Rotation Prep

Published April 21, 2022


Hints of rheumatologic diseases, such as gout and rheumatoid arthritis (RA), are peppered throughout history. Christopher Columbus likely suffered from reactive arthritis (formerly called Reiter syndrome) and Benjamin Franklin from gout. Many historical paintings depict joint diseases such as hand deformities of rheumatoid arthritis and osteoarthritis.

It wasn’t until the late 16th century that Guillaume de Baillou, the father of rheumatology, first used the term “rheumatism” to refer to joint ailments. Later, in the 17th century, Thomas Sydenham described the features of rheumatic fever, which he termed “acute febrile illness.” What we know now as “Heberden nodes” were initially described in the 18th century by the observant William Heberden. And then in 1940, the field of study of these ailments was given a name when the term “rheumatologist” was coined by Bernard Comroe and Joseph Lee Hollander.

Soon after, knowledge in the field rapidly expanded, with the discovery of the lupus erythematosus (LE) cell and rheumatoid factor (RF), in 1948; lupus anticoagulant, in 1952; antinuclear antibodies, in 1958; and the association of HLA B27 with ankylosing spondylitis, in 1970. These new discoveries led to novel ways to diagnose and treat rheumatologic diseases. Philip Hench and colleagues first introduced glucocorticoids for the treatment of RA in 1948, after the discovery of rheumatoid factor and serological tests for diagnosis.

Although glucocorticoids remain a cornerstone of treatment for many rheumatologic diseases, the range of therapies has grown significantly, including tumor necrosis factor (TNF) inhibitors, other biologics such as monoclonal antibodies, with more on the way.

NEJM Knowledge+