Rheumatology--past, present, and future

From ancient times until the middle of the last century--the beginning of the modern scientific era--the description, classification, and study of rheumatologic phenomena played an important role in medicine. There are numerous examples in the literature, beginning with Hippocrates' observations on gout through the discoveries of Sydenham and Heberden. The detection of uric acid as "materia peccans" in gouty arthritis and the differentiation of the chronic arthritides by Garrod in 1853 marked the start of research into the aetiology and pathogenesis of rheumatic diseases. After Garrod's discovery, observation and description of rheumatic diseases lagged, and the only treatment in common usage was symptomatic and left to spas. In the last few decades, interest in the classification of rheumatic disease revived, and the union of clinical rheumatology with basic research provided the basis of a period of rapid progress in the knowledge of pathogenesis and in the development of symptomatic therapies, including non-steroidal anti-inflammatory drugs (NSAIDs). Two major therapeutic goals mark the future of rheumatology: the search for optimum treatment to halt the manifestations of rheumatic diseases and the search for the aetiology, which would lead eventually to prevention and cure.