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1	Rheumatology in the 20 Century. What a Difference a Century Makes! Arthritis Diagnosis and Treatment
2	Nothing to declare
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5	In the 1^st half of 1900’s some important concepts were already present or predictable to be built on. MSU crystals were known in tophi Steinbrocker 1949 & Lansbury 1950’s introduced measurement of outcomes Aspirin in high doses was used as an anti-inflammatory in RA But many current tools & concepts could not have been imagined What might we have in 2109?
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10	Many Experts Have Contributed to the Evolution of Classifications OA. Radiographic Kellgren & Lawrence 1950’s Gout “Preliminary.” Wallace et al, 1977 RA. Ropes et al, 1958. Arnett et al, 1987 Scleroderma. Masi et al 1980 SLE. Tan et al, 1982 Spondylarthropathies. (ESSG). Dougados et al 1991 Vasculitis, Jennette et al 1994
11	Other Experts Made Important Laboratory Advances LE cell. Hargraves 1948 ANA. Friou et al 1958 Rheumatoid Factor. Waaler, Rose. 1948 Anti Sa (citrillinated vimentin). Depres et al 1994 DR4. Stastny. 1980 HLA B27 Schlosstein, Brewerton 1973 MSU Crystals in Synovial Fluid, McCarty, Hollander, Seegmiller 1964
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14	The First DMARDs Gold salt therapy Lande in Germany. Forestier in France. 1927-29 Empire Rheumatism Council. 1960 Cortisone dramatic effects in RA. 1949 Nobel prize to Hench, Kendall and Reichstein in 1950.
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19	Methotrexate Developed for treatment of leukemia. Subbarao & Farber. 1940’s First used for RA but only anecdotes reported. 1951 Williams, Willkens et al. Placebo controlled trial. 1985
20	Our Patients with RA are Definitely Doing Much Better
21	Drug Combinations, Early Aggressive Intervention, & Targeted Therapy Were Beginning to Improve Results Mottonen T et al for the FIN-RACo Trial Group Lancet 1999;353:1568-1573
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23	Some Other Therapeutic Advances Scleroderma malignant hypertension Prevented with ACE inhibitor Whitman et al 1982 Vasculitis and lupus nephritis Cyclophosphamide Fauci et al 1994, Austin et al 1986
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25	Excellent Evidence-Based Patient Education Material Was Developed by the ACR and AF
26	"Lorig et al" Lorig et al. Patient self-help programs were developed and emphasized. 1985 Fries. The HAQ allowed patient oriented targets and outcomes. 1978
27	International Differences in Diseases Have Been Emphasized Polynesian gout. Prior et al 1996 Less RA in Nigeria, Greenwood 1968 Adebajo & Reid 1991 Less Hip OA in Chinese. Hoaglund, Yao & Wong 1973. Ross River virus arthritis in Papua New Guinea Scrimgeour et al 1987
28	So, Is there anything left to be done in this 21^st century? Identification of definite causes and disease cures are still infrequent. Gout – MSU crystals. Allopurinol can control. Rundles et al 1963 Infectious arthritis – bacteria. Can cure with antibiotics Arthroplasty of the hip. Charnley 1960’s
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