As we mark the 60th anniversary of the Association of Rheumatology Professionals (ARP), a group of past ARP presidents gathered to discuss the various changes that have shaped the organization over decades. Taking a long view can help the ARP, the ACR and their members address challenges and create opportunities in the years ahead. Reflecting on the past 60 years of rheumatology, the growth within our many professions and the ARP’s own evolution allows us to assess our current position and envision future advancements while nurturing interdisciplinary communication and collaboration—core strengths of the ARP.
Why Us & Why Now?
We, as four former ARP presidents, come from different professional disciplines and eras and have watched the organization’s evolution from the Paramedical Section of the Arthritis Foundation in 1965, with 40 members, to today’s Interprofessional Division of the ACR, with 1,575 members (18% of the ACR’s total membership) representing 24 diverse disciplines in clinical care, research, education and administration. While we bring robust experience, detailed knowledge and plenty of opinions, we no longer have a seat at the table. Our view from the bleachers, combined with more than 140 years of collective experience in the ACR/ARP, gives us a solid foundation to look back at the past and to look toward the future. Our goal is to place current and emerging challenges and opportunities in a historical context so the ACR/ARP can draw on past lessons to help shape the future.
Practice Changes
Over the years, our focus on meeting patient needs in rheumatic care has remained consistent, but how we meet their needs has evolved and expanded.
Figure 1: Physical management of active RA circa 1968. (Click to enlarge.)
Over the past 60 years, new medications, such as biologics, and new surgical procedures, such as total joint replacements, have dramatically improved patient health outcomes and quality of life. At the same time, non-pharmacological treatments have undergone profound change as well. In 1968, treatment of rheumatoid arthritis emphasized bed rest, range of motion exercise and didactic patient education (see Figure 1).1 This contrasts dramatically with today’s emphasis on aerobic, resistive and balance exercise, and self-management education and support.2
Additionally, the location and model of interdisciplinary care has shifted from predominantly hospital-based team care in the 1970s to today’s decentralized, virtual teams tailored to discrete patient needs. We presented a precursor to this article at ACR Convergence 2024 and encouraged audience members to reflect on changes in practice they had observed (see Table 1). The audience reminded us of what we no longer see: specifically, patients whose mobility depends on a wheelchair. Likewise, it is rare to encounter patients with severe contractures, patients who are severely deconditioned or patients with limited information on how to care for themselves. Our evolving practice has significantly enhanced patient outcomes. Through continued collaboration, we can build on this progress.
Table 1 (Click to enlarge)
These changes have also led to some unintended consequences. The shift toward earlier and more aggressive medication management, with its impressive reductions of inflammatory markers, may overshadow the fact that the physical and mental health statuses of patients are not improving in tandem with reductions in inflammation.3 For example, not all patient pain is inflammatory in nature, and life disruption secondary to the disease or condition often persists. This highlights the importance of interdisciplinary care; ARP members are experts in addressing these patient needs.
Further, the move to decentralized outpatient and community-based care has complicated interdisciplinary collaboration and communication. In this model, rheumatologists and advanced practice providers (APPs), such as nurse practitioners (NPs) and physician assistants (PAs), are located in one setting, and clinics of physical therapists (PTs), occupational therapists (OTs), social workers, psychologists, pharmacologists, orthotists and other health professionals operate in separate locations. In some instances, this decentralization has reduced referrals to these services and disrupted the cohesive understanding of how each discipline contributes to enhancing patient quality of life.
To ensure patients receive the most comprehensive and effective treatment and achieve optimal quality of life, clinicians must be vigilant in identifying issues and concerns that may be better managed by other disciplines. Clinicians must have expansive referral networks and expedited interdisciplinary communication protocols.
