Q: What are you most excited about in rheumatology? What issues are important to you? Where do you see the next advances coming from?

We are advancing from preclinical to clinical stages of investigations, involving therapies and combinations that impact not only 1 arm of the immune system, but also other arms. And this has the potential to be very helpful or to potentially increase risk, but this is all still quite far off on the horizon. Nevertheless, at least at this point, there is still interest in developing new treatments for RA. Even though not much has come yet in the way of investigational attempts to stimulate regulatory Tcells, there is still a lot of interest in various immune mechanisms. But, again, going back to where we started this conversation, I think that if some of our friends in basic research can help us to elucidate effective treatment biomarkers, to begin to deliver on the promise of personalized medicine that I first began hearing about in the 1980s, that would be exciting for me, personally, as I close out my career.

I fully agree. I think that applying genetics to individual patient care is, to me, a huge and exciting area. Yes, it has been frustrating, but I see it slowly moving forward. So, to me, once we actually can define how a patient is going to respond, that is going to be a major and important step forward.

I think that as we learn about the genetics of our diseases and about their immunopathogeneses, it will allow us to target the diseases on a more individual basis. This will, hopefully, allow us to achieve better outcomes than we are already achieving. What we can do for our patients now is so dramatically different from what we could do for our patients 25 years ago. So, we have come a long, long way. But we’ve got a long way to go.

I am going to go rogue on this question. I am most excited about the horizon of scientific work being conducted on how personal behavior can affect wellness in people with RA. And this probably relates to quality-of-life measures. There are dimensions over and above the disease and the metrics of the illness, of which we have talked about extensively. I think that the role of the scientific study of diet, exercise, stress reduction, and sleep hygiene is now just reaching scientific credibility, so I want to be a part of that.