanted and needed more direct interactions with people on a day-to-day basis. I finished my engineering degree so I would have something to fall back on if medical school didn’t go so well – as soon as I got into the clinical years I have never looked back. The engineering background is very helpful in organization and working through things logically – I think this has been particularly true for some of the research that I have done.

"In medical school I thought I would be a family physician or a surgeon and interviewed for residence in those two areas. During January of my senior year after interviewing was over I had a clear epiphany that I was cut out to be an internist! I was able to switch to an IM residence.

"The choice of rheumatology was harder – ultimately I wanted to know one area really well but at the same time continue to take care of the whole patient and not just an organ. I also wanted to follow my patients for the long-term and not just come in and out of their lives. Rheumatology gave me the opportunity to do all of this. After seeing this modeled by Dr. Art Weaver in Lincoln, Nebraska, I was sold, and as they say, the rest is history," said Dr. O’Dell, who is now the Bruce Professor of Internal Medicine, vice-chair of internal medicine, and chief of the division of rheumatology at the University of Nebraska Medical Center in Omaha as well as president of the American College of Rheumatology.

One of his mentors during his rheumatology fellowship at the University of Colorado at Denver was Dr. Herbert Kaplan, now retired. "When [Dr. O’Dell] trained there was a 30-bed rheumatology unit in the hospital. When he made rounds with me, his enthusiasm and ability to relate to patients was unusual as was his ability to soak up knowledge and work cooperatively with the nurses and myself to the patients’ benefit."

Dr. O’Dell has not regretted his decision to become a rheumatologist. He still recalls clearly some of the patients he met during his fellowship at the University of Colorado and what they taught him about the specialty. One such patient was "[a] delightful elderly gentleman from Bolivia who had just come to Denver to live with his daughter. He suffered greatly from what had been diagnosed as rheumatoid arthritis but what was really chronic gout. When we figured this out and got him on the right therapy, it was, at least to him, a miracle," recalled Dr. O’Dell.

"I remember many of my heroic RA patients who suffered greatly from their disease without much in the way of complaints at a time when we did not have much to offer them. These people and their unbelievably positive attitudes are a big reason why I have worked the last 30 years to help understand vastly superior ways to treat them," he said.

Research has long been an important priority for Dr. O’Dell. Among his research projects are studies that compare active treatments in patients whose RA remains active despite methotrexate therapy; genetics of RA; treatment of early aggressive RA; and combination disease-modifying antirheumatic drug therapy for RA.

Dr. Arthur L. Weaver noted of Dr. O’Dell’s research: "He created and continues to manage the RAIN [Rheumatoid Arthritis Investigational Network], which is a unique research consortium of academic and practicing rheumatologists whose primary mission has been to answer everyday questions via investigator initiated research. The RAIN network was responsible for multiple innovative studies including the initial trial and subsequent worldwide prominence of ‘Triple Therapy,’ " said Dr. Weaver, who is clinical professor of medicine at the University of Nebraska and has known Dr. O’Dell since his days as chief resident at the University of Nebraska.

Dr. Kaplan, past president of ACR from 1993-1994, remembers that he mentioned Dr. O’Dell and the RAIN network during his presidential speech as a singular example of research that assessed data gathering from both academic and practice settings. "Most researchers do all one or all the other. [Dr. O’Dell] set the precedent of gathering data from both sources."

Installed as president of the American College of Rheumatology at the annual meeting in November, Dr. O’Dell has a long record of involvement with the ACR, serving in many leadership positions both within the college and its Research and Education Foundation (REF) for the past 20 years. He was president of the REF from 2005-2007, secretary of ACR in 2009, and ACR president-elect in 2011. He served as chair of Patient Giving for the REF’s Within Our Reach campaign, chair of the ACR Registry Task Force, and first chair of the ACR Registry and Health Information Technology Committee.

Some of his earlier committee leadership roles include serving as chair of the Annual Scientific Meeting Abstract Selection Committee in 1998 and 1999, serving on the committee that developed the ACR Guidelines for the Management of Rheumatoid Arthritis in 1996 and 2008, and serving on the Blue Ribbon Committee on Access to Care in 1999. Recently, Dr. O’Dell chaired the association’s Rheumatoid Arthritis Clinical Trial Investigators Ad Hoc Task Force, whose findings were published in the August 2011 issue of Arthritis & Rheumatism.

While he may have been the first physician in his family, Dr. O’Dell’s family is making medicine a family tradition. "[M]y younger brother is an academic general internist and educator at the U. of Nebraska (UNMC). I also now have a son-in-law who is an internist at UNMC, a nephew in residence at UNMC, and a daughter-in-law who is in her first year of medical school also at UNMC," he said.

Dr. O’Dell is not only a rheumatologist, he has been an arthritis patient. His two new knees attest to the fact that he has walked a mile in the shoes of patients with knee pain, and he has followed rheumatologic advice regarding exercise: "I swim 3 to 4 miles per week. I started this 30 years ago when I started having knee arthritis problems. Now even though I have two new knees, I still swim," he said.

When asked to imagine what he will be doing in 5 years, Dr. O’Dell imagines that he will be "[d]oing much the same things I’m doing now – teaching and working to find better ways to treat RA. Also I hope to slow down enough to enjoy my two grand children."

Countless rheumatologists who look back on their training count Dr. James O’Dell as being among their mentors who mattered.

Such has been Dr. O’Dell’s enthusiasm for rheumatology and teaching that many young physicians in their internal medicine residency opted to leave their home states and come to Omaha to focus on rheumatology in a fellowship at the University of Nebraska with him.

One such former resident and then fellow Dr. Steve Craig tells a typical story of inspiration at the hand of Dr. O’Dell: "In my second year of [internal medicine] residency, I stumbled upon my rheumatology rotation.

"Through the course of the rotation, Dr. O’Dell spent no less than 3.5 hours each week in didactic training of the students and residents. Most of these sessions were early in the morning, so as not to interfere with typical resident duties on the rotation. He did this month after month, and has done so year after year.

"He never tires of teaching the residents, and his work shows in the results of national testing scores of his residents. In any case, I found myself not wanting to leave the rotation when the calendar turned," said Dr. Craig, now a rheumatologist in Des Moines, Iowa.

Above all else, Dr. O’Dell "believed firmly that a good rheumatologist must first be a good internist," said Dr. Craig, who noted that during his "intern year, I was impressed to discover that he and other faculty members in the rheumatology department took a month or two a year to act as the staff physician on one of the inpatient internal medicine teams."

Another former resident and then fellow, Dr. Ted R. Mikuls, of the University of Nebraska, noted of Dr. O’Dell: "Like all great mentors, Jim had a much bigger impact on the next generation of rheumatologists and internists than he could possibly imagine. Seldom a day goes by that I don’t hear echoes of lessons I’ve learned from Jim reflected in my approach to training and patient care."

Over the course of his 27 years and counting of running the Internal Medicine Residence Training Program at the University of Nebraska Medical Center in Omaha, Dr. O’Dell has directed the training of more than 600 residents.

Dr. O’Dell followed an unlikely path to a career in medicine in that his undergraduate degree from the University of Nebraska is in electrical engineering. It is difficult to imagine that such a personable man as Dr. O’Dell would be fulfilled living his life among engineers. And indeed, Dr. O’Dell saw that the path to happiness lay elsewhere. "I started college in the school of engineering and worked summers with an engineering firm and realized that I wanted and needed more direct interactions with people on a day-to-day basis. I finished my engineering degree so I would have something to fall back on if medical school didn’t go so well – as soon as I got into the clinical years I have never looked back. The engineering background is very helpful in organization and working through things logically – I think this has been particularly true for some of the research that I have done.

"In medical school I thought I would be a family physician or a surgeon and interviewed for residence in those two areas. During January of my senior year after interviewing was over I had a clear epiphany that I was cut out to be an internist! I was able to switch to an IM residence.

"The choice of rheumatology was harder – ultimately I wanted to know one area really well but at the same time continue to take care of the whole patient and not just an organ. I also wanted to follow my patients for the long-term and not just come in and out of their lives. Rheumatology gave me the opportunity to do all of this. After seeing this modeled by Dr. Art Weaver in Lincoln, Nebraska, I was sold, and as they say, the rest is history," said Dr. O’Dell, who is now the Bruce Professor of Internal Medicine, vice-chair of internal medicine, and chief of the division of rheumatology at the University of Nebraska Medical Center in Omaha as well as president of the American College of Rheumatology.

One of his mentors during his rheumatology fellowship at the University of Colorado at Denver was Dr. Herbert Kaplan, now retired. "When [Dr. O’Dell] trained there was a 30-bed rheumatology unit in the hospital. When he made rounds with me, his enthusiasm and ability to relate to patients was unusual as was his ability to soak up knowledge and work cooperatively with the nurses and myself to the patients’ benefit."

Dr. O’Dell has not regretted his decision to become a rheumatologist. He still recalls clearly some of the patients he met during his fellowship at the University of Colorado and what they taught him about the specialty. One such patient was "[a] delightful elderly gentleman from Bolivia who had just come to Denver to live with his daughter. He suffered greatly from what had been diagnosed as rheumatoid arthritis but what was really chronic gout. When we figured this out and got him on the right therapy, it was, at least to him, a miracle," recalled Dr. O’Dell.

"I remember many of my heroic RA patients who suffered greatly from their disease without much in the way of complaints at a time when we did not have much to offer them. These people and their unbelievably positive attitudes are a big reason why I have worked the last 30 years to help understand vastly superior ways to treat them," he said.

Research has long been an important priority for Dr. O’Dell. Among his research projects are studies that compare active treatments in patients whose RA remains active despite methotrexate therapy; genetics of RA; treatment of early aggressive RA; and combination disease-modifying antirheumatic drug therapy for RA.

