“We have been living history as it is written, with all the attendant emotions and fatigue that come subconsciously with that.”
What a year it’s been.
As Omicron looms, and all the uncertainty that it brings, I think we all feel like the patient with bad RA who is on their third biologic in the form of tocilizumab and can’t get any from the pharmacy. At least we’re not like the UK – the patient with really bad RA on their fifth line agent in the form of rituximab, stuck in an unenviable spot and not sure how they are going to cope.
I just wanted to write to you thank you for this year, for letting us engage the community in the way that you have.
At the beginning of the year, we set out to make sure that this was about starting the conversation, hearing directly from people with interesting things to say, talking about the issues that affect us all. I hope we’ve started to do that, I’m so grateful to those who have contributed, and I look forward to hearing more diverse and engaging voices in the new year.
It strikes me that this year has flown by, yet we have been living history as it is written, with all the attendant emotions and fatigue that come subconsciously with that.
Over the last two years, and in particular this year, our practice has been challenged in a way that it hasn’t been in a long time. As we’ve seen from the latest MBS changes to telehealth items, any gains or positive changes we have made are potentially vulnerable, and there is still much to optimise as we gradually move out of constant emergency mode and into some form of normal. But as a community we have risen to the challenge in a way that I think we can be proud of.
Two things stand out – one from the past flowing into the present, and one from the present flowing into the future.
Our medications have, possibly surprisingly or possibly not, been the stars in the first act of this pandemic play – tocilizumab and baricitinib now (not to mention steroids), but in the future anakinra, infliximab, anti-GM-CSF agents, and potentially more.
In the possibly over-worn metaphor of the covid war, we have sent some of our favourite children off to the front, possibly at the expense of life at home. Our patients have struggled with shortages, and we have struggled to advocate and care for them, despite the admirable (and much appreciated) efforts of the ARA. As supply chains tighten, this will be a current and future threat as covid kicks along in ever amplifying fits and spurts.
Secondly, we are left with thinking about what to do for our patients, many of whom will have inadequate vaccine responses – responses they need as covid roars on through the community. We have much to learn, much to advocate for, but for all our concerns, our patients who are alert to the situation are more scared, and those who aren’t need ‘comorbidity counselling’ regarding vaccination and boosters with an acute urgency that we have not felt in rheumatology before.
Of course, business as usual will roll on. We will fret about JAK inhibitors in cardiovascular risk patients, we will wonder about new drug approvals for underserved diseases such as SLE and vasculitis, we will seek to build better capacity in the dual face of declining capacity and increasing demand, and we will think about how to deliver care better for our patients.
All of these remain problems which do not stop for us, and our patients will hope we can do better. All I know is that we are stronger for having a community of good people to have these conversations with.
So, once again, thank you for letting Rheumatology Republic be part of your thinking. As we plan out more – and we have some exciting ventures planned for the coming year – we will always seek to earn our place in your mind space.
We hope that our ACR coverage, with early career clinicians at the heart, is just the start. We hope to give you more than just syndicated headlines or the snippets of individual experts; we hope to bring you that broader conversation for all the challenges that lie ahead.
Happy holidays, and we look forward to bringing it bigger and better next year.
Seasons Greetings from all of us at Rheumatology Republic
and Medical Republic
