Ed Behrens, MD, chief of the Division of Rheumatology at Children’s Hospital of Philadelphia, underscores the ongoing need to develop more targeted treatments to address the underlying pathophysiology of a given condition. “When you get drugs more specific to the biology at hand, you get more effective cures with less side effects,” he says.
Relatedly, Dr. Bracken points out, a major long-term goal in the field is the development of therapies that can achieve disease control without the degree of immunosuppression that is currently needed, eliminating current concerns such as increased risks of infection or cancer.
However, developing such targeted therapies requires a sophisticated understanding of underlying pathophysiology. This is part of why basic science research about immunology, autoimmunity, inflammation, tissue repair and fundamental disease topics is also so essential.
Dr. Behrens points out that research progress is often slow, requiring many incremental steps along the way. “Sometimes there are big innovations that happen, like the [tumor necrosis factor] inhibitors, but they’re not coming out of nowhere when that happens,” he adds. “We’ve got to be willing to invest in that slow pace to make those big things happen.”
In addition to developing new therapies, research is essential for diagnostic improvements, developing better biomarkers and identifying environmental and lifestyle risk factors. Research is also necessary for solidifying evidence-based medicine approaches, promoting the development of sounder clinical practice guidelines to support high-quality care. Although not yet realized, researchers are also working to understand what approaches might actually prevent full-blown disease.
Rheumatology research on complex disease mechanisms can also yield data critically important for other fields, such as cancer or infectious diseases. Previous innovations in rheumatology, such as the tumor necrosis factor inhibitors, are now also commonly used in other fields, such as gastroenterology and dermatology. Research in rheumatology has also heavily influenced other fields with respect to such areas as precision medicine and patient-reported outcomes.
Even beyond the personal impact of rheumatic diseases on patients and their families, these diseases substantially impact society. As leading causes of workplace disability and decreased productivity, the social and economic burdens of rheumatic diseases are hard to underestimate.
Challenges in Rheumatology Research
Given just the scope and complexity of both rheumatic diseases and new research tools, making real research progress is demanding. But additional practical constraints can make pursuing a career in academic rheumatology even more challenging.
