Hooked on Rheum with Kevin D. Deane, MD, PhD
I first considered pursuing rheumatology because of several inpatient cases that I encountered as a medical resident.
The patients with rheumatic diseases themselves were interesting; however, what I found most intriguing was how the rheumatology attending who was on service, Sterling West, MD, approached their diagnosis and management. That experience was followed by having another rheumatologist, David Collier, MD, as my ward attending at the county hospital in Denver. That let me further see, on a day-to-day basis, how rheumatologists approached clinical care — and I was hooked!
In rheumatology fellowship at the University of Colorado, I had the opportunity to pursue a research track — which involves 1 year of clinical rheumatology followed by 2 years of research — right at the time that Mike Holers, MD, and Jill Norris, PhD, MPH, were launching a prospective study of the natural history of rheumatoid arthritis. That study took advantage of years of existing work in type 1 diabetes using autoantibodies, and other features, to predict the future onset of type 1 diabetes, as well as the newly emerging “anti-CCP” test that had high specificity for RA.
After a few years of learning how to perform prospective, natural history studies of RA, the American College of Rheumatology launched the Within Our Reach program, designed to advance research into RA. That program provided support for some of our early work into how mucosal inflammation in the lung may play a role in triggering and propagating RA. The Within Our Reach program also launched funding for clinical trials in RA.
With the support of Drs. Holers and Norris, as well as others, including Bill Arend, MD, at the University of Colorado, Jim O’Dell, MD, at the University of Nebraska, Elizabeth Karlson, MD, at Brigham and Women’s Hospital, Michael Weisman, MD, at Cedars-Sinai and Hani El-Gabalawy, MD, at the University of Manitoba — and building on a growing worldwide understanding of RA’s natural history and the predictive ability of anti-CCP — we put together an application for a prevention trial in RA. It was not funded by the ACR, but the lessons we learned from that process supported us in successfully launching the StopRA trial, funded by the NIH/NIAID and the Autoimmunity Centers of Excellence shortly thereafter.
Although the StopRA trial showed us that hydroxychloroquine does not prevent the onset of RA in anti-CCP positive individuals, the network of investigators that we built with the study, as well as the growing number of observational studies and clinical trials for prevention in rheumatic diseases worldwide, will support the next round of studies designed to prevent RA, as well as other rheumatic diseases. Following that, one of my next goals is to establish a nationwide — or larger — network of rheumatologists and individuals who are at-risk for future RA called StopRA:National.
I am looking forward to the day — hopefully soon — when we as rheumatologists will not just wait for people to get sick, but will also seek out those who are at-risk and intervene to prevent or modulate future rheumatic disease. Importantly, I hope that I will, like my mentors have with me, encourage future generations of health care professionals to participate in rheumatology as well as prevention.
Kevin D. Deane, MD, PhD
Professor of Rheumatology
University of Colorado Anschutz Medical Campus
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