Hooked on Rheum with Nancy E. Lane, MD
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Reflecting on my decision to forge a career path in medicine and rheumatology, there were a series of experiences that strongly influenced me.
I chose to study medicine because I was really fascinated by, and enjoyed learning, the science. However, I was too gregarious and social to spend all my time in a research laboratory. For me, studying medicine and treating patients was just the ticket.
In medical school, I started running at the noon hour — and was soon participating in marathons. My running colleagues were complaining to me about stress fractures and arthritis pain, and what they could do to treat their ailments, but at that time I had no answers for them.
As an internal medicine resident, I was drawn to patients with rheumatic diseases, the complexities of the immune system and how its dysregulation caused the diseases. There were a few newly trained clinical rheumatologists at our hospital who were gifted teachers — one of whom, Neil S. Birnbaum, MD, went on to become the president of the American College of Rheumatology — and were great role models for me.
At Stanford, where I was a rheumatology fellow, I was surrounded by accomplished physician scientists on the rheumatology service, and I was in awe of how these physicians could take these very complicated patient histories and distill the cases down to just a few diagnoses and treatment decisions. I knew then that I was going to be a physician scientist.
Luckily, I was also surrounded by very clever outcomes researchers, including James F. Fries, MD, who had just developed the Health Assessment Questionnaire (HAQ), which asked questions about activities of daily living in rheumatoid arthritis patients. The HAQ score fared better in predicting rheumatoid arthritis outcomes than the physician’s questions and physical examinations.
I also saw the initiation of the arthritis self-help courses by Kate Lorig, DrPH, which informed the medical community that patients with rheumatic diseases who were educated by lay individuals demonstrated improved disease outcomes and self- efficacy.
After my clinical fellowship, I studied older runners with relatively normal knees. The results of that research determined that the older, slower runners and joggers did not have an increased risk for knee osteoarthritis, and had higher central bone mass than nonrunners.
I went on to acquire skills in basic and epidemiologic research, and, after securing my own external funding, I have had the opportunity to ask very basic questions related to musculoskeletal diseases, osteoporosis and OA. I have also been able to perform some seminal clinical trials, such as determining that hPTH (1-34) treatment could reverse glucocorticoid induced osteoporosis. I have also had the opportunity to describe the epidemiology and genetics of OA of the hip and knee.
When I started my rheumatology journey, we only had NSAIDs, corticosteroids, methotrexate, intramuscular or oral gold compounds, and alkylating agents to treat our most diseased patients. Sadly, we lost several patients due to diagnostic delay and a lack of safe medications. Today, it is very gratifying to see our patients with chronic inflammatory diseases treated with biologic agents that for many make their disease chronic and stable. It has also been so exciting to watch the development and FDA approval of medications that prevent organ damage in our patients with autoimmune vasculitis.
Lastly, what has made rheumatology such a rewarding career is that we as a subspecialty are there both for our patients and for each other. We support each other with difficult patients and challenges that we all face in our careers. I am grateful for the camaraderie we have in rheumatology, with our patients as well as with colleagues — it keeps me hooked on rheum!
Nancy E. Lane, MD
Endowed Professor of Medicine, Rheumatology, and Aging Research
Director for the Center for Musculoskeletal Health
Director of the K12 NIH Building Interdisciplinary Research Careers in Women’s Health
University of California at Davis School of Medicine