Dr. Arthur L. Weaver noted of Dr. O’Dell’s research: "He created and continues to manage the RAIN [Rheumatoid Arthritis Investigational Network], which is a unique research consortium of academic and practicing rheumatologists whose primary mission has been to answer everyday questions via investigator initiated research. The RAIN network was responsible for multiple innovative studies including the initial trial and subsequent worldwide prominence of ‘Triple Therapy,’ " said Dr. Weaver, who is clinical professor of medicine at the University of Nebraska and has known Dr. O’Dell since his days as chief resident at the University of Nebraska.

Dr. Kaplan, past president of ACR from 1993-1994, remembers that he mentioned Dr. O’Dell and the RAIN network during his presidential speech as a singular example of research that assessed data gathering from both academic and practice settings. "Most researchers do all one or all the other. [Dr. O’Dell] set the precedent of gathering data from both sources."

Installed as president of the American College of Rheumatology at the annual meeting in November, Dr. O’Dell has a long record of involvement with the ACR, serving in many leadership positions both within the college and its Research and Education Foundation (REF) for the past 20 years. He was president of the REF from 2005-2007, secretary of ACR in 2009, and ACR president-elect in 2011. He served as chair of Patient Giving for the REF’s Within Our Reach campaign, chair of the ACR Registry Task Force, and first chair of the ACR Registry and Health Information Technology Committee.

Some of his earlier committee leadership roles include serving as chair of the Annual Scientific Meeting Abstract Selection Committee in 1998 and 1999, serving on the committee that developed the ACR Guidelines for the Management of Rheumatoid Arthritis in 1996 and 2008, and serving on the Blue Ribbon Committee on Access to Care in 1999. Recently, Dr. O’Dell chaired the association’s Rheumatoid Arthritis Clinical Trial Investigators Ad Hoc Task Force, whose findings were published in the August 2011 issue of Arthritis & Rheumatism.

While he may have been the first physician in his family, Dr. O’Dell’s family is making medicine a family tradition. "[M]y younger brother is an academic general internist and educator at the U. of Nebraska (UNMC). I also now have a son-in-law who is an internist at UNMC, a nephew in residence at UNMC, and a daughter-in-law who is in her first year of medical school also at UNMC," he said.

Dr. O’Dell is not only a rheumatologist, he has been an arthritis patient. His two new knees attest to the fact that he has walked a mile in the shoes of patients with knee pain, and he has followed rheumatologic advice regarding exercise: "I swim 3 to 4 miles per week. I started this 30 years ago when I started having knee arthritis problems. Now even though I have two new knees, I still swim," he said.

When asked to imagine what he will be doing in 5 years, Dr. O’Dell imagines that he will be "[d]oing much the same things I’m doing now – teaching and working to find better ways to treat RA. Also I hope to slow down enough to enjoy my two grand children."

Dr. Martin Lee maintains his come-what-may intention to kayak the circumference of Great Britain, despite a growing number of challenges to his plan to raise £100,000 in pledges for the National Rheumatoid Arthritis Society.

His launch date is April 1, 2012. Dr. Lee intends to put his kayak into the Thames at the Ahoy Centre in Greenwich. "There is absolutely no chance that I won’t launch, come wind, rain, or high water!" he declared in a recent interview.

Photos courtesy Dr. Martin Lee

When setting his fund-raising goal, Dr. Lee did not take into account new regulations that limit contributions by pharmaceutical companies to charitable efforts such as his.

Dr. Lee’s undertaking is inspired by his beloved aunt, Maureen Rayner, of Bournemouth in the south of England, who has active rheumatoid arthritis despite treatment with various anti-tumor necrosis factor drugs as well as rituximab. "She is severely limited in activities or daily living by her RA but is incredibly stoical and non-complaining," noted Dr. Lee.

The 32-year-old, newly minted rheumatologist estimates that it will take him 100 days to kayak the 2,600 miles.

Training must be worked in around a tight schedule of a full-time position at the Royal National Hospital of Rheumatic Diseases in Bath that involves 2-3 hours of daily commuting. By the time he gets to the gym to work out, the day has darkened and he is tired. Yet Dr. Lee does not flag. "I have been training about 2 hours a day in the gym and have been doing lots of running. As the days have been getting shorter, it has been more and more difficult getting on the water," he said.

Running has included about 10 half marathons in the last 3 months. However, an injury in the form of piriformis syndrome has hampered his training.

Food is another important part of Dr. Lee’s training regimen. "I have been trying to lose weight (unsuccessfully) to improve my half marathon times but am now looking to maintain fat stores as I will need a higher body fat percentage for the challenge to cope with the 8-9 hours of paddling a day," he said.

Leaner than his body mass index are his pledge totals. To date, Dr. Lee has raised £2,500 in pledges. "New regulations regarding donations from pharmaceutical companies have severely hampered my fundraising. If I complete the challenge but have not raised the £100,000 I will feel that I have failed as the fundraising is my main target and kayaking around the United Kingdom as a means to achieve that target," noted Dr. Lee

"I don’t know whether the same [Association of the British Pharmaceutical Industry] rules apply to U.S. pharmaceutical companies as they do in the United Kingdom, but I suspect the rules are even stricter in the United States, if anything." This leaves much of the charitable donations in the hands of individuals.

Once Dr. Lee is in the water and underway, "I will be using a spot tracker device so people can visit the website and keep track of where I am. I hope to post a blog most days (which may be via friends/family). I hope to post photos fairly regularly depending on when I can get Internet access."

For more information about the challenge and to sponsor Dr. Lee, visit www.martinkayaking.co.uk.

Dr. Martin Lee maintains his come-what-may intention to kayak the circumference of Great Britain, despite a growing number of challenges to his plan to raise £100,000 in pledges for the National Rheumatoid Arthritis Society.

His launch date is April 1, 2012. Dr. Lee intends to put his kayak into the Thames at the Ahoy Centre in Greenwich. "There is absolutely no chance that I won’t launch, come wind, rain, or high water!" he declared in a recent interview.

Photos courtesy Dr. Martin Lee

When setting his fund-raising goal, Dr. Lee did not take into account new regulations that limit contributions by pharmaceutical companies to charitable efforts such as his.

Dr. Lee’s undertaking is inspired by his beloved aunt, Maureen Rayner, of Bournemouth in the south of England, who has active rheumatoid arthritis despite treatment with various anti-tumor necrosis factor drugs as well as rituximab. "She is severely limited in activities or daily living by her RA but is incredibly stoical and non-complaining," noted Dr. Lee.

The 32-year-old, newly minted rheumatologist estimates that it will take him 100 days to kayak the 2,600 miles.

Training must be worked in around a tight schedule of a full-time position at the Royal National Hospital of Rheumatic Diseases in Bath that involves 2-3 hours of daily commuting. By the time he gets to the gym to work out, the day has darkened and he is tired. Yet Dr. Lee does not flag. "I have been training about 2 hours a day in the gym and have been doing lots of running. As the days have been getting shorter, it has been more and more difficult getting on the water," he said.

Running has included about 10 half marathons in the last 3 months. However, an injury in the form of piriformis syndrome has hampered his training.

Food is another important part of Dr. Lee’s training regimen. "I have been trying to lose weight (unsuccessfully) to improve my half marathon times but am now looking to maintain fat stores as I will need a higher body fat percentage for the challenge to cope with the 8-9 hours of paddling a day," he said.

Leaner than his body mass index are his pledge totals. To date, Dr. Lee has raised £2,500 in pledges. "New regulations regarding donations from pharmaceutical companies have severely hampered my fundraising. If I complete the challenge but have not raised the £100,000 I will feel that I have failed as the fundraising is my main target and kayaking around the United Kingdom as a means to achieve that target," noted Dr. Lee

"I don’t know whether the same [Association of the British Pharmaceutical Industry] rules apply to U.S. pharmaceutical companies as they do in the United Kingdom, but I suspect the rules are even stricter in the United States, if anything." This leaves much of the charitable donations in the hands of individuals.

Once Dr. Lee is in the water and underway, "I will be using a spot tracker device so people can visit the website and keep track of where I am. I hope to post a blog most days (which may be via friends/family). I hope to post photos fairly regularly depending on when I can get Internet access."

For more information about the challenge and to sponsor Dr. Lee, visit www.martinkayaking.co.uk.

Dr. Martin Lee maintains his come-what-may intention to kayak the circumference of Great Britain, despite a growing number of challenges to his plan to raise £100,000 in pledges for the National Rheumatoid Arthritis Society.

His launch date is April 1, 2012. Dr. Lee intends to put his kayak into the Thames at the Ahoy Centre in Greenwich. "There is absolutely no chance that I won’t launch, come wind, rain, or high water!" he declared in a recent interview.

Photos courtesy Dr. Martin Lee

When setting his fund-raising goal, Dr. Lee did not take into account new regulations that limit contributions by pharmaceutical companies to charitable efforts such as his.

Dr. Lee’s undertaking is inspired by his beloved aunt, Maureen Rayner, of Bournemouth in the south of England, who has active rheumatoid arthritis despite treatment with various anti-tumor necrosis factor drugs as well as rituximab. "She is severely limited in activities or daily living by her RA but is incredibly stoical and non-complaining," noted Dr. Lee.

The 32-year-old, newly minted rheumatologist estimates that it will take him 100 days to kayak the 2,600 miles.

Training must be worked in around a tight schedule of a full-time position at the Royal National Hospital of Rheumatic Diseases in Bath that involves 2-3 hours of daily commuting. By the time he gets to the gym to work out, the day has darkened and he is tired. Yet Dr. Lee does not flag. "I have been training about 2 hours a day in the gym and have been doing lots of running. As the days have been getting shorter, it has been more and more difficult getting on the water," he said.

Running has included about 10 half marathons in the last 3 months. However, an injury in the form of piriformis syndrome has hampered his training.

Food is another important part of Dr. Lee’s training regimen. "I have been trying to lose weight (unsuccessfully) to improve my half marathon times but am now looking to maintain fat stores as I will need a higher body fat percentage for the challenge to cope with the 8-9 hours of paddling a day," he said.

