Major advances have already been made in Rheumatology, many of which have translated into improved clinical care and management. These have largely centred around:

Descriptive studies. These have resulted in:

1. a better classification/diagnosis and thus treatment of rheumatic conditions

2. a clearer understanding of the natural history of diseases

3. epidemiologically defined disease parameters (e.g. prevalence, incidence, geographical distribution, age at onset, gender ratios)

Imaging and definition of relevant laboratory tests

1. higher resolution imaging of hard and soft tissues for appreciating both early disease processes and disease progression/severity.

2. Laboratory investigations, as useful aids for diagnosis (autoantibody profiles, rheumatoid factor) and disease activity (e.g. CRP)

Treatments and interventions

1. The development of effective and lasting joint replacement prostheses

2. The introduction of better treatments (e.g. Cox2 inhibitors) and biological based therapies to antagonise inflammatory cytokines and processes (e.g. TNF-alpha antagonists)

What can be expected in the future for rheumatology remains speculation but exciting prospects are likely for clinical medicine in the post human genome sequencing era. A primary objective will be the identification of the genetic and environmental components to disease aetiopathogenesis. These should lead to:

• a better understanding of disease processes and classification resulting in more appropriate treatments.

• The identification of novel targets for pharmaceutical intervention.

• An ability to predict disease risk and disease outcome, permiting early screening and a more rapid or aggressive treatment plan.

• The characterisation of gene-environment interactions, resulting in health education and changes in life style or in possible proplylactic intervention.

• The identification of the pharmacogenetic basis for response to drugs and why there is variation in efficacy or adverse drug reactions. This should lead to personalised medicine.

New developments in molecular biology and cell biology are also likely to impinge on rheumatology in the areas of:

• Tissue Engineering

• Gene therapy

• Stem cell transplation