In the twilight days of the escaping year, there is an urgency to reflect on how what has come to pass in the preceding 12 months. We inevitably think of the difficulties – war and its awful consequences, pandemics and politics, people and poverty. We mourn those we lost and rejoice in friendships gained. Our phone photos remind us of memorable moments that might otherwise be lost in the frenetic activity of our everyday lives.
Each year brings progress, new information, new technology, new drugs and new hope for patients with challenging diseases. We can become easily overwhelmed with new information or impatient for such knowledge to be applied in a practical way.
When I started researching the history of rheumatology in Ireland, what
really struck me was the enormity of the problem faced by patients with severe rheumatic disease, before the availability of the incredible drugs
we use today. People with rheumatoid arthritis, for example, developed early
disability with joint deformities that prevented self-care and led to a life of
dependency on others. They succumbed to heart disease, infections, cancer or osteoporotic fractures. Hope was derived from high doses of painkillers,
physical medicine techniques and the kindness of the medical professionals who cared for them. But hope was also limited in the face of inevitable decline once the disease became established.
The discovery of steroids in 1948 and their dramatic effect on inflammatory
joint disease led to renewed interest in the potential reversibility of
arthritis. The development of non-steroidal anti-inflammatory drugs (NSAIDs), greatly improved quality of life, but had significant side-effects. Serendipity and astute observation of both scientists and clinicians led to the use of disease-modifying anti-rheumatic drugs (DMARDs) such as gold, penicillamine, hydroxychloroquine, sulfasalazine and methotrexate in patients with joint inflammation and facilitated the much needed reduction in dosages of steroids and NSAIDs. At the turn of the century, the commercial use of the biologic agents and their continued development has, at last, allowed many patients to lead normal lives despite such a major and chronic diagnosis.
Although it is easy to summarize this progress in a paragraph, there are
many heroes in the background – patients, clinicians, scientists, nurses and
allied health professionals. Some of their names are known; others will always be confined to the shadows. The purpose of my book on the history of rheumatology in Ireland is to highlight as many of these names as possible and give credit to those who facilitated this progress in rheumatology. We have come a long way.
It’s about perspective. And it’s about gratitude. And both are important at
any time of the year.
Rheum for health 