The Demise of the Inpatient Rheumatology Unit

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Through much of the 20th century, dedicated rheumatic disease units were found in hospitals across the U.S. and countries around the world. In the latter part of the century, this began to change, with hospitals moving toward the consult model of care for rheumatic patients. This change reflects larger shifts in the medical world toward increased outpatient care as well as improvements in rheumatological treatments.

Background

The loose concept of a special center for the treatment of rheumatology patients is at least a couple of centuries old. In the 19th century and into the 20th century, many rheumatology patients flocked to spas in Europe and in the U.S., such as in Hot Springs, Ark.

Eric Matteson, MD, MPH, is a professor of medicine in the divisions of rheumatology and epidemiology at the Mayo Clinic in Rochester, Minn. He explains, “These spas were places where people with musculoskeletal diseases could go and get various treatments, such as mud treatments and physical therapy. Different spas had different mineral waters with different concentrations of minerals that were said to be good for gout or inflammatory arthritis or any number of other diseases. So patients would go and spend a few days, a week or a whole summer at one of these spas.”

The idea of the modern inpatient rheumatic disease unit first began to appear in the early part of the 20th century. One of the earliest developments was the 1912 opening of the Landesbad Hospital in Aachen, Germany.¹ In the U.S., the Robert Breck Brigham Hospital opened in Boston in 1914, the first institution in the U.S. dedicated to the treatment of rheumatic and orthopedic conditions. The idea was that many debilitated patients needed extended periods of hospital therapy with dedicated treatments.²

In 1928, James Allison Glover, MD, DPH, first described in detail the idea of the arthritis unit working as a department of a general hospital. He argued that, ideally, these should work in close coordination with a school of medicine or a university, enabling the unit to perform both research and treatment functions.¹ Subsequently, rheumatic disease units appeared at Good Samaritan Hospital in Baltimore, at the Alpert Arthritis Center in Denver, and in many other locations.³

Eventually these units became quite common. Most institutions had a dedicated rheumatic unit as part of their inpatient care, often more than one. The idea was that on such floors rheumatic patients could receive better targeted and more coordinated care than if they were scattered throughout a hospital. Having a separate rheumatic unit also decreased competition with nonrheumatic patients for hospital admission.¹