Most people think of rheumatology as the study of joint disorders, such as arthritis, but they may not know just how broad the field really is. Because rheumatologic disorders also affect blood vessels, organs and a host of other body parts, rheumatology research delves down into the effects on those systems as well.
At UCLA, rheumatology research has taken some interesting directions—for instance, examining the role that cholesterol and the microbiome plays. Dr. John Fitzgerald, interim chief of the UCLA Division of Rheumatology at the David Geffen School of Medicine at UCLA, where more than 30 faculty members are investigating better ways to treat rheumatologic conditions, recently answered some questions about the topic.
WHAT IS RHEUMATOLOGY? Rheumatology is the study of arthritis and types of inflammatory disease. For instance, rheumatoid arthritis and lupus arthritis are both inflammatory arthritis, but lupus can do a lot of other things, too, like damage organs. We also treat myositis, which is inflammatory muscle disease and vasculitis, an inflammatory blood vessel or vascular disease. It also covers musculoskeletal conditions, regular osteoarthritis, fibromyalgia and gout. However, rheumatology is non-surgical, so orthopaedics would cover surgical issues, but not musculoskeletal issues.
WHAT ATTRACTED YOU TO THE FIELD? Rheumatology is interesting because it goes across different systems, so you have to approach it like an internist where you think about the multiple organs it’s affecting. Basically it’s the body’s immune system attacking itself. Treatments weren’t as innovative when I joined, but now treatments are very specific and targeted. One of the reasons I decided to specialize in rheumatology was because of the mentors I had at UCLA. They were some of the best teachers, such as Ken Kalunian (now at UC San Diego’s division of rheumatology, allergy and immunology) and Bevra Hahn (emeritus professor of medicine).
WHAT ARE THE MOST COMMON AILMENTS IN RHEUMATOLOGY? Arthritis is probably the most common condition, but most arthritis patients are managed by their internist and they don’t need specialty consultation. We treat conditions that are more inflammatory, a little bit more complex, like rheumatoid arthritis. Also, UCLA receives many referrals, so we see a lot of lupus and scleroderma, as well as vasculitis, myositis and gout.
YOUR RESEARCHERS HAVE ALSO BEEN STUDYING THE ROLE OF CHOLESTEROL IN LUPUS. HOW DID THAT START? It started with the observation that lupus patients were having heart attacks at much higher rates than non-lupus patients. Cardiologists were starting to figure out that heart attacks were an inflammatory condition; it wasn’t just plaque and blockages, but inflammation was associated with these that led to cardiac events. So it became a natural progression to look at lupus and how the inflammatory system relates to cholesterol. What happens is that the so-called good cholesterol, HDL, should be gobbling up the so-called bad, or LDL, cholesterol. In lupus, the good cholesterol actually makes the bad cholesterol behave worse. It’s pro-inflammatory instead of anti-inflammatory. So a few of our researchers have been looking at pro-inflammatory HDL. They’ve looked at it in lupus and rheumatoid arthritis, and now they’re starting to look at it in gout.
WHEN SHOULD YOU SEE A DOCTOR BECAUSE OF JOINT PAIN? You should see someone if it starts interfering with activity, your ability to get around and to be comfortable. Everybody has minor aches and pains and you don’t have to worry about the minor stuff that goes away. But if something’s not going away or something’s getting worse, that’s when it’s worth getting it evaluated.