Leaner than his body mass index are his pledge totals. To date, Dr. Lee has raised £2,500 in pledges. "New regulations regarding donations from pharmaceutical companies have severely hampered my fundraising. If I complete the challenge but have not raised the £100,000 I will feel that I have failed as the fundraising is my main target and kayaking around the United Kingdom as a means to achieve that target," noted Dr. Lee

"I don’t know whether the same [Association of the British Pharmaceutical Industry] rules apply to U.S. pharmaceutical companies as they do in the United Kingdom, but I suspect the rules are even stricter in the United States, if anything." This leaves much of the charitable donations in the hands of individuals.

Once Dr. Lee is in the water and underway, "I will be using a spot tracker device so people can visit the website and keep track of where I am. I hope to post a blog most days (which may be via friends/family). I hope to post photos fairly regularly depending on when I can get Internet access."

For more information about the challenge and to sponsor Dr. Lee, visit www.martinkayaking.co.uk.

A career in medicine snuck up on Dr. David Wofsy. After graduating from Harvard with a degree in mathematics in 1968, his mind was occupied by the large moral issues of the day.

As the son of a labor-organizer father and social-worker mother who were hounded by the late Sen. Joseph R. McCarthy and the House on Un-American Activities Committee, Dr. Wofsy knew that one’s stand on important social matter might come at a price. And he paid it.

Inspired by the teachings and writings of the Rev. Dr. Martin Luther King, Dr. Wofsy applied for and was granted conscientious objector status during the time of the American involvement in Vietnam. Medicine’s appeal became clearer to him while he was performing his alternative service in the emergency room at the Los Angles County Hospital.

After graduating from medical school at the University of California at San Diego, Dr. Wofsy was a resident in internal medicine at the University of California at San Francisco, where he encountered what turned into his life’s work, he said in an interview.

"I was deeply moved by several young patients whom I met during my residency, who were dealing with life-threatening autoimmune diseases, especially systemic lupus. I also believed that the rapid pace of progress in immunology and biotechnology were likely to lead to exciting advances in rheumatology during the course of my career. I wanted to be part of that excitement."

That promise of impending clinical breakthroughs stayed with Dr. Wofsy through his rheumatology fellowship. Yet the frustrations with the clinical realities remained.

"I remember most the young women and men whom we could not help, who died when we all felt confident that we were within a few years of having treatments that might have saved them. When things are going well in our research, the excitement of discovery is all the motivation we need. However, when things are going poorly, it is the memory of those patients that compels us to keep trying."

Dr. Wofsy has remained at the UCSF, where he now holds the George A. Zimmermann Distinguished Professorship and is professor of medicine and microbiology and immunology. He was director of the rheumatology training program there from 1992-2006.

Dr. Betty Diamond, his long-time colleague, "I have known David well for 15 or more years, been a friend and collaborator. Our current clinical trial is one that we conceived in 2000, wrote a proposal for in 2001 and enrolled our first patient in 2007, so he certainly has patience.

"He is an avid Giants fan (the San Francisco Giants, not the New York Giants) and uses Barry Bonds to exemplify the concept of biomarkers (biceps for steroids). He is deeply committed to training, patient care, and integrity," said Dr. Diamond, professor of medicine and microbiology at the Feinstein Institute for Medical Research in New York, speaking in an interview.

According to one of his former fellows, Dr. Maria Dall’Era, happening upon him in the course of her training shaped her career.

"I joined the rheumatology fellowship program at UCSF in 2001 and began working closely with Dr. Wofsy as his mentee in 2002. Dr. Wofsy has been my mentor ever since, and it is because of his guidance, support, and leadership that I have been able to pursue a career in academic rheumatology at UCSF. I am currently associate professor of medicine at UCSF and I am director of the UCSF Lupus Clinic and [Rheumatology] Clinical Research Center. I can honestly say that I would not have achieved my success at UCSF if it were not for Dr. Wofsy."

"I remember most the young women and men whom we could not help, who died when we all felt confident that we were within a few years of having treatments that might have saved them," said Dr. Wofsy.

Asked about his own place in lupus research after decades at the task, Dr. Wofsy reflected that: "Within the lupus world, there are better basic scientists than I ever will be; there are better clinical scientists than I ever will be; there are better clinicians than I ever will be; and there are better teachers than I ever will be. To the extent that I have been able to contribute, it may be primarily as a translator in an era of translational research. Because I spent years doing bench research before devoting myself fully to clinical research, I speak both languages. That turns out to be an important niche that helps to make the most of the hard work and accomplishments of others."

While Dr. Wofsy may be modest about his own contributions to lupus research, those who have spent time with him beg to differ.

Dr. Dall’Era noted that "Dr. Wofsy is the quintessential physician/scientist who excels in every aspect of his work. He has an extensive knowledge of basic immunology from his years in the lab working with murine models of lupus, and he has become a leading international figure in the design and execution of clinical trials in lupus. His vision and creativity were critical in the development of the [UCSF] division of rheumatology clinical trials center in which several important clinical trials of novel agents for the treatment of autoimmune diseases were conducted. His knowledge of basic science and clinical rheumatology enables him to design clinical trials that serve to address clinical questions of efficacy as well as more basic questions about the mechanism of action of the drug being studied," Dr. Dall’Era said.

"Most important, Dr. Wofsy is a compassionate and caring person who always places other people’s interests in front of his own. He is an extremely generous mentor who has given me every opportunity to be the lead author on manuscripts and to participate in various projects and clinical trials in a leadership position. In his humble manner, he is always quick to give me credit for work and downplay the work and skills that were needed on his part to create the opportunity for me in the first place," according to Dr. Dall’Era.

Dr. Wofsy credits his own fellowship director with having a great influence. "Bill Seaman was my fellowship director. I still aspire to match the qualities that Bill modeled for his fellows – intellectual honesty, modesty, compassion, and selflessness. The two lessons I learned from Bill that have always mattered most to me are: the most important quality a physician can have is to be a good human being; and it is always OK to say ‘I don’t know’ as long as the next sentence is ‘Let’s find out.’ Words to live by."

While president of the American College of Rheumatology from 2003-2004, Dr. Wofsy continued work begun by earlier ACR leaders to increase the supply of rheumatologists to meet an anticipated shortage. In addition, Dr. Wofsy’s presidency placed emphasis on "establishment of principles and strengthening of procedures designed to ensure that the ACR set the standard among professional societies for integrity and freedom from conflict of interest. It is an appropriate source of pride for the organization that its leadership in this area is widely recognized."

Rheumatology is in the midst of a demographic sea change. "A remarkable thing is about to happen in our subspecialty. In the course of a single generation, the profession will go from being overwhelmingly male to being predominantly female," he said. "We all have a responsibility to insure that that change is reflected at all levels of the profession, including especially in the leadership of our academic programs and our professional society. The ACR has been successful in the past at seeing the future and getting ahead of it. This kind of dramatic social transformation is probably the greatest challenge yet. The ACR needs to be proactive in this area by developing a strategy to insure that there are rewarding career paths available to women in rheumatology and that women have a leadership role in preparing for this future. A simple first step would be to set some goals regarding division and ACR leadership and then to monitor success in achieving these goals."

When asked what inspires him these days, Dr. Wofsy cited the applications for UCSF medical school that he reads in his position as associate dean for admissions. "Reading the applications from the next generation of physicians, and meeting the new students each year, is very inspiring. I recommend this role to everyone. It is the best way to remain inspired and optimistic about the future. Having children – I have three – helps, too."

Sally Koch Kubetin is managing editor of Rheumatology News. You may contact her at [email protected].

A career in medicine snuck up on Dr. David Wofsy. After graduating from Harvard with a degree in mathematics in 1968, his mind was occupied by the large moral issues of the day.

As the son of a labor-organizer father and social-worker mother who were hounded by the late Sen. Joseph R. McCarthy and the House on Un-American Activities Committee, Dr. Wofsy knew that one’s stand on important social matter might come at a price. And he paid it.

Inspired by the teachings and writings of the Rev. Dr. Martin Luther King, Dr. Wofsy applied for and was granted conscientious objector status during the time of the American involvement in Vietnam. Medicine’s appeal became clearer to him while he was performing his alternative service in the emergency room at the Los Angles County Hospital.

After graduating from medical school at the University of California at San Diego, Dr. Wofsy was a resident in internal medicine at the University of California at San Francisco, where he encountered what turned into his life’s work, he said in an interview.

"I was deeply moved by several young patients whom I met during my residency, who were dealing with life-threatening autoimmune diseases, especially systemic lupus. I also believed that the rapid pace of progress in immunology and biotechnology were likely to lead to exciting advances in rheumatology during the course of my career. I wanted to be part of that excitement."

That promise of impending clinical breakthroughs stayed with Dr. Wofsy through his rheumatology fellowship. Yet the frustrations with the clinical realities remained.

"I remember most the young women and men whom we could not help, who died when we all felt confident that we were within a few years of having treatments that might have saved them. When things are going well in our research, the excitement of discovery is all the motivation we need. However, when things are going poorly, it is the memory of those patients that compels us to keep trying."

Dr. Wofsy has remained at the UCSF, where he now holds the George A. Zimmermann Distinguished Professorship and is professor of medicine and microbiology and immunology. He was director of the rheumatology training program there from 1992-2006.

Dr. Betty Diamond, his long-time colleague, "I have known David well for 15 or more years, been a friend and collaborator. Our current clinical trial is one that we conceived in 2000, wrote a proposal for in 2001 and enrolled our first patient in 2007, so he certainly has patience.

"He is an avid Giants fan (the San Francisco Giants, not the New York Giants) and uses Barry Bonds to exemplify the concept of biomarkers (biceps for steroids). He is deeply committed to training, patient care, and integrity," said Dr. Diamond, professor of medicine and microbiology at the Feinstein Institute for Medical Research in New York, speaking in an interview.

According to one of his former fellows, Dr. Maria Dall’Era, happening upon him in the course of her training shaped her career.