Expanding the Rheumatology Workforce
A significant shift in rheumatology practice and in ARP membership was the introduction of APPs into the rheumatology workforce. Until the mid-1990s, few PAs or NPs worked in rheumatology. By 2005, however, 25% of rheumatologists reported working with APPs and another 25% anticipated hiring one within the next five years.4 This recruitment was originally driven by ongoing concerns that demand for rheumatology services would far exceed supply. The ACR’s 2005 Workforce Study report recommended incorporating APPs, and by 2015, the Workforce Study report included APPs in workforce estimates.4,5
Initially recommended as a pragmatic solution to workforce shortages, APPs proved exceptionally well suited to the field. Working alongside physicians in rheumatology practice, they have excelled in providing many functions, such as routine clinical care, triage, managing calls, follow-up and referrals.
Their contributions allow practices to see more patients and can often free up time for rheumatologists to focus more on complex medical decision making.
This expanding workforce brought an influx of NPs and PAs into the ARP, broadening both its membership and the range of professional roles it represents. A common thread between the original ARP members, who traditionally worked outside physician offices, and the new membership groups, who work inside physician offices, is a focus on helping patients articulate and achieve their goals.
The ARP’s role in this workforce expansion was to help orient APPs to the specialty. Rising to the occasion, the organization created educational products, such as the online Advanced Rheumatology Course, the NP/PA Core Curriculum and The Training Rheum. Numerous rheumatology practices have now incorporated APPs into their care teams, further strengthening the ARP through the addition of NP and PA members. The Rheumatology Research Foundation offers scholarships for training and mentorship, which enable NP and PA members to take advantage of educational opportunities to hone their skills.
Additionally, pharmacologists, infusion nurses, nurse case managers, research coordinators and other professionals have further expanded the rheumatology workforce and enriched the ARP membership’s rich diversity. The organization now includes 24 distinct disciplines within its membership (see Figure 2).
Figure 2: ARP membership by discipline as of May 2025. Click to enlarge
Although increasing the number and varied disciplines of ARP members is a valuable step toward addressing workforce demands, it will not be enough. The demand is predicted to increase as both the population and the rheumatology workforce age. This gap has been documented for physicians and APPs, and similar trends are anticipated among other essential rheumatology providers, including PTs, OTs, nurses, social workers and mental health professionals. For example, between 2023 and 2033, the demand for PTs and OTs is projected to grow by 14% and 11%, respectively—rates faster than most other occupations.6,7
The ARP continues work with the ACR to creatively address workforce changes through the use of telehealth, artificial intelligence and alternative healthcare delivery models. The ACR and the Foundation are focused on the big workforce challenges that lie ahead. The ARP is part of the solution and eager to participate in that planning.
Building the Evidence Base to Guide Practice
The impressive changes to practice over the years were greatly influenced by the expansion of research conducted by ARP professionals and the development of a supporting research infrastructure. Initially, clinical practice evolved from collective clinical wisdom passed down from more experienced clinicians, or from mentor to mentee. Carolee Moncur, PhD, PT, the ARP president in 1992, captured this in her seminal article, “Attacking the Sacred Cows,” in which she summarized the state of our science as based on “early research, a small number of subjects and anecdotal experience.”8
The landscape for rheumatology changed dramatically in the late 1970s and 1980s, the halcyon days for rheumatology research. National Institutes of Health-funded Multipurpose Arthritis Centers attracted numerous health professional researchers into the field, who began to establish the evidence base for physical activity, self-management education and therapeutic modalities. Other agencies and nonprofit organizations also funded rheumatology-related research. Paradigm-shifting articles, such as Minor’s publication on aerobic exercise and Lorig’s work on self-management education, were published in this era and fundamentally altered the course of rheumatology care.9,10
Figure 3: Growth sprout.
As research expanded, it significantly influenced rheumatology practice. By the mid-1980s, the ARP recognized the need for a dedicated, central platform to publish this important research. In response, the ARP launched the interdisciplinary journal Arthritis Care & Research (AC&R) in 1988, which now ranks in the top quarter of rheumatology journals worldwide.
Moncur’s article attacking the sacred cows was published in the first issue of AC&R. In 1994, she published a second article, titled “Re-visiting the Sacred Cows,” in a special issue of AC&R on exercise and arthritis.11 Her first article summarized the limited scientific evidence supporting various exercise recommendations for rheumatology patients. The follow-up article highlighted new research conducted during the intervening seven years and concluded that recommendations were now based on appropriately asked questions and well-designed investigations, not sacred cows. This evidence trend continues to grow and influence our ever-improving practice.
