As a medical subspecialty, rheumatology was something of a late bloomer until the late 20th century. Even so, the ACR has, since its origins in the 1920s and 1930s, helped to build rheumatology into one of the most internationally collaborative and inclusive medical specialties in the world.
The Rheumatologist talked recently with two former leaders of the ACR, both ACR Masters, whose foundational efforts helped put rheumatology on the map. One was initially fascinated with connective tissue disorders, and the other preferred to care for chronically ill people. How their career paths intertwined with the ACR is emblematic of its diverse membership and scientific stature.
Lawrence E. Shulman, MD, PhD, served as president of what was then called the American Rheumatism Association (and was renamed the ACR in 1988) from 1975–1976, and later became the first director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (1986–1994) in Bethesda, Md. Herbert Kaplan, MD, medical director and co-founder of the Denver Arthritis Clinic and first distinguished clinical professor of medicine at the University of Colorado Health Sciences Center in Denver, served as president of the ACR from 1993–1994.
Spanning the Growth of the Field
“I had two careers that related to and mutually fed into one another,” says Dr. Shulman, now director emeritus of NIAMS. His first career in rheumatology, following a degree in biology at Harvard University in Boston and a PhD in public health at Yale University in New Haven, Conn., was at Johns Hopkins University in Baltimore in the early 1950s. “That was quite a wonderful education,” he recalls warmly. “It was at that time that cortisone and ACTH [adrenocorticotropic hormone] were discovered to have the most remarkable effects on rheumatoid arthritis. At the same time, the NIH [National Institutes of Health], in its wisdom, was developing graduate training programs in various medical specialties.” When a graduate training program in rheumatology was proposed at the Johns Hopkins Medical Institutions (JHMI), his mentor Dr. A. McGehee Harvey appointed Dr. Shulman director of the Connective Tissue Division.
“When I had the opportunity to start that division, I decided I would deal from strength,” recalls Dr. Shulman. He emphasized “the exotic diseases rather than the more ‘ordinary’ diseases of rheumatoid arthritis and osteoarthritis. And in that way, I was able to attract the very best and brightest of the young house officers; that’s how I built my division.” The division grew and blossomed, training fellows over the next 20 years who went on to become leading investigators in their own rights (such as former ACR President Bevra Hahn, MD, James Fries, MD, and Frank Arnett, MD). Throughout the 1960s and into the early 70s, Dr. Shulman combined his leadership at JHMI with innumerable other collaborations, serving on ARA committees as well as with the Lupus and Scleroderma Foundations. In 1975–76, he served as president of the ARA.
Dispelling Misconceptions
Despite the flurry of activity at top institutions such as Johns Hopkins, divisions of rheumatology were still in short supply in the 1950s and early 1960s when Dr. Kaplan acquired his medical education. He received little exposure to rheumatology while in training. He completed an internship and residency at Duke University in Durham, N.C., as well as a residency and fellowship at Yale, and then joined the Army. While stationed at the U.S. Army Hospital in Munich, Germany, Dr. Kaplan discovered that arthritis was not just “an old person’s disease.”
