Rheuminations

I’ll be honest…it has been 35+ years since I started Medical School [MBBS]. And in the realm of Medicine at large, and Immunology/Rheumatology in specific, we are still struggling to find a ‘cure’ for chronic systemic inflammatory immune-mediated diseases also known as ‘autoimmune rheumatic diseases (ARD)’. Rheumatology is still in its cradle having gotten the recognition as a subspecialty of Medicine only in 1972. I have seen the field evolve in terms of understanding the orchestrated ‘play’ of the immune cells along with cytokines etc. over the past 3 decades, all of which has led to the concept and birth of ‘biologic’ disease modifying anti-rheumatic drugs [b-DMARDs]. The first b-DMARD to get approved by the Food and Drugs Administration [FDA] was etanercept, a TNF-alpha receptor fusion protein in 1998. Infliximab, a chimeric monoclonal antibody against TNF soon followed in 1999. Ever since then, there has been a flurry of b-DMARDs including 3 more in the same family of TNF-antagonists, 2 in the Interleukin [IL]-6 antagonist class, 1 blocker of the second co-stimulatory T-cell signaling: CTLA-4Ig, 3 IL-1 antagonists, B-cell depleting chimeric monoclonal antibody directed against CD-20 etc. Also, 3 oral Janus-kinase inhibitors have joined the ‘gang’ and are called targeted synthetic DMARDs. I still remember the pre-b-DMARD era when rip roaring rheumatoid arthritis was still around, and with my Ustaad Saheb (Mentor), all what we had to offer pharmaceutically were the conventional synthetic [cs] DMARDs including methotrexate, hydroxychloroquine, sulfasalazine, leflunomide and [the younger generation can hold their breath] cyclosporine, d-penicillamine, chlorambucil…GOLD injections and even cyclophosphamide! Corticosteroids have been around since 1950! The 1st and “so far” […well, I/You might be next one!] the only Nobel Prize winning revelation in the realm of Rheumatology.....................................