Currently, both challenges and opportunities exist for research. Research performed by health professionals is well regarded, research mentorship continues, and federal funding agencies are including more rheumatology researchers as reviewers on review panels. However, federal funding for rheumatology professional research is significantly reduced from those halcyon days, making it more competitive to get funded. Fortunately, the Foundation has stepped into this void, dramatically increasing funding for ARP-relevant research and education over the past decade, and it continues to expand its funding portfolio.12
The ARP: Nothing Stays the Same … Nor Should It
The ARP has continually evolved during its 60-year history, with one of the most notable changes being its integration into the ACR. For approximately 30 years, the ARP was a section within the Arthritis Foundation, until it joined the ACR in 1994.13 Since then, great strides have been made to more closely integrate the ARP into the ACR. Initially, the ARP maintained a full complement of ARP-specific committees and had individual representation on some ACR committees.
Although this arrangement helped meet ARP member needs and fostered leadership development, it did not facilitate integration within the ACR or interdisciplinary collaboration between physicians and the many disciplines represented within the ARP.
Over time, many ARP and ACR committees merged and included increased ARP representation. Currently, ACR committees typically include two to four ARP members. The ARP president is now a full voting member of the ACR Board of Directors and Executive Committee. This combined structure has strengthened connections between the organizations, fostering increased understanding among physicians and ARP members and better facilitating interdisciplinary collaboration.
The merging of committee structures has strengthened both organizations. The ARP has used its seat at the table to inform ACR members of its diverse membership, advocate for addressing patient needs from a broad perspective and highlight ARP members’ skills and tools to address those needs.
While the ACR/ARP organizational integration has been successful, it also presents challenges that must be monitored and mitigated. For example, ARP members have limited opportunities to develop their ARP leadership perspective and skills before being appointed to represent the organization on blended committees. It is essential the ARP ensure its committee members are well prepared to represent its broad membership. With fewer ARP committees, and, thus, fewer leadership opportunities for members, the ARP needs to intentionally focus on leadership development.
Another challenge presented by the organizational integration is meeting the wide-ranging learning needs of ARP’s diverse membership. For example, when the merged ACR/ARP Annual Meeting Planning Committee (AMPC) adopted an all sessions are for everybody philosophy, the number of ARP-planned sessions decreased. This philosophy does not account for the diversity of educational needs within the ARP’s membership. With a limited number of ARP-oriented sessions, the College risks not fully meeting the needs of all members.
But there is good news. The 2025 AMPC has nearly doubled the number of ARP-planned sessions (from 21 to 38) for ACR Convergence 2025, and attendees will see more integration of ACR and ARP speakers within sessions. These changes demonstrate College’s commitment to meeting the needs of all members and to making mid-course adjustments to support continued growth.
Invest in Growth
For the past 60 years, the ARP’s commitment to helping members achieve the best possible health outcomes for each patient has been unwavering. The organization has adapted to contemporary challenges over time, and now has an expanded and thriving membership, a robust professional journal and a wealth of educational tools that ACR and ARP members can use to optimize patient care.
A defining strength of the ARP is interdisciplinary communication and collaboration, along with shared learning across its 24 disciplines, between ARP and ACR members and among researchers and clinicians. This “big tent” approach allows members to gain insights from various disciplines, all with an aim to ensure our patients receive exceptional care that addresses the extensive impact of rheumatic disease on their lives. It truly takes a village. We need a broad array of practitioners, both within and outside of physician offices, to address disease management, physical functioning, mental health strains, social and economic impacts and the many other issues that accompany rheumatic disease. Fortunately, the ARP can help practitioners identify and address these broad issues and foster interprofessional learning and collaboration. The ARP’s online Fundamentals of Rheumatology Course introduces the multiple issues encountered by people living with rheumatic disease.
