An American in Paris

Paris, a magnificent city that invariably dazzles, provided a grand stage for the 2008 EULAR Congress, an international meeting that grows continuously in size and prestige. People from all over the world gleefully flocked to the Paris edition, but, thankfully, English is the official language of the EULAR meeting. In the lecture rooms and corridors of the congress center, an American like me could feel at home. Outside on the streets of Paris, however, the going was tougher. Although I got an “A” in high school French, other than greeting people with bonjour, I was otherwise wordless in France’s mellifluous language. With my guidebook in hand as I strolled the tree-lined boulevards, I was unmistakable as a lost and bewildered tourist.

Despite speaking English virtually nonstop at EULAR, I had a French saying that kept circulating in my head: “Plus ça change, plus c’est la même chose.” The translation is simple: “The more things change, the more things are the same.” While this saying, with its cynical and world-weary view, may be true in many spheres of life, it is not true in rheumatology. Indeed, one of the main messages of this year’s EULAR congress (which will no doubt be reprised at the ACR meeting in San Francisco) is that things have changed in rheumatology—and I am talking big-time change.

Frequently, in medicine, improvements in clinical outcomes are gradual and incremental, with studies of tens of thousands of patients needed to show appreciable difference.

At present, in the treatment of rheumatoid arthritis (RA) and other forms of inflammatory arthritis, change is not subtle and it is not small. Rather, the change is a massive transformation of a global scale. It is my firm belief that, if rheumatology is to flourish in the future, it has to acknowledge the ramifications of this change and set a brand new agenda. If we, as rheumatology providers, do not harness and channel this change, the survival of the specialty may become precarious.

RA: A (Formerly) Impossible Challenge

Consider one of the satellite symposia at EULAR entitled “Mission Possible: Remission in Rheumatoid Arthritis” (or something like that). The title is a clever play of words on the old TV show (and, I guess, a Tom Cruise movie). While I did not attend this symposium, I can imagine the thrust of the discussion and the overriding message that remission in RA is possible.

Thirty years ago, remission in RA would have been a dream or fantasy, a piece of science fiction rivaling those of the Frenchman Jules Verne, who spun tales about rockets to the moon and submarines under the seas. Furthermore, thirty years ago, investigators believed that new approaches to control RA would require drastic, even dangerous, interventions that would clobber the immune system and leave the patient near the brink of disaster.