The Near Future of Rheumatology: A Conversation with David Pisetsky


(AUDIO) David Pisetsky MD, new President-elect of the US Bone and Joint Initiative, offers his perspective.on the role of rheumatologists in a patient-centered, multidisciplinary medical future.

Expect David Pisetsky MD to have an important impact on the future of rheumatology when he takes the helm as President of the United States Bone and [[{"type":"media","view_mode":"media_crop","fid":"25683","attributes":{"alt":"David Pisetsky MD","class":"media-image media-image-right","id":"media_crop_142382488270","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2388","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 105px; height: 144px; float: right;","title":" ","typeof":"foaf:Image"}}]]Joint Initiative (USBJI), next year.

As you'll hear in this brief podcast, Dr. Pisetsky has strong opinions about that future. USBJI's mission is to promote multidisciplinary, coordinated, and patient-centered care for musculoskeletal conditions, and it should continue to advocate strongly for effective interactions between rheumatologists and other health-care providers, importantly affecting the role of the specialty in the reforming health system.

Dr. Pisetsky, who is a rheumatologist, comes to his role with a very broad perspective. His activities range from molecular studies of antinuclear antibody (ANA) complexes in pathogenesis of lupus to chairmanship of the USBJI task force that wrote recommendations defining "value" in musculoskeletal care.

Dr. Pisetsky is Professor of Medicine and Immunology at Duke University Medical Center. He served as Chief of Rheumatology at the Duke University Medical Center from 1996-2007 and remains as the principal investigator of the NIH-sponsored training program in inflammatory diseases.

The questions:

How does your research inform your new role as President Elect (and President)?

The [USBJI] was formed as a result of the international Bone and Joint Decade, which officially ended in 2010. Why is this Initiative continuing?

Last year this organization completed a summit on best practices in patient-centered musculoskeletal care. What is, or would you hope would be, the impact of events like that on practicing rheumatologists?

We already have large numbers of guidelines from any number of professional organizations. Why is a different set of best practices needed?

Another one of the projects of the organization is the Chronic Osteoarthritis (OA) Management Initiative. What's resulting from this effort?

I was speaking yesterday to a rheumatologist [who said] that the future for rheumatology is to focus on the conditions that are truly known to be autoimmune and autoimflammatory, and ... that osteoarthritis and conditions like fibromyalgia really belong elsewhere. What's your reaction to that suggestion?

Key quotes:

[Because many OA patients have surgery] it's important for rheumatologists to understand what is best practice in surgery. Best practices come when there's involvement of physical medicine ... That really gives an impetus to learn about what's going on in other fields.

OA is frequently treated episodically. It's treated by different specialists or frequently non-specialists... For best outcomes, there needs to be a plan for comprehensive continuous management because .... interventions like exercise [and] weight loss can really improve outcomes ... not just manage pain in an episodic way.

With respect to fibromyalgia, I think we've dealt with pain for a long time. We have understanding of pain. Probably 90% of our patients come with a complaint of pain. .... For those patients with fibromyalgia, I think we can provide guidance about approaches to pain and importantly make sure we're not missing something that can be confused with fibromyalgia.

We're very good at treating patients as a whole. ... I think that's one of our skill sets, to look more comprehensively at a patient. I think as clinical problems change we should bring that perspective to other specialties, and work with them.


Announcing USBJI President-Elect, Dr. David Pisetsky. Press release, United States Bone and Joint Initiative. June 23, 2014.

Pisetsky DS. The complex role of DNA, histones and HMGB1 in the pathogenesis of SLE.Autoimmunity (2014) Jun 11:1-7. [Epub ahead of print]

Magna M and Pisetsky DS. The role of HMGB1 in the pathogenesis of inflammatory and autoimmune diseases. Molecular Medicine (2014) Mar 24;20:138-46. doi: 10.2119/molmed.2013.00164.

Gnatz SM, Pisetsky DS, Andersson GB. The Value in Musculoskeletal Care: Summary and Recommendations. Seminars in Arthritis & RheumatismVolume 41, Issue 5, April 2012, Pages 741–744


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