Not Sexy Enough

The annual meeting of the American College of Rheumatology has just ended. As usual, it was frenetic. So many lectures to choose from, so little time (and, as I age, energy) to get to them all.

The meeting is a great opportunity for the motivated rheumatologist if you know how to use it to your advantage – and that’s a skill that’s learned over a few years of attendance. Apart from catching up with old mentors and friends, you can catch up on the latest and greatest in basic science research. You can find out how experts manage difficult cases. There are sessions on how to manage your practice more efficiently. There are thousands of posters from all over the world to peruse.

Year after year there are several sessions on the autoimmune diseases, covering everything from basic science to bench and clinical research to clinical practice. An ever-growing pool of information about the genetic and molecular bases of disease has led to a rapid expansion of treatment targets – primarily for rheumatoid arthritis but extending to other autoimmune diseases as well.

But there are certain bread-and-butter illnesses that are not as sexy and, as such, do not get as much airtime.

This year, for example, there was only one clinical session on gout, and it was held in one of the smaller rooms. Slated for the same time slot were "Dermatology Topics for Rheumatologists" and "Preclinical Autoimmunity – Potential for Prevention," both much sexier-sounding and held in much larger venues. If my small cohort of friends and colleagues is a microcosm of the attendee population, it made complete sense to do this because I was the only one out of six who was interested in gout.

I understand that "Dermatology Topics for Rheumatologists" – by far the most popular in my small cohort – is indeed interesting, but I do not think it provides terribly useful information. No offense to the ACR or to my friends who picked this topic, but while you may see an interesting rash here and there and maybe remember seeing a similar picture from a lecture that you attended somewhere, I contend that it is more valuable for a clinician to be able to treat challenging gout cases, to learn more postmarketing information about pegloticase, and to understand what asymptomatic hyperuricemia might potentially indicate.

And what of osteoarthritis? There was a popular lecture on back pain, though I heard it was not very good. OA has become one of my biggest frustrations. It is never easy to tell patients that there is not much that can be done for their condition. Thankfully there was a basic science lecture on OA. Hopefully, this means more funding for more research, and ultimately perhaps a disease-modifier as well.

I appreciate that there was a session on paraneoplastic syndromes, one on polymyalgia rheumatica, and one on osteoporosis. I see more of these conditions in my practice than I do systemic lupus erythematosus, scleroderma, or vasculitis.

Without a doubt, ours is a wonderful field to be in. Our diseases have historically been very challenging to define, let alone treat. I feel lucky to be a rheumatologist at such a heady time, when it is now possible to go into drug-free remission if you have rheumatoid arthritis. We understand mechanisms of autoimmune disease better and are making great strides in therapeutics.

But there are other diseases that have been largely ignored, for reasons that are not entirely clear to me (perhaps the unfettered profit motivation that I talked about a few columns ago?), and I think it is about time we had a more equitable distribution of resources for research. Glamorous zebras aside, I will be grateful for the day that I can tell my patients: "yes, there is a nonsurgical option for your osteoarthritis, and no, it is not an antidepressant."

Dr. Chan practices rheumatology in Pawtucket, R.I. E-mail her at [email protected].

The annual meeting of the American College of Rheumatology has just ended. As usual, it was frenetic. So many lectures to choose from, so little time (and, as I age, energy) to get to them all.

The meeting is a great opportunity for the motivated rheumatologist if you know how to use it to your advantage – and that’s a skill that’s learned over a few years of attendance. Apart from catching up with old mentors and friends, you can catch up on the latest and greatest in basic science research. You can find out how experts manage difficult cases. There are sessions on how to manage your practice more efficiently. There are thousands of posters from all over the world to peruse.

Year after year there are several sessions on the autoimmune diseases, covering everything from basic science to bench and clinical research to clinical practice. An ever-growing pool of information about the genetic and molecular bases of disease has led to a rapid expansion of treatment targets – primarily for rheumatoid arthritis but extending to other autoimmune diseases as well.

But there are certain bread-and-butter illnesses that are not as sexy and, as such, do not get as much airtime.

This year, for example, there was only one clinical session on gout, and it was held in one of the smaller rooms. Slated for the same time slot were "Dermatology Topics for Rheumatologists" and "Preclinical Autoimmunity – Potential for Prevention," both much sexier-sounding and held in much larger venues. If my small cohort of friends and colleagues is a microcosm of the attendee population, it made complete sense to do this because I was the only one out of six who was interested in gout.

