Rheumatology: Challenges for the millennium

Journal/Book: Z Rheumatol 1999; 58: 293-294. 1999;

Abstract: J. Dequeker; Rheumatology Unit K. U. Leuven University Hospital Pellenberg Rheumatology has been moving from a specialty treating ill defined aches and pain syndromes considered to be incurable and thus treated with palliative tools to a diagnostic specialty akin to internal medicine a specialty directed to a diagnostic and multidisciplinary approach of musculoskeletal diseases. Arthritis has become in developed countries and will become soon in developing countries one of the most pressing public health problems. Research of the last decades has yielded a better understanding of many types of arthritis and an array of effective interventions to prevent and treat arthritis and its complications yet these interventions are not widely applied. In 1966 when I started rheumatology rheumatic fever in adults and even in children was so rare that all attention was oriented to autoimmune diseases as rheumatoid arthritis systemic lupus erythematosus myositis and ankylosing spondylitis. The importance of infection was minimized but basic autoimmune mechanisms were explored and immunosuppressive therapy started. A number of these new therapies has been established as the new gold standard as methotrexate for rheumatoid arthritis and cyclophosphamide for vasculitis. Other aggressive therapies have been tried out as lymphoplasmapheresis and total lymphoid irradiation the latter however has disappeared. Many physiopathological mechanisms have been disclosed: T-cells B-cells antigen presenting cells histocompatibility complex ... this process is still going on leading to discoveries of subcell types cytokines and the importance of epitopes. New aggressive immunosuppressive therapies are explored in some centres as bone marrow transplantation for autoimmune diseases. At present however we have to wait for controlled studies in order to know the longterm results and the cost/side-effects/benefit. ... le

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