Figure 4 (Click to enlarge)
Our ACR Convergence 2024 session featured a small but significant handout: a lapel pin in the shape of a young leaf (see Figure 3). This symbolizes investment in growth: your own professional growth, the growth of the ACR and the ARP, and the growth of interdisciplinary care. Figure 4 offers some sprouts, or starter ideas, for ways you can invest in this multidimensional development.
As past ARP presidents, we commend the advancements in rheumatology care and organizational development. We encourage all members to explore new opportunities for growth and to enhance interdisciplinary collaboration.
We believe this is also the time for thoughtful self-reflection and analysis to ensure the ARP’s continued success. How well does the ARP meet the needs of its diverse membership? As the need for skilled rheumatology professionals increases, does the ARP provide the right mix of benefits to attract new members? What committee structure will help the ARP best achieve its mission and foster effective communication? Are there other organizational models that would lead to even greater success?
The authors from left: Marian T. Hannan, Teresa Brady, Kimberly Kimpton and Basia Belza.
ARP and ACR members are dedicated to helping patients achieve optimal health outcomes and quality of life. As with the sprouts noted above, growth needs thoughtful assessment, planning and implementation. The future of the ARP requires our collective innovative thinking, building on a rich history to address today’s challenges and tomorrow’s opportunities. This shared creativity will nourish a vibrant organization that delivers on its promise to “Be there for you so you can be there for your patients.”
Teresa Brady, PhD, MACR, was the ARP president in 1991 and is principal of Clarity Consulting and Communications, Atlanta.
Basia Belza, PhD, RN, FAAN, FGSA, was the ARP president from 2000–2001 and is the de Tornyay Endowed Professor in Aging, School of Nursing, University of Washington, Seattle.
Kimberly Kimpton, PT, MACR, was the ARP president from 2008–2009 and lives in Centennial, Colo.
Marian T. Hannan, DSc, MPH, MACR, was the ARP president from 1998–1999 and is professor of medicine, Harvard Medical School and senior scientist, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston.
References
- Harris R. Physical methods in the management of rheumatoid arthritis. Med Clinics North Am. 1968 May;52(:3):707–716.
- England BR, Smith BJ, Baker NA, et al. 2022 American College of Rheumatology Guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis. Arthritis Rheumatol. 2023 Aug;75(8):1299–1311.
- Carpenter L, Nikiphorou E, Kiely PDW, et al. Secular changes in the progression of clinical markers and patient-reported outcomes in early rheumatoid arthritis. Rheumatology (Oxford). 2020 Sep 1; 59(9):2381–2391.
- Deal CL, Hooker R, Harrington T, et al. The United States rheumatology workforce: Supply and demand, 2005–2025. Arthritis Rheum. 2007 Mar; 56(3):722–729.
- Battafarano DF, Ditmyer M, Bolster MB, et al. 2015 American College of Rheumatology Workforce Study: Supply and demand projections of adult rheumatology workforce, 2015–2030. Arthritis Care Res (Hoboken). 2018 Apr;70(4):617–626.
- U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Physical Therapists. Updated 2025 Apr 18. https://tinyurl.com/48evtp68.
- U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Occupational Therapists. Updated 2025 Apr 18. https://tinyurl.com/yz7wee28.
- Moncur C. Attacking the sacred cows. Arthritis Rheum. 1988 Jun;1(2):116–121. https://tinyurl.com/26u57dxk.
- Minor MA, Hewett JE, Webel RR, et al. Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis. Arthritis Rheum. 1989 Nov;32(11):1396–1405.
- Lorig K, Lubeck D, Kraines RG, et al. Outcomes of self-help education for patients with arthritis. Arthritis Rheum. 1985 Jun;28(6):680–685.
- Moncur C. Introduction: Revisiting the sacred cows. Arthritis Care Res. 1994 Dec;7(4):167–168.
- Rheumatology Research Foundation. Awards & Grants. https://www.rheumresearch.org/awards-grants.
- Brady TJ. The history of the Association of Rheumatology Health Professionals (ARHP). The ACR at 75: A Diamond Jubilee, edited by David Pisetsky, Hoboken, NJ: Wiley-Blackwell, 2009.
Acknowledgments
The authors thank Deena Kanopkin for her timely and creative graphic design.