"I joined the rheumatology fellowship program at UCSF in 2001 and began working closely with Dr. Wofsy as his mentee in 2002. Dr. Wofsy has been my mentor ever since, and it is because of his guidance, support, and leadership that I have been able to pursue a career in academic rheumatology at UCSF. I am currently associate professor of medicine at UCSF and I am director of the UCSF Lupus Clinic and [Rheumatology] Clinical Research Center. I can honestly say that I would not have achieved my success at UCSF if it were not for Dr. Wofsy."

"I remember most the young women and men whom we could not help, who died when we all felt confident that we were within a few years of having treatments that might have saved them," said Dr. Wofsy.

Asked about his own place in lupus research after decades at the task, Dr. Wofsy reflected that: "Within the lupus world, there are better basic scientists than I ever will be; there are better clinical scientists than I ever will be; there are better clinicians than I ever will be; and there are better teachers than I ever will be. To the extent that I have been able to contribute, it may be primarily as a translator in an era of translational research. Because I spent years doing bench research before devoting myself fully to clinical research, I speak both languages. That turns out to be an important niche that helps to make the most of the hard work and accomplishments of others."

While Dr. Wofsy may be modest about his own contributions to lupus research, those who have spent time with him beg to differ.

Dr. Dall’Era noted that "Dr. Wofsy is the quintessential physician/scientist who excels in every aspect of his work. He has an extensive knowledge of basic immunology from his years in the lab working with murine models of lupus, and he has become a leading international figure in the design and execution of clinical trials in lupus. His vision and creativity were critical in the development of the [UCSF] division of rheumatology clinical trials center in which several important clinical trials of novel agents for the treatment of autoimmune diseases were conducted. His knowledge of basic science and clinical rheumatology enables him to design clinical trials that serve to address clinical questions of efficacy as well as more basic questions about the mechanism of action of the drug being studied," Dr. Dall’Era said.

"Most important, Dr. Wofsy is a compassionate and caring person who always places other people’s interests in front of his own. He is an extremely generous mentor who has given me every opportunity to be the lead author on manuscripts and to participate in various projects and clinical trials in a leadership position. In his humble manner, he is always quick to give me credit for work and downplay the work and skills that were needed on his part to create the opportunity for me in the first place," according to Dr. Dall’Era.

Dr. Wofsy credits his own fellowship director with having a great influence. "Bill Seaman was my fellowship director. I still aspire to match the qualities that Bill modeled for his fellows – intellectual honesty, modesty, compassion, and selflessness. The two lessons I learned from Bill that have always mattered most to me are: the most important quality a physician can have is to be a good human being; and it is always OK to say ‘I don’t know’ as long as the next sentence is ‘Let’s find out.’ Words to live by."

While president of the American College of Rheumatology from 2003-2004, Dr. Wofsy continued work begun by earlier ACR leaders to increase the supply of rheumatologists to meet an anticipated shortage. In addition, Dr. Wofsy’s presidency placed emphasis on "establishment of principles and strengthening of procedures designed to ensure that the ACR set the standard among professional societies for integrity and freedom from conflict of interest. It is an appropriate source of pride for the organization that its leadership in this area is widely recognized."

Rheumatology is in the midst of a demographic sea change. "A remarkable thing is about to happen in our subspecialty. In the course of a single generation, the profession will go from being overwhelmingly male to being predominantly female," he said. "We all have a responsibility to insure that that change is reflected at all levels of the profession, including especially in the leadership of our academic programs and our professional society. The ACR has been successful in the past at seeing the future and getting ahead of it. This kind of dramatic social transformation is probably the greatest challenge yet. The ACR needs to be proactive in this area by developing a strategy to insure that there are rewarding career paths available to women in rheumatology and that women have a leadership role in preparing for this future. A simple first step would be to set some goals regarding division and ACR leadership and then to monitor success in achieving these goals."

When asked what inspires him these days, Dr. Wofsy cited the applications for UCSF medical school that he reads in his position as associate dean for admissions. "Reading the applications from the next generation of physicians, and meeting the new students each year, is very inspiring. I recommend this role to everyone. It is the best way to remain inspired and optimistic about the future. Having children – I have three – helps, too."

Sally Koch Kubetin is managing editor of Rheumatology News. You may contact her at [email protected].

A career in medicine snuck up on Dr. David Wofsy. After graduating from Harvard with a degree in mathematics in 1968, his mind was occupied by the large moral issues of the day.

As the son of a labor-organizer father and social-worker mother who were hounded by the late Sen. Joseph R. McCarthy and the House on Un-American Activities Committee, Dr. Wofsy knew that one’s stand on important social matter might come at a price. And he paid it.

Inspired by the teachings and writings of the Rev. Dr. Martin Luther King, Dr. Wofsy applied for and was granted conscientious objector status during the time of the American involvement in Vietnam. Medicine’s appeal became clearer to him while he was performing his alternative service in the emergency room at the Los Angles County Hospital.

After graduating from medical school at the University of California at San Diego, Dr. Wofsy was a resident in internal medicine at the University of California at San Francisco, where he encountered what turned into his life’s work, he said in an interview.

"I was deeply moved by several young patients whom I met during my residency, who were dealing with life-threatening autoimmune diseases, especially systemic lupus. I also believed that the rapid pace of progress in immunology and biotechnology were likely to lead to exciting advances in rheumatology during the course of my career. I wanted to be part of that excitement."

That promise of impending clinical breakthroughs stayed with Dr. Wofsy through his rheumatology fellowship. Yet the frustrations with the clinical realities remained.

"I remember most the young women and men whom we could not help, who died when we all felt confident that we were within a few years of having treatments that might have saved them. When things are going well in our research, the excitement of discovery is all the motivation we need. However, when things are going poorly, it is the memory of those patients that compels us to keep trying."

Dr. Wofsy has remained at the UCSF, where he now holds the George A. Zimmermann Distinguished Professorship and is professor of medicine and microbiology and immunology. He was director of the rheumatology training program there from 1992-2006.

Dr. Betty Diamond, his long-time colleague, "I have known David well for 15 or more years, been a friend and collaborator. Our current clinical trial is one that we conceived in 2000, wrote a proposal for in 2001 and enrolled our first patient in 2007, so he certainly has patience.

"He is an avid Giants fan (the San Francisco Giants, not the New York Giants) and uses Barry Bonds to exemplify the concept of biomarkers (biceps for steroids). He is deeply committed to training, patient care, and integrity," said Dr. Diamond, professor of medicine and microbiology at the Feinstein Institute for Medical Research in New York, speaking in an interview.

According to one of his former fellows, Dr. Maria Dall’Era, happening upon him in the course of her training shaped her career.

"I joined the rheumatology fellowship program at UCSF in 2001 and began working closely with Dr. Wofsy as his mentee in 2002. Dr. Wofsy has been my mentor ever since, and it is because of his guidance, support, and leadership that I have been able to pursue a career in academic rheumatology at UCSF. I am currently associate professor of medicine at UCSF and I am director of the UCSF Lupus Clinic and [Rheumatology] Clinical Research Center. I can honestly say that I would not have achieved my success at UCSF if it were not for Dr. Wofsy."

"I remember most the young women and men whom we could not help, who died when we all felt confident that we were within a few years of having treatments that might have saved them," said Dr. Wofsy.

Asked about his own place in lupus research after decades at the task, Dr. Wofsy reflected that: "Within the lupus world, there are better basic scientists than I ever will be; there are better clinical scientists than I ever will be; there are better clinicians than I ever will be; and there are better teachers than I ever will be. To the extent that I have been able to contribute, it may be primarily as a translator in an era of translational research. Because I spent years doing bench research before devoting myself fully to clinical research, I speak both languages. That turns out to be an important niche that helps to make the most of the hard work and accomplishments of others."

While Dr. Wofsy may be modest about his own contributions to lupus research, those who have spent time with him beg to differ.

Dr. Dall’Era noted that "Dr. Wofsy is the quintessential physician/scientist who excels in every aspect of his work. He has an extensive knowledge of basic immunology from his years in the lab working with murine models of lupus, and he has become a leading international figure in the design and execution of clinical trials in lupus. His vision and creativity were critical in the development of the [UCSF] division of rheumatology clinical trials center in which several important clinical trials of novel agents for the treatment of autoimmune diseases were conducted. His knowledge of basic science and clinical rheumatology enables him to design clinical trials that serve to address clinical questions of efficacy as well as more basic questions about the mechanism of action of the drug being studied," Dr. Dall’Era said.

"Most important, Dr. Wofsy is a compassionate and caring person who always places other people’s interests in front of his own. He is an extremely generous mentor who has given me every opportunity to be the lead author on manuscripts and to participate in various projects and clinical trials in a leadership position. In his humble manner, he is always quick to give me credit for work and downplay the work and skills that were needed on his part to create the opportunity for me in the first place," according to Dr. Dall’Era.

Dr. Wofsy credits his own fellowship director with having a great influence. "Bill Seaman was my fellowship director. I still aspire to match the qualities that Bill modeled for his fellows – intellectual honesty, modesty, compassion, and selflessness. The two lessons I learned from Bill that have always mattered most to me are: the most important quality a physician can have is to be a good human being; and it is always OK to say ‘I don’t know’ as long as the next sentence is ‘Let’s find out.’ Words to live by."

While president of the American College of Rheumatology from 2003-2004, Dr. Wofsy continued work begun by earlier ACR leaders to increase the supply of rheumatologists to meet an anticipated shortage. In addition, Dr. Wofsy’s presidency placed emphasis on "establishment of principles and strengthening of procedures designed to ensure that the ACR set the standard among professional societies for integrity and freedom from conflict of interest. It is an appropriate source of pride for the organization that its leadership in this area is widely recognized."

Rheumatology is in the midst of a demographic sea change. "A remarkable thing is about to happen in our subspecialty. In the course of a single generation, the profession will go from being overwhelmingly male to being predominantly female," he said. "We all have a responsibility to insure that that change is reflected at all levels of the profession, including especially in the leadership of our academic programs and our professional society. The ACR has been successful in the past at seeing the future and getting ahead of it. This kind of dramatic social transformation is probably the greatest challenge yet. The ACR needs to be proactive in this area by developing a strategy to insure that there are rewarding career paths available to women in rheumatology and that women have a leadership role in preparing for this future. A simple first step would be to set some goals regarding division and ACR leadership and then to monitor success in achieving these goals."

