Dr. Landewé lauds his colleague’s modesty: “I believe he has done very good work in determining the relationship between disease activity, function, and radiographic damage. Under his guidance and supervision, a lot of longitudinal statistics have been incorporated into the field of rheumatology.”
The development of the DAS and other assessments also converged with efforts on the international level to standardize assessments. Before the 1980s, Dr. van Riel notes, “every rheumatologist was assessing patients in their own way, and publishing in different ways. Therefore, you couldn’t compare results of the different trials with each other.” Another serendipitous occurrence was the growing level of patient involvement in their treatments. Dr. van Riel recalls a marked change in the 1980s when patients became interested in knowing “the exact details of their medical story – their response to treatments and how their disease was progressing.”
Philosophical about Acceptance
Dr. van Riel notes that assessment instruments are not used by practicing rheumatologists as much as he would like. “You know, when we developed this instrument and published it and talked about it at conferences, I thought, ‘That’s it: We have shown that it is worthwhile to assess patients in this way, so everybody should do it .… And that was 15 years ago!” he says.
Dr. van Riel says he has realized that it takes “a long, long time” to convince colleagues about the usefulness of these measures. He concedes that time may be the biggest barrier. “Incorporating this kind of assessment in your outpatient clinic routine means you have to prioritize and rearrange the way you perform patient examinations,” he says.
By all accounts, Dr. van Riel has been quietly but unswervingly dedicating himself to the principles of assessment in RA – and will continue to do so. Dr. van Riel is a person of commitment, says Dr. Barrera, who considers him not only her mentor but her friend. “He’s kept to his idea that measuring gives an improvement in the way to treat patients,” she says. “To measure is to know – and that’s something he introduced.”
Gretchen Henkel is writing the “Metrics in Rheumatology” series.
References
- Mallya RK, Mace BE. The assessment of disease activity in rheumatoid arthritis using a multivariate analysis. Rheumatol and Rehabil. 1981;20:14-20.
- van Riel PLCM, Reekers P, van de Putte LBA, Gribnau FWJ. Association of HLA antigens, toxic reactions and therapeutic response to auranofin and aurothioglucose in patients with rheumatoid arthritis. Tissue Antigens. 1983;22:194-199.
- van der Heijde DMFM, van ‘t Hof MA, van Riel PLCM, et al. Judging disease activity in clinical practice in rheumatoid arthritis. Ann Rheum Dis. 1990; 49:916-920.
- van der Heijde DMFM, van ‘t Hof MA, van Riel PLCM, et al. Validity of single variables and composite indices for measuring disease activity in rheumatoid arthritis. Ann Rheum Dis. 1992; 51:177-181.
