Flashback to LU4. During our very first lecture in Rheumatology,
the lecturer (the indefatigable Dr. Penserga) stepped up the podium and uttered
her first sentence: A joint is an organ.
Right away, there was a personal moment of epiphany. What I had previously believed
to be a mere site of connection between two bones was, in fact, an active organ
harboring a host of cells, cytokines, and everything in between.
Three years seems an awfully long time when one
looks back at that definitive split-second and pauses to consider the potential
array of knowledge (and yet to be discovered knowledge) that lay beyond the
simple fabric of a joint capsule. Joints, as I later found out, only comprise a
minute fraction of this exciting field. In rheumatology, it was always about
recognizing patterns and asking oneself: “Could
it be?” with surefire gusto and the confidence of an acrobat on a tightrope,
hovering between a particular diagnosis and its really close mimic, never mind
that one or the other appeared nothing like the classic textbook illustration. Dermatomyositis, polymyositis. Scleroderma,
scleredema. (And you have overlap syndromes, too.) For the unwitting novice
with the untrained eye, the difference could only stretch a little farther than
a syllable – and the subtle signs that come with it.
Add that to the fact that the Philippines only has
about 90+ rheumatologists wracking their brains off a plethora of syndromes and
one rare disease after another. In my two week rotation alone, I was lucky to
have seen both ends of the spectrum – from the almost symptom-free individual
in remission to the barely conscious, intubated patient; from several cases of
Behcet’s disease to Takayasu’s arteritis and polyarteritis nodosa – and smugly
went home knowing something has piqued my intellectual curiosity and slaked my
inner thirst for the unconventional and the unfamiliar.
Two weeks slowly gave me insight into the palpable
difference between rheumatology and most other specialties. Rheumatologists
seek not an ultimate cure but rather, an acceptable functional capacity and
health-related quality of life for patients. And this is where tinkering with
steroids and NSAIDS comes into the picture – the same old drugs with brand new
tricks.
Even now we are already being ushered into the age
of biologicals. Meeting IL-17 – the latest kid on the block – had been a real
pleasure and so is trying my hand on the ultra-modern MSK UTZ. I thank all the
consultants and fellows for a time well spent and for generously accommodating
me into the world of inflammation and autoimmunity, where SLE and SSc are close
cousins with everyone else. When all else fails, I guess there will always be your
friendly neighborhood rheumatologist to help solve that rigged diagnostic
dilemma.
Now I say: ankylosing spondylitis, anyone?
(Postscript:
I eventually did my internship research on ankylosing spondylitis, which went
on to win second place in the Annual Interns’ Research Forum for that year, got
accepted for poster presentation in an international conference in Granada,
Spain, and was eventually published in the Philippine Journal of Internal
Medicine.)