When asked what inspires him these days, Dr. Wofsy cited the applications for UCSF medical school that he reads in his position as associate dean for admissions. "Reading the applications from the next generation of physicians, and meeting the new students each year, is very inspiring. I recommend this role to everyone. It is the best way to remain inspired and optimistic about the future. Having children – I have three – helps, too."

Sally Koch Kubetin is managing editor of Rheumatology News. You may contact her at [email protected].

One of the first things one may notice about Dr. Roy D. Altman are his neckties. They are hand painted by his wife Linda and have been his trademark since the 1970s.

At first glance, you might think you recognize the silly dog or other fanciful creatures included in their design. But rest assured that any resemblance to a copyrighted character is only in your imagination.

Courtesy Dr. Roy D. Altman

Dr. Altman’s adoption of hand-painted ties was born of the sensible desire to be recognizable in a busy world: "I was at an ASIM national meeting when a reporter stopped me in the hall to ask where the rheumatology meetings were. When I asked him how he knew me, he answered that he recognized me because of my painted tie. Since then, the ties have become my trademark, and I almost never wear anything else," Dr. Altman said in an interview.

He did not need the ties to be memorable. Dr. Altman stands out in the specialty of rheumatology because of the strength of his career as a teacher, researcher, clinician, and editor. He was the chief of rheumatology and immunology at the University of Miami until 2003 when he traded the swelter of Miami for the Pacific breezes of UCLA, where he is professor of medicine in the division of rheumatology and immunology at the University of California, Los Angeles.

While in Miami, Dr. Altman had a second academic appointment as professor of orthopedics. In addition, he served as the clinical director of the geriatric research, education, and clinical center (GRECC), and chief of the arthritis section in the division of medicine at the Miami Veterans Affairs Medical Center.

Courtesy Dr. Roy D. Altman

But before all of that, before the 16-year stint as editor of Osteoarthritis & Cartilage and 30 years as coeditor with Dr. Norman Gottlieb of Seminars in Arthritis and Rheumatism, before the awards and honors, there were the formative experiences.

It was Dr. Altman’s father’s contact dermatitis that made it necessary for him to leave his job with a dye manufacturer and uproot his young family to follow his own snowbird father to Miami. There as a youngster Dr. Altman worked around the apartment house his grandfather owned and learned maintenance in the form of plumbing, painting, and electrical repair. As he got a bit older, Dr. Altman helped out at the hotel his own parents owned. In those jobs he became skilled at "dealing with elderly crotchety people." That must have come in handy later.

After graduating from Miami Beach high school and Michigan State University, East Lansing, Dr. Altman attended and graduated from the University of Miami School of medicine, where he also did his internship, residency, and fellowship in rheumatology.

Military service interrupted his training. Between his internship and residency, Dr. Altman served as a lieutenant in the U.S. Navy active duty reserve. He began his service as a general medical officer on a World War II–era aircraft carrier delegated to transporting President John F. Kennedy’s helicopters. After the president’s assassination, the ship was decommissioned and Dr. Altman was stationed at Naval Air Station Point Mugu in Oxnard, Calif., which was home of the U.S. Navy Pacific missile range. There he took care of sailors and officers. From that experience, Dr. Altman said that he took away a few life lessons, such as what a pleasant way of the life the military could provide, as long as there was no war. His own time of service coincided with the Vietnam War, which he somehow missed "by a week."

He also appreciated the "the comradery of the military" and experienced compassion for those who were injured. Perhaps not a war wound, the most interesting case he treated while with the navy was a captain with "a toothpick from a martini lodged in his cecum." The most difficult case involved "dealing with appendicitis at sea in a hurricane with no surgeon and unable to arrange an air evacuation." Among the rheumatologic cases he saw were men with calcific bursitis, reactive arthritis, and arthritis due to Neisseria gonorrhea.

Dr. Altman settled on rheumatology as a specialty in part because he enjoyed the contact with patients. In addition, the complexity of the diseases was a challenge he could not refuse. And no small part of the credit for moving him into rheumatology goes to his mentors.

Often a person reaches their career path through the intervention of a number of mentors. Dr. Altman names his greatest mentors as being: Dr. Harvey Brown, whom he called an "incredible clinician, extremely knowledgeable." Also on Dr. Altman’s personal pantheon was his research mentor, Dr. David Howell, who was internationally known for his work on osteoarthritis. "He brought me into the field." Dr. Altman credits his interest in intra-articular therapy and systemic lupus erythematosus to Dr. Alonso Portuondo, who, before he fled Cuba, cared for most of the SLE patients there.

Norman Gottlieb was a mentor who became a colleague. "Roy was my first rheumatology fellow when I joined the faculty at the University of Miami. We have worked together ever since. I have known and worked with him for 40 years," said Dr. Gottleib, who has retired to Black Mountain, S.C.

Calling Dr. Altman an extremely hard working, even driven, individual, Dr. Gottleib noted that for Dr. Altman, teaching was not confined to the medical school. Rather, he regularly had students to his house to view his clinical slide collection.

One of Dr. Altman’s former fellows, Dr. Rafael Rivas-Chacon recalls a time when he was a newly arrived rheumatology fellow from El Salvador, Dr. Rivas-Chacon felt a long way from home and homesick. Dr. Altman "used to take care of us. We did not have any family here, so he would invite us to his house for Thanksgiving and for Christmas."

Dr. Rivas-Chacon also remembers Dr. Altman as being available at any time for consultation. "He was very strict, with a very strong character. He was a very clinically oriented physician," whose first question when a fellow approached him was, "How can I help you?" And help Dr. Rivas-Chacon he did. In part on the strength of Dr. Altman’s recommendation, Dr. Rivas-Chacon went to Northwestern University in Chicago to do an additional year of training in pediatric rheumatology. Dr. Rivas-Chacon is now chief of pediatric rheumatology at Children’s Hospital in Miami.

According to Dr. Rivas-Chacon, physicians liked to consult Dr. Altman on difficult cases because "he was very definitive in his opinions and advice, which made him more useful.

"We had a dinner when he retired from the University of Miami. Almost every rheumatologist in Miami and Broward County was there," having either been trained by Dr. Altman or consulted with him on a case.

Dr. Altman’s achievements and awards could fill a ledger. He has received the Osteoarthritis Research Society International Clinical Science Award and Lifetime Achievement Award in Osteoarthritis, the American College of Rheumatology Distinguished Service Award, the Veterans Affairs Special Advancement for Achievement three times; the Physicians Recognition Award seven times; the Certificate of Merit from the Disabled American Veterans; Alumnus Membership in the Alpha Omega Alpha, Honor Medical Society; was listed in Best Doctors in America three times; won the Certificate of Appreciation from the AMA’s Division of Drug and Toxicology; won the Essence of GRECC Award; was named an Honorary Member of the Czech Republic Rheumatism Association; was named an Honorary Member Italian Rheumatism Association; was made an Honorary Member National Directory of Who’s Who, 1994–present; received the John B. Johnson Award for contributions to Paget’s Disease; won the Award on the Reunion of the Medical Faculty, Krakow, Poland; and won the Help & Hope Excellence in Rheumatology Award from the Arthritis Foundation.

One of the first things one may notice about Dr. Roy D. Altman are his neckties. They are hand painted by his wife Linda and have been his trademark since the 1970s.

At first glance, you might think you recognize the silly dog or other fanciful creatures included in their design. But rest assured that any resemblance to a copyrighted character is only in your imagination.

Courtesy Dr. Roy D. Altman

Dr. Altman’s adoption of hand-painted ties was born of the sensible desire to be recognizable in a busy world: "I was at an ASIM national meeting when a reporter stopped me in the hall to ask where the rheumatology meetings were. When I asked him how he knew me, he answered that he recognized me because of my painted tie. Since then, the ties have become my trademark, and I almost never wear anything else," Dr. Altman said in an interview.

He did not need the ties to be memorable. Dr. Altman stands out in the specialty of rheumatology because of the strength of his career as a teacher, researcher, clinician, and editor. He was the chief of rheumatology and immunology at the University of Miami until 2003 when he traded the swelter of Miami for the Pacific breezes of UCLA, where he is professor of medicine in the division of rheumatology and immunology at the University of California, Los Angeles.

While in Miami, Dr. Altman had a second academic appointment as professor of orthopedics. In addition, he served as the clinical director of the geriatric research, education, and clinical center (GRECC), and chief of the arthritis section in the division of medicine at the Miami Veterans Affairs Medical Center.

Courtesy Dr. Roy D. Altman

But before all of that, before the 16-year stint as editor of Osteoarthritis & Cartilage and 30 years as coeditor with Dr. Norman Gottlieb of Seminars in Arthritis and Rheumatism, before the awards and honors, there were the formative experiences.

It was Dr. Altman’s father’s contact dermatitis that made it necessary for him to leave his job with a dye manufacturer and uproot his young family to follow his own snowbird father to Miami. There as a youngster Dr. Altman worked around the apartment house his grandfather owned and learned maintenance in the form of plumbing, painting, and electrical repair. As he got a bit older, Dr. Altman helped out at the hotel his own parents owned. In those jobs he became skilled at "dealing with elderly crotchety people." That must have come in handy later.

After graduating from Miami Beach high school and Michigan State University, East Lansing, Dr. Altman attended and graduated from the University of Miami School of medicine, where he also did his internship, residency, and fellowship in rheumatology.

Military service interrupted his training. Between his internship and residency, Dr. Altman served as a lieutenant in the U.S. Navy active duty reserve. He began his service as a general medical officer on a World War II–era aircraft carrier delegated to transporting President John F. Kennedy’s helicopters. After the president’s assassination, the ship was decommissioned and Dr. Altman was stationed at Naval Air Station Point Mugu in Oxnard, Calif., which was home of the U.S. Navy Pacific missile range. There he took care of sailors and officers. From that experience, Dr. Altman said that he took away a few life lessons, such as what a pleasant way of the life the military could provide, as long as there was no war. His own time of service coincided with the Vietnam War, which he somehow missed "by a week."

