Although I reviewed the American College of Rheumatology presidential address (Weinblatt ME. ACR presidential address: the best of times, the worst of times, rheumatology 2001. Arthritis Rheum 2002;46:567–73) with great interest as soon as it arrived, I regret that its Tale of Two Cities metaphor inspired not only juxtaposition, but also a conflicting emotional response quite separate from its intended message.
Although the address triumphantly chronicled many accomplishments and described our new challenges, I felt belittled by the comments regarding fibromyalgia. Rheumatologists have a proud tradition of walking where others fear to tread. Our participation in investigating the enigmas of breast implants, Lyme disease, tryptophan, and myriad other puzzles only hastened the eventual understanding of these problems. Who is better qualified than rheumatologists to finally unravel the daunting mystery of fibromyalgia? I believe that Dr. Weinblatt may be inaccurate when he suggests that rheumatologists provide “little value” to patients with fibromyalgia.
The comments regarding Mary Betty Stevens personified my hopes and aspirations as well. While each specialty seems to be trying to discard their most emotionally challenging disorders to primary care physicians and psychiatrists, I doubt that those inspiring pioneers ever took the easy road by “restricting followup visits.” We will overcome this daunting adversary called fibromyalgia. And, as with previous challenges, we will eventually be just as proud of that effort and determination.
We are all committed to caring for patients with inflammatory diseases, but our past success should inspire us to conquer all of our challenges, not just to enjoy the fruits of our recent advances for a portion of our patients.