Arthritis & RheumatologyVolume 71, Issue 12 p. 1974-1975 Special Article Winners of the 2018 and 2019 American College of Rheumatology Annual Image Competition American College of Rheumatology Image Library Subcommittee, American College of Rheumatology Image Library SubcommitteeSearch for more papers by this author American College of Rheumatology Image Library Subcommittee, American College of Rheumatology Image Library SubcommitteeSearch for more papers by this author First published: 01 July 2019 https://doi.org/10.1002/art.41025 Members of the Image Library Subcommittee of the American College of Rheumatology Committee on Education: Christopher E. Collins, MD, Washington, DC (Chair); Senada Arabelovic, DO, Boston, Massachusetts; Sharon Banks, DO, Hershey, Pennsylvania; Elana Bernstein, MD, New York, New York; Abhishek Nandan, MD, Richmond, Virginia; Rochella Ostrowski, MD, MS, Maywood, Illinois; Lesley Saketkoo, MD, MPH, New Orleans, Louisiana; Virginia Steen, MD: Washington, DC; Michael Jennings, RT, CBDT, New Lebanon, New York (Association of Rheumatology Professionals representative). Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume71, Issue12December 2019Pages 1974-1975 RelatedInformation

Dear Editor, The Rheumatism Society of the District of Columbia (D.C. Rheum) is one of the oldest rheumatologic societies in the United States. Founding member Dr. Darrell C. Crain organized the first meeting on June 4, 1946. A photograph of that meeting (Fig. 1a)1 portrays many of the members, all of whom came from a variety of backgrounds, including rheumatology as well as orthopedic surgery, cardiology and pediatrics. Dr. Philip Hench, the speaker at the first meeting, had established one of the first dedicated rheumatologic services at the Mayo Clinic in 1926.2 Since rheumatology as a specialty was at that time in its infancy, it was not uncommon for fledgling rheumatologists to travel to the Mayo Clinic to receive specialist training under Hench's mentorship. Hench had established his clinic largely to serve a role in the pre-operative evaluation of patients undergoing orthopedic surgery, but as the subspecialty evolved it blossomed into one of the premier rheumatology divisions in the United States. Crain was among those who spent time with Hench at the Mayo Clinic and the two had a long friendship (Fig. 1b).3 The mission of D.C. Rheum, according to its constitution, was ‘to stimulate interest in and increase the knowledge of rheumatic diseases among physicians and laymen.’ It functioned as an interest group for physicians and its goals were largely achieved via outreach to local organizations, including the Arthritis Foundation. During this period, the pathogenesis of rheumatic disease was hotly debated. For a time, it was believed that rheumatoid arthritis (RA) was caused by chronic infection. Organs thought to harbor latent infection were removed in the hope of curing disease. Therapeutic vaccination against endogenous mycoplasma infection (called ‘auto-vaccination’) was also tried. As early as the 1930s, gold salts and antibiotics were also used for treatment of RA.4, 5 The first use of steroids, which went on to revolutionize the field of treating autoimmunity, was not until 1948, when Hench famously used cortisone to treat a patient with RA at the Mayo Clinic.6 Hench returned to give a presentation to D.C. Rheum in 1976 on the history of steroids and their clinical utility. During the 1940s and 1950s, D.C. Rheum members met several times per year to discuss rheumatic disease management, but at that time it was difficult to determine which rheumatologic therapies were truly effective. Case reports defined illness symptomatically and administered therapies without controlling for confounders. The 1950 establishment of the National Institute of Arthritis and Metabolic Diseases (NIAMD) sought to address some of these challenges by allocating federal funding to evidence-based research as well as funding subspecialty training for medical graduates. Eventually, the NIAMD was continued by its daughter institute, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The Cooperating Clinics of the Arthritis and Rheumatism Association also sought to improve the available data. Investigators in these clinics collaborated in the development of randomized controlled trials for gold therapy and other protocols. In the 1960s and 1970s, the goal of rheumatologic care became that of identifying more specific therapeutic targets for rheumatologic diseases. The 1968 discovery that cytotoxic agents were effective in treating RA was a huge breakthrough. Understanding the role of autoimmunity7 and its over-activation in rheumatic disease processes further propelled therapies. During this explosively productive period in the history of rheumatology, D.C. Rheum was beginning to solidify its place in the Washington, D.C. Rheumatology Community. Meetings were held on the third Wednesday of the month between September and June. Speakers included prominent rheumatologists, orthopedic surgeons, immunologists, basic scientists, radiologists and the U.S. Surgeon General. By 1979, there were designated nights devoted to talks by ‘local talent’, as the executive committee put it, and limitations on how many lectures could be given by orthopedists, signaling a distinction from the old view of rheumatology as pre-operative evaluation to orthopedic surgery. At this time, the society also began to foster international connections and was the host organization for the PanAmerican Rheumatism meeting. By the 1970s, archives show that the majority of D.C. Rheum members were dedicated rheumatologists with a handful of related specialists – including podiatrists, physical therapists and even a dentist – still attending. Meeting topics kept with the pace of scientific discovery, including the first description of drug-induced lupus presented by Lawrence Shulman, the first director of the NIAMS, on October 14, 1970. The society's founder, Dr. Darrell Crain (Fig. 2a),8 remained one of the most active members in the organization. In 1976, Dr. Joseph Croft (Fig. 2b) became the society's president. He organized notable scientific talks for members, which were, according to the meeting minutes, ‘well received by both clinicians and researchers’. Other members of the D.C. Rheum