He also appreciated the "the comradery of the military" and experienced compassion for those who were injured. Perhaps not a war wound, the most interesting case he treated while with the navy was a captain with "a toothpick from a martini lodged in his cecum." The most difficult case involved "dealing with appendicitis at sea in a hurricane with no surgeon and unable to arrange an air evacuation." Among the rheumatologic cases he saw were men with calcific bursitis, reactive arthritis, and arthritis due to Neisseria gonorrhea.

Dr. Altman settled on rheumatology as a specialty in part because he enjoyed the contact with patients. In addition, the complexity of the diseases was a challenge he could not refuse. And no small part of the credit for moving him into rheumatology goes to his mentors.

Often a person reaches their career path through the intervention of a number of mentors. Dr. Altman names his greatest mentors as being: Dr. Harvey Brown, whom he called an "incredible clinician, extremely knowledgeable." Also on Dr. Altman’s personal pantheon was his research mentor, Dr. David Howell, who was internationally known for his work on osteoarthritis. "He brought me into the field." Dr. Altman credits his interest in intra-articular therapy and systemic lupus erythematosus to Dr. Alonso Portuondo, who, before he fled Cuba, cared for most of the SLE patients there.

Norman Gottlieb was a mentor who became a colleague. "Roy was my first rheumatology fellow when I joined the faculty at the University of Miami. We have worked together ever since. I have known and worked with him for 40 years," said Dr. Gottleib, who has retired to Black Mountain, S.C.

Calling Dr. Altman an extremely hard working, even driven, individual, Dr. Gottleib noted that for Dr. Altman, teaching was not confined to the medical school. Rather, he regularly had students to his house to view his clinical slide collection.

One of Dr. Altman’s former fellows, Dr. Rafael Rivas-Chacon recalls a time when he was a newly arrived rheumatology fellow from El Salvador, Dr. Rivas-Chacon felt a long way from home and homesick. Dr. Altman "used to take care of us. We did not have any family here, so he would invite us to his house for Thanksgiving and for Christmas."

Dr. Rivas-Chacon also remembers Dr. Altman as being available at any time for consultation. "He was very strict, with a very strong character. He was a very clinically oriented physician," whose first question when a fellow approached him was, "How can I help you?" And help Dr. Rivas-Chacon he did. In part on the strength of Dr. Altman’s recommendation, Dr. Rivas-Chacon went to Northwestern University in Chicago to do an additional year of training in pediatric rheumatology. Dr. Rivas-Chacon is now chief of pediatric rheumatology at Children’s Hospital in Miami.

According to Dr. Rivas-Chacon, physicians liked to consult Dr. Altman on difficult cases because "he was very definitive in his opinions and advice, which made him more useful.

"We had a dinner when he retired from the University of Miami. Almost every rheumatologist in Miami and Broward County was there," having either been trained by Dr. Altman or consulted with him on a case.

Dr. Altman’s achievements and awards could fill a ledger. He has received the Osteoarthritis Research Society International Clinical Science Award and Lifetime Achievement Award in Osteoarthritis, the American College of Rheumatology Distinguished Service Award, the Veterans Affairs Special Advancement for Achievement three times; the Physicians Recognition Award seven times; the Certificate of Merit from the Disabled American Veterans; Alumnus Membership in the Alpha Omega Alpha, Honor Medical Society; was listed in Best Doctors in America three times; won the Certificate of Appreciation from the AMA’s Division of Drug and Toxicology; won the Essence of GRECC Award; was named an Honorary Member of the Czech Republic Rheumatism Association; was named an Honorary Member Italian Rheumatism Association; was made an Honorary Member National Directory of Who’s Who, 1994–present; received the John B. Johnson Award for contributions to Paget’s Disease; won the Award on the Reunion of the Medical Faculty, Krakow, Poland; and won the Help & Hope Excellence in Rheumatology Award from the Arthritis Foundation.

One of the first things one may notice about Dr. Roy D. Altman are his neckties. They are hand painted by his wife Linda and have been his trademark since the 1970s.

At first glance, you might think you recognize the silly dog or other fanciful creatures included in their design. But rest assured that any resemblance to a copyrighted character is only in your imagination.

Courtesy Dr. Roy D. Altman

Dr. Altman’s adoption of hand-painted ties was born of the sensible desire to be recognizable in a busy world: "I was at an ASIM national meeting when a reporter stopped me in the hall to ask where the rheumatology meetings were. When I asked him how he knew me, he answered that he recognized me because of my painted tie. Since then, the ties have become my trademark, and I almost never wear anything else," Dr. Altman said in an interview.

He did not need the ties to be memorable. Dr. Altman stands out in the specialty of rheumatology because of the strength of his career as a teacher, researcher, clinician, and editor. He was the chief of rheumatology and immunology at the University of Miami until 2003 when he traded the swelter of Miami for the Pacific breezes of UCLA, where he is professor of medicine in the division of rheumatology and immunology at the University of California, Los Angeles.

While in Miami, Dr. Altman had a second academic appointment as professor of orthopedics. In addition, he served as the clinical director of the geriatric research, education, and clinical center (GRECC), and chief of the arthritis section in the division of medicine at the Miami Veterans Affairs Medical Center.

Courtesy Dr. Roy D. Altman

But before all of that, before the 16-year stint as editor of Osteoarthritis & Cartilage and 30 years as coeditor with Dr. Norman Gottlieb of Seminars in Arthritis and Rheumatism, before the awards and honors, there were the formative experiences.

It was Dr. Altman’s father’s contact dermatitis that made it necessary for him to leave his job with a dye manufacturer and uproot his young family to follow his own snowbird father to Miami. There as a youngster Dr. Altman worked around the apartment house his grandfather owned and learned maintenance in the form of plumbing, painting, and electrical repair. As he got a bit older, Dr. Altman helped out at the hotel his own parents owned. In those jobs he became skilled at "dealing with elderly crotchety people." That must have come in handy later.

After graduating from Miami Beach high school and Michigan State University, East Lansing, Dr. Altman attended and graduated from the University of Miami School of medicine, where he also did his internship, residency, and fellowship in rheumatology.

Military service interrupted his training. Between his internship and residency, Dr. Altman served as a lieutenant in the U.S. Navy active duty reserve. He began his service as a general medical officer on a World War II–era aircraft carrier delegated to transporting President John F. Kennedy’s helicopters. After the president’s assassination, the ship was decommissioned and Dr. Altman was stationed at Naval Air Station Point Mugu in Oxnard, Calif., which was home of the U.S. Navy Pacific missile range. There he took care of sailors and officers. From that experience, Dr. Altman said that he took away a few life lessons, such as what a pleasant way of the life the military could provide, as long as there was no war. His own time of service coincided with the Vietnam War, which he somehow missed "by a week."

He also appreciated the "the comradery of the military" and experienced compassion for those who were injured. Perhaps not a war wound, the most interesting case he treated while with the navy was a captain with "a toothpick from a martini lodged in his cecum." The most difficult case involved "dealing with appendicitis at sea in a hurricane with no surgeon and unable to arrange an air evacuation." Among the rheumatologic cases he saw were men with calcific bursitis, reactive arthritis, and arthritis due to Neisseria gonorrhea.

Dr. Altman settled on rheumatology as a specialty in part because he enjoyed the contact with patients. In addition, the complexity of the diseases was a challenge he could not refuse. And no small part of the credit for moving him into rheumatology goes to his mentors.

Often a person reaches their career path through the intervention of a number of mentors. Dr. Altman names his greatest mentors as being: Dr. Harvey Brown, whom he called an "incredible clinician, extremely knowledgeable." Also on Dr. Altman’s personal pantheon was his research mentor, Dr. David Howell, who was internationally known for his work on osteoarthritis. "He brought me into the field." Dr. Altman credits his interest in intra-articular therapy and systemic lupus erythematosus to Dr. Alonso Portuondo, who, before he fled Cuba, cared for most of the SLE patients there.

Norman Gottlieb was a mentor who became a colleague. "Roy was my first rheumatology fellow when I joined the faculty at the University of Miami. We have worked together ever since. I have known and worked with him for 40 years," said Dr. Gottleib, who has retired to Black Mountain, S.C.

Calling Dr. Altman an extremely hard working, even driven, individual, Dr. Gottleib noted that for Dr. Altman, teaching was not confined to the medical school. Rather, he regularly had students to his house to view his clinical slide collection.

One of Dr. Altman’s former fellows, Dr. Rafael Rivas-Chacon recalls a time when he was a newly arrived rheumatology fellow from El Salvador, Dr. Rivas-Chacon felt a long way from home and homesick. Dr. Altman "used to take care of us. We did not have any family here, so he would invite us to his house for Thanksgiving and for Christmas."

Dr. Rivas-Chacon also remembers Dr. Altman as being available at any time for consultation. "He was very strict, with a very strong character. He was a very clinically oriented physician," whose first question when a fellow approached him was, "How can I help you?" And help Dr. Rivas-Chacon he did. In part on the strength of Dr. Altman’s recommendation, Dr. Rivas-Chacon went to Northwestern University in Chicago to do an additional year of training in pediatric rheumatology. Dr. Rivas-Chacon is now chief of pediatric rheumatology at Children’s Hospital in Miami.

According to Dr. Rivas-Chacon, physicians liked to consult Dr. Altman on difficult cases because "he was very definitive in his opinions and advice, which made him more useful.

"We had a dinner when he retired from the University of Miami. Almost every rheumatologist in Miami and Broward County was there," having either been trained by Dr. Altman or consulted with him on a case.

