A quarter-century of excellence and still growing: Arthritis Care & Research


  • Marian T. Hannan

    Corresponding author
    1. Institute for Aging Research, Hebrew SeniorLife, and Harvard Medical School, Boston, Massachusetts (Editor, Arthritis Care & Research)
    • Institute for Aging Research, Hebrew SeniorLife, and Harvard Medical School 1200 Centre Street, Boston, MA 02131
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This year marks the 25th anniversary of Arthritis Care & Research (AC&R). Many notable events occurred in 1988 (AC&R's first year of publication), such as the archaeological discovery of the original Globe Theatre in London, the first operational transatlantic fiber optic telephone cable, and the launching of the Space Shuttle Discovery (NASA's first launch after the Challenger accident). In March 1988, Volume 1, No. 1 of AC&R, the official journal of the Arthritis Health Professions Association (AHPA), was published. AC&R was published quarterly for its first 8 years, and the topic of the first original article in the premiere issue was an evaluation of a computer-based educational session for patients with systemic lupus erythematosus. The computer-based module required a mainframe computer to complete; however, versions of the program were also available (upon request) for the Apple II microcomputer. (It may be worth noting that 1988 was also the year of the first documented major computer virus that infected computers connected to the Internet.)

In 1988, Stephen Hawking published his wonderful book A Brief History of Time. Following his lead, I would like to take you on a brief history of AC&R to highlight its growth and progress. What prompted this new journal? In the mid-1980s, a survey of AHPA members found that in the previous 3-year period, the membership was responsible for authoring 214 original articles in 51 different journals along with 75 book chapters. During that same time period, 266 research abstracts were presented at annual scientific meetings, but only 19% of those resulted in publication, in part because of a lack of a suitable venue. AC&R was founded to help remedy this situation. Dr. Donna J. Hawley of Wichita State University was selected as the first editor, and led the journal from 1988 to 1990. In the early years of AC&R, manuscripts were submitted by postal mail and authors were required to submit their article in triplicate (one copy for the journal and two to be mailed to reviewers).

Within its first twelve months, AC&R produced the first special issue (Volume 2, No. 3), which reported the proceedings of the Symposium on Compliance in Rheumatoid Arthritis. Also during this time, the journal started its continuing tradition of publication of articles by international authors, as well as those from within the US.

Dr. Graciela S. Alarcón from the University of Alabama at Birmingham served as editor from 1990 to 1994. In her first year of editorship, Case Reports were debuted and became a popular article type for the journal. Midway through Dr. Alarcón's tenure, a survey examining AC&R reader satisfaction noted that two-thirds of the respondents were strongly in favor of dedicating issues of AC&R to specific topics (and an overwhelming 160 topics were proposed). During the following year, the first theme issue dedicated to a specific topic (Health Status Assessment, Volume 5, No. 3) was published. Although AC&R has not yet been able to publish all 160 proposed topics, theme issues are a continuing tradition, as evidenced by the Obesity and the Rheumatic Diseases theme in this issue.

Beginning in 1994 (Volume 7, No. 1), AC&R was published for the Association of Rheumatology Health Professionals (ARHP), a division of the American College of Rheumatology. In 1995, the third editor of AC&R (Dr. Leigh F. Callahan, 1995–1999) expanded the Editorial Board to include members with specialties beyond rehabilitation and also to include international members. Dr. Callahan and her team now requested that authors send four sets of the submitted manuscript along with a cover letter highlighting the paper's contributions to the field of rheumatology. Starting with the September 1995 issue of AC&R (Volume 8, No. 3), all American College of Rheumatology members received the journal, and this helped introduce them to the range of topics covered, especially those of interest to clinicians.

In 1996, AC&R expanded the number of issues per year from four to six, and also increased the page count per issue to ∼90 pages. The 1990s brought great concerns and interest in managed care in the US health care system. Thus, a brief work of fiction was published in Volume 9, No. 4 that focused on issues of managed care. Reactions to the story were also solicited from a variety of sources and included in the issue.

Dr. Gene G. Hunder of the Mayo Clinic was named editor for the 2000–2005 term. His February 2000 issue of AC&R was the first to be published both in print and online. In 2001, AC&R became a section of Arthritis & Rheumatism, and as a consequence achieved an index in PubMed and was assigned the odd-volume numbers starting with Volume 45. With this change, AC&R was now published as one of the two official journals of the American College of Rheumatology and the ARHP, a division of the College. During this time, the journal expanded in size and 3 new article types were introduced: Pro and Con (debates that covered both sides of an important, often complex clinical issue for which no broad consensus existed), Updates (expert reviews that provided helpful information to guide clinicians in the treatment or understanding of a specific rheumatic disease or other aspect of rheumatology, typically based upon four to six evidence-based articles published in the previous two years), and Trainee Rounds (case reports written by a trainee in rheumatology or related area with the advice and counsel of a mentor).

Information on author contributions was a new policy initiated by AC&R in 2003, along with the requirement of formal disclosure forms for manuscripts. These policies were in line with many major medical journals. In 2003, under the guidance of a special guest editor, Dr. Patricia P. Katz, a supplement on Patient Outcomes in Rheumatology: A Review of Measures (Volume 49, No. S5) was produced. This supplement presented summary reviews of common measures of patient outcomes used in rheumatology research. This special volume was popular among readers as it contained the most frequently-used outcome measures along with precision and reliability information in one easily accessible location, and represented the single source of up-to-date information about these measures. I speak from experience that this supplement saved me much time and effort when planning studies and writing research grants. Also noteworthy in 2003, AC&R began using an online system for submission of manuscripts.