leadership included Ronald Lamont-Havers, Paul Rochmis, John Decker, Jack Klippel, Henry Roth, Nathan Zvaifler and Kenneth Austin. Many of these members also participated in national organizations for rheumatic disease such as the American Rheumatism Association. In the late 1970s, the continuing medical education (CME) survey became a standard component of monthly meetings. CME forms collected after each meeting were designed to elicit feedback and members’ ideas for future speakers. In 1983, D.C. Rheum also successfully applied for CME accreditation with the local Medical Society of the District of Columbia (Fig. 2c). Members of D.C. Rheum did not always agree about new developments in rheumatology and D.C. Rheum provided the perfect venue for scientific debate. For some time a hotly debated issue was whether chronic mycoplasma infection was the driver of RA.9 Other contested issues included the continued use of broad cytotoxic therapies, even as more specific biologic therapeutics were being developed. In 1989, the relationship between tumor necrosis factor alpha (TNF-α) and induction of inflammatory response via interleukin-1 was described by Drs. Ravinder Maini and Marc Feldmann.10 This finding drove the development of biologic therapies, in which monoclonal antibodies were developed against specific targets in immune response pathways. This change contrasted with the broad cytotoxic approach of prior decades but internationally revolutionized rheumatologic care. Like many novel medications, these agents were expensive. Dr. James O'Dell gained national recognition for his work, demonstrating that ‘triple therapy’ with hydroxychloroquine, methotrexate and sulfasalazine11 was a cheaper alternative to up-front therapy with TNF-α inhibitors, and presented this work to D.C. Rheum. As the society continued to grow and the workforce within rheumatology became more diverse, female physicians started to play a larger role in D.C. Rheum. Many women have pursued leadership roles within the society and, in recent years, the society has had several female presidents. While trainees and fellows were always welcome at D.C. Rheum meetings, in 2002, Dr. Arthur Weinstein created an Annual Fellows Forum for the society. This was an event at which Fellows-in-training in the area were able to present their work at a half-day conference. Prizes were awarded for best presentations in clinical research, basic science and case presentations. Guest speakers were invited to each Forum as well. In 2016 alone, 31 abstracts were submitted by over 25 trainees. Recent guest speakers have included Dr. John O'Shea, who presented his discovery of the Janus Kinase pathway's role in RA, and Dr. Robert Inman, who presented new developments in ankylosing spondylitis research, as well as Drs. Bevra Hahn and Brian Mandell. As technology has evolved, so too has the society. In 2011, Dr. Christopher Collins, who later served as the group's president, was asked to develop a web site for D.C. Rheum. The product was a modern interface which could facilitate networking within the society. Included was a calendar of upcoming and past events, access to information on job postings and a membership list. The newest initiative on the horizon, courtesy of current president Dr. Donald Thomas, is a platform to increase the interaction between D.C. Rheum and local rheumatologic non-profit groups. Another initiative, designed by Dr. Paul DeMarco, is a CME course in musculoskeletal ultrasound, one of the most rapidly growing practices in clinical rheumatology. Over the last 70 years, D.C. Rheum has grown and evolved in parallel with the field of rheumatology itself. From its origins as an interest group it developed into an organization dedicated to continuing medical education for rheumatologists, providing a forum for professional networking and debate. As a result, it has become a meeting place for the great minds of rheumatology and an interface between basic sciences and clinical practice in the field. This work would not have been possible without the historical and personal recollections of many current and former members of D.C. Rheum, including Drs. Herbert Baraf, Christopher Collins, Joseph Croft, Paul DeMarco, Gregory Dennis, Paul Plotz, Paul Rochmis, Raymond Scalettar and Arthur Weinstein. Other contributors included Mrs. Alice Makl and Drs. B.T. and Daniel Walsh, relatives of Darrell Crain and Bernard Walsh, respectively. Thanks also to the Rheumatism Society of the District of Columbia for providing archived meeting minutes and consultation regarding future directions for the society. D.C. Rheum is a 501(c)(03) charitable non-profit organization. The authors have no industrial affiliations or conflicts of interest to report.

To determine whether calcium plus vitamin D supplementation (CaD) affects incidence of rheumatoid arthritis (RA). Participants enrolled in the Women's Health Initiative CaD trial (n = 36,282) were randomized to 1,000 mg calcium carbonate plus 400 IU of vitamin D(3) daily or to placebo. Incident RA cases were identified via self-report and validated rheumatic medication use. Cox proportional hazards models were used to compare RA incidence in the treatment versus placebo groups. The analysis included 32,435 women without the history of RA, of which 163 incident RA cases were identified over an average of 5.1 years. No significant differences in demographics, total personal vitamin D intake [P = 0.36], or solar irradiance [P = 0.68] were seen between the groups. In intention-to-treat analyses, no differences were observed in RA incidence [HR 1.04, 95% CI 0.76, 1.41]. No significant modifying effects were seen for stratum of age, solar irradiance, or total vitamin D intake, overall or when adjusted for adherence. Significant effect modifications were seen between CaD and total vitamin D intake and CaD and solar irradiance that suggest increased RA incidence with high vitamin D exposure. CaD supplementation did not demonstrate a significant effect on RA incidence in postmenopausal women. Modifying effects between CaD and both solar irradiance and dietary vitamin D intake are suggestive that multiple high vitamin D exposures may increase RA incidence. Further research is needed to fully explore the benefits and possible adverse effects of vitamin D supplementation on RA.