Dr. Altman’s achievements and awards could fill a ledger. He has received the Osteoarthritis Research Society International Clinical Science Award and Lifetime Achievement Award in Osteoarthritis, the American College of Rheumatology Distinguished Service Award, the Veterans Affairs Special Advancement for Achievement three times; the Physicians Recognition Award seven times; the Certificate of Merit from the Disabled American Veterans; Alumnus Membership in the Alpha Omega Alpha, Honor Medical Society; was listed in Best Doctors in America three times; won the Certificate of Appreciation from the AMA’s Division of Drug and Toxicology; won the Essence of GRECC Award; was named an Honorary Member of the Czech Republic Rheumatism Association; was named an Honorary Member Italian Rheumatism Association; was made an Honorary Member National Directory of Who’s Who, 1994–present; received the John B. Johnson Award for contributions to Paget’s Disease; won the Award on the Reunion of the Medical Faculty, Krakow, Poland; and won the Help & Hope Excellence in Rheumatology Award from the Arthritis Foundation.

SAN FRANCISCO – Methotrexate is not a disease-modifying antirheumatic drug in psoriatic arthritis, despite how well it works in psoriasis, according to Dr. Christopher T. Ritchlin.

Methotrexate is the most widely used drug in the world for psoriatic arthritis (PsA), based on almost no supporting evidence. There have been only two published double-blind, randomized, controlled trials of methotrexate in PsA done over the last 20 years, and both were underpowered and used a low dose of methotrexate (10 mg/week), said Dr. Ritchlin, professor of medicine and director of the clinical immunology research center at the University of Rochester (N.Y.).

A still-unpublished study that was presented at the annual meeting of the American College of Rheumatology in 2010 showed that methotrexate was not more effective than placebo in PsA (Arthritis Rheum. 2010:62 [suppl.]:S277, abstract 664). The study involved 221 patients who were given 15 mg/week of methotrexate or placebo for 6 months. About 65% of subjects in each group dropped out. The primary outcome measure was the psoriatic arthritis response criteria (PsARC), which most rheumatologists do not think is a good outcome measure, Dr. Ritchlin said at the Perspectives in Rheumatic Diseases 2011 meeting.

At the end of 3 and 6 months of the study, there were no differences between methotrexate and placebo on the PsARC, the ACR 20 (the American College of Rheumatology scale based on a 20% improvement in certain parameters), the DAS28 (Disease Activity Score based on a 28-joint count), a sensitive joint count, a tender joint count, and the C-reactive protein level/erythrocyte sedimentation rates. Only the patient and physician global scores and the skin score showed significant improvement in the methotrexate group.

Methotrexate is the most widely used drug in the world for psoriatic arthritis (PsA), based on almost no supporting evidence.

Another unpublished study, conducted in the former Soviet Union and presented at the ARC’s annual meeting in 2009, showed the opposite. The researchers compared infliximab vs. methotrexate in methotrexate-naive patients. The dosage used was 15-20 mg/week. They found that 66% of the patients achieved an ACR 20 improvement on methotrexate alone, as did 86% of those on methotrexate plus infliximab. Remissions according to the DAS28 were reported in 30% of those on methotrexate and in 69% of those on combination therapy.

Although it may be possible to find methotrexate-naive patients in the former Soviet Union, such patients are much less likely to walk into their rheumatologist’s office in the West.

Indirect data supporting the inefficacy of methotrexate come from NOR-DMARD. These data show that 6 months of treatment with a tumor necrosis factor inhibitor (146 patients) had significantly greater beneficial effects on patients with PsA than did methotrexate (356 patients) (Ann. Rheum. Dis. 2007;66:1038-42).

The propensity toward liver disease is another reason not to use methotrexate in patients with PsA, said Dr. Ritchlin at the meeting, which was sponsored by Skin Disease Education Foundation. Methotrexate is hepatotoxic. Data on the findings of 169 liver biopsies that were done on 71 patients with psoriasis showed that methotrexate significantly increased the risk for stage 3 or 4 fibrosis. The risk was highest in obese patients or those with diabetes (J. Hepatol. 2007;46:1111-8).

These findings serve to support "my own bias that this is due to their fatty livers," which have developed as a consequence of their obesity, a common comorbidity in PsA, he said. Another cause of fatty liver in this population may be the metabolic syndrome that often develops in patients with psoriasis.

Dr. Ritchlin reported financial relationships with Abbott, Amgen, Centocor, Genentech, Targacept, UCB, and Wyeth. SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – Methotrexate is not a disease-modifying antirheumatic drug in psoriatic arthritis, despite how well it works in psoriasis, according to Dr. Christopher T. Ritchlin.

Methotrexate is the most widely used drug in the world for psoriatic arthritis (PsA), based on almost no supporting evidence. There have been only two published double-blind, randomized, controlled trials of methotrexate in PsA done over the last 20 years, and both were underpowered and used a low dose of methotrexate (10 mg/week), said Dr. Ritchlin, professor of medicine and director of the clinical immunology research center at the University of Rochester (N.Y.).

A still-unpublished study that was presented at the annual meeting of the American College of Rheumatology in 2010 showed that methotrexate was not more effective than placebo in PsA (Arthritis Rheum. 2010:62 [suppl.]:S277, abstract 664). The study involved 221 patients who were given 15 mg/week of methotrexate or placebo for 6 months. About 65% of subjects in each group dropped out. The primary outcome measure was the psoriatic arthritis response criteria (PsARC), which most rheumatologists do not think is a good outcome measure, Dr. Ritchlin said at the Perspectives in Rheumatic Diseases 2011 meeting.

At the end of 3 and 6 months of the study, there were no differences between methotrexate and placebo on the PsARC, the ACR 20 (the American College of Rheumatology scale based on a 20% improvement in certain parameters), the DAS28 (Disease Activity Score based on a 28-joint count), a sensitive joint count, a tender joint count, and the C-reactive protein level/erythrocyte sedimentation rates. Only the patient and physician global scores and the skin score showed significant improvement in the methotrexate group.

Methotrexate is the most widely used drug in the world for psoriatic arthritis (PsA), based on almost no supporting evidence.

Another unpublished study, conducted in the former Soviet Union and presented at the ARC’s annual meeting in 2009, showed the opposite. The researchers compared infliximab vs. methotrexate in methotrexate-naive patients. The dosage used was 15-20 mg/week. They found that 66% of the patients achieved an ACR 20 improvement on methotrexate alone, as did 86% of those on methotrexate plus infliximab. Remissions according to the DAS28 were reported in 30% of those on methotrexate and in 69% of those on combination therapy.

Although it may be possible to find methotrexate-naive patients in the former Soviet Union, such patients are much less likely to walk into their rheumatologist’s office in the West.

Indirect data supporting the inefficacy of methotrexate come from NOR-DMARD. These data show that 6 months of treatment with a tumor necrosis factor inhibitor (146 patients) had significantly greater beneficial effects on patients with PsA than did methotrexate (356 patients) (Ann. Rheum. Dis. 2007;66:1038-42).

The propensity toward liver disease is another reason not to use methotrexate in patients with PsA, said Dr. Ritchlin at the meeting, which was sponsored by Skin Disease Education Foundation. Methotrexate is hepatotoxic. Data on the findings of 169 liver biopsies that were done on 71 patients with psoriasis showed that methotrexate significantly increased the risk for stage 3 or 4 fibrosis. The risk was highest in obese patients or those with diabetes (J. Hepatol. 2007;46:1111-8).

These findings serve to support "my own bias that this is due to their fatty livers," which have developed as a consequence of their obesity, a common comorbidity in PsA, he said. Another cause of fatty liver in this population may be the metabolic syndrome that often develops in patients with psoriasis.

Dr. Ritchlin reported financial relationships with Abbott, Amgen, Centocor, Genentech, Targacept, UCB, and Wyeth. SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – Methotrexate is not a disease-modifying antirheumatic drug in psoriatic arthritis, despite how well it works in psoriasis, according to Dr. Christopher T. Ritchlin.

Methotrexate is the most widely used drug in the world for psoriatic arthritis (PsA), based on almost no supporting evidence. There have been only two published double-blind, randomized, controlled trials of methotrexate in PsA done over the last 20 years, and both were underpowered and used a low dose of methotrexate (10 mg/week), said Dr. Ritchlin, professor of medicine and director of the clinical immunology research center at the University of Rochester (N.Y.).

A still-unpublished study that was presented at the annual meeting of the American College of Rheumatology in 2010 showed that methotrexate was not more effective than placebo in PsA (Arthritis Rheum. 2010:62 [suppl.]:S277, abstract 664). The study involved 221 patients who were given 15 mg/week of methotrexate or placebo for 6 months. About 65% of subjects in each group dropped out. The primary outcome measure was the psoriatic arthritis response criteria (PsARC), which most rheumatologists do not think is a good outcome measure, Dr. Ritchlin said at the Perspectives in Rheumatic Diseases 2011 meeting.

At the end of 3 and 6 months of the study, there were no differences between methotrexate and placebo on the PsARC, the ACR 20 (the American College of Rheumatology scale based on a 20% improvement in certain parameters), the DAS28 (Disease Activity Score based on a 28-joint count), a sensitive joint count, a tender joint count, and the C-reactive protein level/erythrocyte sedimentation rates. Only the patient and physician global scores and the skin score showed significant improvement in the methotrexate group.

Methotrexate is the most widely used drug in the world for psoriatic arthritis (PsA), based on almost no supporting evidence.

Another unpublished study, conducted in the former Soviet Union and presented at the ARC’s annual meeting in 2009, showed the opposite. The researchers compared infliximab vs. methotrexate in methotrexate-naive patients. The dosage used was 15-20 mg/week. They found that 66% of the patients achieved an ACR 20 improvement on methotrexate alone, as did 86% of those on methotrexate plus infliximab. Remissions according to the DAS28 were reported in 30% of those on methotrexate and in 69% of those on combination therapy.

Although it may be possible to find methotrexate-naive patients in the former Soviet Union, such patients are much less likely to walk into their rheumatologist’s office in the West.

