What Would Our Forefathers Think?

The ACR celebrated the 75th anniversary of our organization at the annual meeting in Philadelphia this October. While an occasion to look forward, an anniversary inevitably stirs the urge to look back. The past elicits powerful emotions because it is known and fixed in time, with 75 candles blazing away in a mini-inferno, signaling the passage of years. In contrast, the future is unknown and uncertain. Optimism notwithstanding, the future can make us anxious.

As the lectures at the opening session dramatically illustrated, to paraphrase an old commercial for a product that most certainly needed a Risk Evaluation and Mitigation Strategy, we have come a long, long way, baby. The tales of rheumatologic disease during the Civil War were horrifying. Whether the joint afflictions were reactive arthritis or gonococcal arthritis, treatment by instillation of boiling chlorinated water was as likely to kill as to cure. The mortality during the Civil War was staggering, although I was surprised by the immense toll of “rheumatism.”

Civil War–era physician.

Great Leaps Forward for Rheumatology

Like most medical specialties during the last century, rheumatology has made spectacular progress. Certainly, since the founding of the ACR, our specialty has followed a steep upward trajectory, with continuous advances in the diagnosis and treatment of our major diseases, some of which have actually just about disappeared. Rheumatoid arthritis, osteoarthritis, gout, and lupus have all had major improvements in outcomes. Some of our most dreaded diseases are also being tamed. Indeed, as reported at one of the plenary sessions, anti–B cell treatment may provide a new alternative to treat vasculitis with fewer of the nasty effects of cyclophosphomide, the current standard.

Had one of the ACR founders attended the conclave in Philadelphia, he (I don’t think there was a she) would have been dazzled by the progress.

The history of an organization is like that of a person and springs from the complex interplay of genes and the environment. The genetics of the ACR are strong. Our founders were brave, resilient, and visionary physicians who banded together during the depth of the Depression to focus on the care of patients with arthritis. Even if the country was bankrupt and the treatment options paltry, these physicians saw a better future and charted a path than sustains us today. To our forebears in the ACR, thank you for a job well done. I wish you were here to blow out the candles with us.