I understand that "Dermatology Topics for Rheumatologists" – by far the most popular in my small cohort – is indeed interesting, but I do not think it provides terribly useful information. No offense to the ACR or to my friends who picked this topic, but while you may see an interesting rash here and there and maybe remember seeing a similar picture from a lecture that you attended somewhere, I contend that it is more valuable for a clinician to be able to treat challenging gout cases, to learn more postmarketing information about pegloticase, and to understand what asymptomatic hyperuricemia might potentially indicate.

And what of osteoarthritis? There was a popular lecture on back pain, though I heard it was not very good. OA has become one of my biggest frustrations. It is never easy to tell patients that there is not much that can be done for their condition. Thankfully there was a basic science lecture on OA. Hopefully, this means more funding for more research, and ultimately perhaps a disease-modifier as well.

I appreciate that there was a session on paraneoplastic syndromes, one on polymyalgia rheumatica, and one on osteoporosis. I see more of these conditions in my practice than I do systemic lupus erythematosus, scleroderma, or vasculitis.

Without a doubt, ours is a wonderful field to be in. Our diseases have historically been very challenging to define, let alone treat. I feel lucky to be a rheumatologist at such a heady time, when it is now possible to go into drug-free remission if you have rheumatoid arthritis. We understand mechanisms of autoimmune disease better and are making great strides in therapeutics.

But there are other diseases that have been largely ignored, for reasons that are not entirely clear to me (perhaps the unfettered profit motivation that I talked about a few columns ago?), and I think it is about time we had a more equitable distribution of resources for research. Glamorous zebras aside, I will be grateful for the day that I can tell my patients: "yes, there is a nonsurgical option for your osteoarthritis, and no, it is not an antidepressant."

Dr. Chan practices rheumatology in Pawtucket, R.I. E-mail her at [email protected].

The annual meeting of the American College of Rheumatology has just ended. As usual, it was frenetic. So many lectures to choose from, so little time (and, as I age, energy) to get to them all.

The meeting is a great opportunity for the motivated rheumatologist if you know how to use it to your advantage – and that’s a skill that’s learned over a few years of attendance. Apart from catching up with old mentors and friends, you can catch up on the latest and greatest in basic science research. You can find out how experts manage difficult cases. There are sessions on how to manage your practice more efficiently. There are thousands of posters from all over the world to peruse.

Year after year there are several sessions on the autoimmune diseases, covering everything from basic science to bench and clinical research to clinical practice. An ever-growing pool of information about the genetic and molecular bases of disease has led to a rapid expansion of treatment targets – primarily for rheumatoid arthritis but extending to other autoimmune diseases as well.

But there are certain bread-and-butter illnesses that are not as sexy and, as such, do not get as much airtime.

This year, for example, there was only one clinical session on gout, and it was held in one of the smaller rooms. Slated for the same time slot were "Dermatology Topics for Rheumatologists" and "Preclinical Autoimmunity – Potential for Prevention," both much sexier-sounding and held in much larger venues. If my small cohort of friends and colleagues is a microcosm of the attendee population, it made complete sense to do this because I was the only one out of six who was interested in gout.

I understand that "Dermatology Topics for Rheumatologists" – by far the most popular in my small cohort – is indeed interesting, but I do not think it provides terribly useful information. No offense to the ACR or to my friends who picked this topic, but while you may see an interesting rash here and there and maybe remember seeing a similar picture from a lecture that you attended somewhere, I contend that it is more valuable for a clinician to be able to treat challenging gout cases, to learn more postmarketing information about pegloticase, and to understand what asymptomatic hyperuricemia might potentially indicate.

And what of osteoarthritis? There was a popular lecture on back pain, though I heard it was not very good. OA has become one of my biggest frustrations. It is never easy to tell patients that there is not much that can be done for their condition. Thankfully there was a basic science lecture on OA. Hopefully, this means more funding for more research, and ultimately perhaps a disease-modifier as well.

I appreciate that there was a session on paraneoplastic syndromes, one on polymyalgia rheumatica, and one on osteoporosis. I see more of these conditions in my practice than I do systemic lupus erythematosus, scleroderma, or vasculitis.

Without a doubt, ours is a wonderful field to be in. Our diseases have historically been very challenging to define, let alone treat. I feel lucky to be a rheumatologist at such a heady time, when it is now possible to go into drug-free remission if you have rheumatoid arthritis. We understand mechanisms of autoimmune disease better and are making great strides in therapeutics.

But there are other diseases that have been largely ignored, for reasons that are not entirely clear to me (perhaps the unfettered profit motivation that I talked about a few columns ago?), and I think it is about time we had a more equitable distribution of resources for research. Glamorous zebras aside, I will be grateful for the day that I can tell my patients: "yes, there is a nonsurgical option for your osteoarthritis, and no, it is not an antidepressant."

Dr. Chan practices rheumatology in Pawtucket, R.I. E-mail her at [email protected].