Indirect data supporting the inefficacy of methotrexate come from NOR-DMARD. These data show that 6 months of treatment with a tumor necrosis factor inhibitor (146 patients) had significantly greater beneficial effects on patients with PsA than did methotrexate (356 patients) (Ann. Rheum. Dis. 2007;66:1038-42).

The propensity toward liver disease is another reason not to use methotrexate in patients with PsA, said Dr. Ritchlin at the meeting, which was sponsored by Skin Disease Education Foundation. Methotrexate is hepatotoxic. Data on the findings of 169 liver biopsies that were done on 71 patients with psoriasis showed that methotrexate significantly increased the risk for stage 3 or 4 fibrosis. The risk was highest in obese patients or those with diabetes (J. Hepatol. 2007;46:1111-8).

These findings serve to support "my own bias that this is due to their fatty livers," which have developed as a consequence of their obesity, a common comorbidity in PsA, he said. Another cause of fatty liver in this population may be the metabolic syndrome that often develops in patients with psoriasis.

Dr. Ritchlin reported financial relationships with Abbott, Amgen, Centocor, Genentech, Targacept, UCB, and Wyeth. SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – Most patients with systemic lupus nephritis should be on hydroxychloroquine, according to guidelines on the management of lupus nephritis to be issued by the American College of Rheumatology.

Renal involvement increases mortality in patients with systemic lupus erythematosus (SLE). About 95% of patients with lupus survive 10 years. That was not true 25 years ago; mortality was much worse. "Every now and then in rheumatology we make some progress. This is such progress," said Dr. Bevra Hahn, division chief and professor of rheumatology at the University of California, Los Angeles.

However, when the lupus patient has nephritis, survival drops to 85% for all races combined. For blacks and Hispanics, the 10-year year survival is even worse.

Guidelines on the management of lupus nephritis have been developed by a committee of the American College of Rheumatology, which Dr. Hahn chairs. Those guidelines will be published after review by several ACR committees.

Hydroxychloroquine is one of the reasons that outcomes have improved so much for patients with SLE. Data from a study of 518 patients who had SLE for less than 5 years showed that 56% of them were on hydroxychloroquine at the time of enrollment, said Dr. Hahn at the Perspectives in Rheumatic Diseases 2011 meeting.

"Every now and then in rheumatology we make some progress. This is such progress," said Dr. Bevra Hahn.

Use of hydroxychloroquine was associated with a reduced risk for developing new damage (hazard ratio, 0.73; 95% confidence interval, 0.52-1.00; P = .05). Of note, patients on hydroxychloroquine who had no damage at study entry had a statistically significant decrease in the risk of developing any organ damage (HR, 0.55; 95% CI, 0.34-0.87; P = .0111), whereas those on hydroxychloroquine who had damage at study entry did not (HR, 1.106; 95% CI, 0.70-1.74; P = .6630) (Arthritis Rheum. 2005;52:1473-80).

The big stick in the management of lupus is glucocorticoids. Rheumatologists have known since 1985 that high-dose intravenous glucocorticoids save lives. Intravenous cyclophosphamide preserved renal function better than steroids or steroids plus azathioprine in patients with class IV lupus nephritis. It became the standard of care for close to 10 years, based on research done at the National Institutes of Health (Arthritis Rheum. 2002;46:2121-31).

Because of its side effects, "patients absolutely despise cyclophosphamide" and it takes a long time to work, noted Dr. Hahn at the meeting, which was sponsored by Skin Disease Education Foundation.

However, mycophenolate seems to produce outcomes that are comparable to those from cyclophosphamide. Findings from a study of 364 patients with acute lupus nephritis showed that, overall, 6 months of induction treatment with mycophenolate worked as well as cyclophosphamide in whites. However, blacks and Hispanics have a significantly lower response to cyclophosphamide than to mycophenolate (J. Am. Soc. Nephrol. 2009;20:1103-12).

Dr. Hahn urged the audience to keep in mind that mycophenolate is a teratogen, but added that in all other respects the two agents are equally safe (J. Rheumatol. 2011;38:69-78).

Dr. Hahn reported financial relationships with Abbott, Aspreva, Teva, and UCB. SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – Most patients with systemic lupus nephritis should be on hydroxychloroquine, according to guidelines on the management of lupus nephritis to be issued by the American College of Rheumatology.

Renal involvement increases mortality in patients with systemic lupus erythematosus (SLE). About 95% of patients with lupus survive 10 years. That was not true 25 years ago; mortality was much worse. "Every now and then in rheumatology we make some progress. This is such progress," said Dr. Bevra Hahn, division chief and professor of rheumatology at the University of California, Los Angeles.

However, when the lupus patient has nephritis, survival drops to 85% for all races combined. For blacks and Hispanics, the 10-year year survival is even worse.

Guidelines on the management of lupus nephritis have been developed by a committee of the American College of Rheumatology, which Dr. Hahn chairs. Those guidelines will be published after review by several ACR committees.

Hydroxychloroquine is one of the reasons that outcomes have improved so much for patients with SLE. Data from a study of 518 patients who had SLE for less than 5 years showed that 56% of them were on hydroxychloroquine at the time of enrollment, said Dr. Hahn at the Perspectives in Rheumatic Diseases 2011 meeting.

"Every now and then in rheumatology we make some progress. This is such progress," said Dr. Bevra Hahn.

Use of hydroxychloroquine was associated with a reduced risk for developing new damage (hazard ratio, 0.73; 95% confidence interval, 0.52-1.00; P = .05). Of note, patients on hydroxychloroquine who had no damage at study entry had a statistically significant decrease in the risk of developing any organ damage (HR, 0.55; 95% CI, 0.34-0.87; P = .0111), whereas those on hydroxychloroquine who had damage at study entry did not (HR, 1.106; 95% CI, 0.70-1.74; P = .6630) (Arthritis Rheum. 2005;52:1473-80).

The big stick in the management of lupus is glucocorticoids. Rheumatologists have known since 1985 that high-dose intravenous glucocorticoids save lives. Intravenous cyclophosphamide preserved renal function better than steroids or steroids plus azathioprine in patients with class IV lupus nephritis. It became the standard of care for close to 10 years, based on research done at the National Institutes of Health (Arthritis Rheum. 2002;46:2121-31).

Because of its side effects, "patients absolutely despise cyclophosphamide" and it takes a long time to work, noted Dr. Hahn at the meeting, which was sponsored by Skin Disease Education Foundation.

However, mycophenolate seems to produce outcomes that are comparable to those from cyclophosphamide. Findings from a study of 364 patients with acute lupus nephritis showed that, overall, 6 months of induction treatment with mycophenolate worked as well as cyclophosphamide in whites. However, blacks and Hispanics have a significantly lower response to cyclophosphamide than to mycophenolate (J. Am. Soc. Nephrol. 2009;20:1103-12).

Dr. Hahn urged the audience to keep in mind that mycophenolate is a teratogen, but added that in all other respects the two agents are equally safe (J. Rheumatol. 2011;38:69-78).

Dr. Hahn reported financial relationships with Abbott, Aspreva, Teva, and UCB. SDEF and this news organization are owned by Elsevier.

SAN FRANCISCO – Most patients with systemic lupus nephritis should be on hydroxychloroquine, according to guidelines on the management of lupus nephritis to be issued by the American College of Rheumatology.

Renal involvement increases mortality in patients with systemic lupus erythematosus (SLE). About 95% of patients with lupus survive 10 years. That was not true 25 years ago; mortality was much worse. "Every now and then in rheumatology we make some progress. This is such progress," said Dr. Bevra Hahn, division chief and professor of rheumatology at the University of California, Los Angeles.

However, when the lupus patient has nephritis, survival drops to 85% for all races combined. For blacks and Hispanics, the 10-year year survival is even worse.

Guidelines on the management of lupus nephritis have been developed by a committee of the American College of Rheumatology, which Dr. Hahn chairs. Those guidelines will be published after review by several ACR committees.

Hydroxychloroquine is one of the reasons that outcomes have improved so much for patients with SLE. Data from a study of 518 patients who had SLE for less than 5 years showed that 56% of them were on hydroxychloroquine at the time of enrollment, said Dr. Hahn at the Perspectives in Rheumatic Diseases 2011 meeting.

"Every now and then in rheumatology we make some progress. This is such progress," said Dr. Bevra Hahn.

Use of hydroxychloroquine was associated with a reduced risk for developing new damage (hazard ratio, 0.73; 95% confidence interval, 0.52-1.00; P = .05). Of note, patients on hydroxychloroquine who had no damage at study entry had a statistically significant decrease in the risk of developing any organ damage (HR, 0.55; 95% CI, 0.34-0.87; P = .0111), whereas those on hydroxychloroquine who had damage at study entry did not (HR, 1.106; 95% CI, 0.70-1.74; P = .6630) (Arthritis Rheum. 2005;52:1473-80).

The big stick in the management of lupus is glucocorticoids. Rheumatologists have known since 1985 that high-dose intravenous glucocorticoids save lives. Intravenous cyclophosphamide preserved renal function better than steroids or steroids plus azathioprine in patients with class IV lupus nephritis. It became the standard of care for close to 10 years, based on research done at the National Institutes of Health (Arthritis Rheum. 2002;46:2121-31).

Because of its side effects, "patients absolutely despise cyclophosphamide" and it takes a long time to work, noted Dr. Hahn at the meeting, which was sponsored by Skin Disease Education Foundation.

However, mycophenolate seems to produce outcomes that are comparable to those from cyclophosphamide. Findings from a study of 364 patients with acute lupus nephritis showed that, overall, 6 months of induction treatment with mycophenolate worked as well as cyclophosphamide in whites. However, blacks and Hispanics have a significantly lower response to cyclophosphamide than to mycophenolate (J. Am. Soc. Nephrol. 2009;20:1103-12).

Dr. Hahn urged the audience to keep in mind that mycophenolate is a teratogen, but added that in all other respects the two agents are equally safe (J. Rheumatol. 2011;38:69-78).

Dr. Hahn reported financial relationships with Abbott, Aspreva, Teva, and UCB. SDEF and this news organization are owned by Elsevier.