August 2005 welcomed the talents of Drs. Patricia P. Katz and Edward H. Yelin of the University of California, San Francisco (co-editors, 2005–2011). These editors instituted many of the changes and improvements still evident in current issues of AC&R. Special themed issues were emphasized each year so that multidisciplinary work on specific issues affecting the welfare of people with rheumatic conditions could be presented in a single forum. Themes included rheumatic disease through the lifespan, disparities in rheumatic diseases, costs, social and psychological impact, disability and rehabilitation, as well as biologic agents in the treatment of rheumatic diseases: the first decade, and other topics. These themed issues continue to be quite popular with the AC&R readership. Drs. Katz and Yelin also instituted invited article series on Policy Matters (cross-cultural views of issues of importance to rheumatology) and Clinical Aspects of Molecular Research in Rheumatology (summaries of the molecular science of a critical area of research that has had or promised to have translational impact on a clinician's ability to diagnose and treat rheumatic disorders or their pathogenesis).

A number of new policies were put into place during 2005–2011, including required registration of clinical trials, a required statement on institutional review board approval of studies involving human subjects, and allowing an open public access database (PubMed Central) for studies funded by the National Institutes of Health (in whole or in part) within one year of publication. Additionally, in 2006, formal policy and consequences for violation of authorship guidelines, duplicate submission, and fraudulent disclosures of interest were put into place. Limits on manuscript length and the number of tables and figures were also instituted.

A major milestone in the growth of AC&R was the transition to monthly publication in 2008. This expansion to 12 issues a year dramatically reduced the time from acceptance of manuscripts to their publication. Also during this year, a new article type was introduced, the Clinicopathologic Conference (CPC) series. CPCs emphasize new ideas in medical science that shed light on the approach to diagnosis, disease management, or an emerging aspect of pathophysiology. CPCs are not case reports; instead this type of article is most often used as a teaching module and follows a formal structure (case presentation, case summary, differential diagnosis, discussion, patient's course, and final diagnosis). The CPCs have been extremely popular, especially in the Rheumatology Fellowship programs in the US.

The year 2010 marked the separation of AC&R from Arthritis & Rheumatism. AC&R became a stand-alone journal with its own PubMed citation, ISSN number, and separate impact factor. Over the past several years, and in particular since the separation, AC&R has been viewed as an influential rheumatology journal, with a clear focus on clinical, epidemiological, health services, psychological, behavioral, and outcomes research. Many articles are relevant to clinical care and public policy for people with rheumatic diseases. At the time of separation, AC&R's stand-alone impact factor was 4.152. The 2010 impact factor for AC&R was 4.749, and the most recent 2011 impact factor was 4.851, clearly marking growth in breadth and depth.

I assumed editorial responsibilities for AC&R with great enthusiasm on July 1, 2011. As I stated in my initial editorial in the journal, my tenure started with a huge influx of energy from the previous editors who brought improved communications and wonderful gains for the journal and its readership. One example of improved communications is the simple box we have added at the beginning of each published original article that highlights 2–4 bulleted points on the significance of the article and its innovation in the field of rheumatology. This feature is well-appreciated by readers and helps to focus the translational aspect of each article. The bulleted points are in line with the new emphasis on significance and innovation by the National Institutes of Health and others in grant applications. During this past year, AC&R also published an expansion and update of the 2003 outcomes supplement (Patient Outcomes in Rheumatology, 2011: A Review of Measures), and we were once again honored to have Dr. Patricia P. Katz serve as the special guest editor for this supplement.

AC&R's success and growth are measurable by any number of metrics. The number of manuscripts submitted to AC&R has increased each year, with 2012 recording the highest number of submissions ever received. The vast majority of submissions are original articles and come from authors around the world. Our articles also generate a great deal of lay press interest, and monthly releases have resulted in coverage by the New York Times, Los Angeles Times, USA Today, television news coverage, WebMD, and US News & World Report. As reflected in the high number of submissions and the growth in the journal's impact factor, AC&R is viewed as an important worldwide source for scholarship pertaining to clinical issues in rheumatic disease.

Two recent improvements are also noteworthy. We have substantially shortened our average days in review and have started providing feedback to authors (in the vast majority of cases) for submissions that are rejected without receiving peer review. This is not standard practice with other journals and we have received appreciative comments by submitting authors.

January 2013 will mark our 25th year of publication. As evidenced above, AC&R has undergone many changes and seen tremendous growth over these years. Overall, there is no question that the trajectory for AC&R continues in a strong growth pattern. Because the future is built upon the past, I know as we move forward in the 21st century that great challenges and opportunities await AC&R. In many business models, one sees that those who are proactive and continually seeking new directions most often succeed. Those who wait for changes to be foisted upon them and try to adapt often fail. My aim for AC&R is to invent the future and walk in new pathways to address the essential mission of AC&R, which is to address the needs of practicing rheumatologists and health professionals.

It is an honor to serve as editor for such a distinguished and prestigious journal. I have read AC&R since the journal's inception in 1988. The science and clinical practices expressed in AC&R spark intellectual curiosity and lend increasing knowledge to the cognitive discipline of rheumatology. As a past reviewer, author, and Associate Editor, I take great pride in the high-quality, peer-reviewed papers that have been published in AC&R. Happy 25th Anniversary to AC&R and the readership! I am confident that the journal will continue to thrive in the years to come, and I greatly anticipate the 50th Golden Anniversary of AC&R!


Dr. Hannan drafted the article, revised it critically for important intellectual content, and approved the final version to be published.