In Rheumatology, we have more bits of information about our patients with chronic diseases than we can manage, without help. Just one visit, for example, generates results of tests and scans, autoantibody profiles, patient-reported symptoms, and findings from the history and physical exam. Multiply that every few months, times many years, and what we get are trajectories. Timelines and graphs of a patient’s chronic rheumatic disease over a lifetime. Now – in the case of scleroderma at Johns Hopkins – multiply that by more than 4,000. That’s how many patients we have in our Johns Hopkins Scleroderma Center database, some of whom have been treated here for many years. We have similar databases for lupus, Sjögren’s, myositis, rheumatoid arthritis, vasculitis, and other rheumatic diseases. Patients each have their own trajectory, but we can learn much more by comparing a single individual’s course to the trajectories of many, even thousands, of patients with similar diseases.
We are collaborating with people who are highly expert at making sense of data. We believe this is essential, so that we can truly unleash the power of this data era. And although some people worry that “the machines will take over,” that humans have become irrelevant to understanding medicine, disease, managing people, affecting life and death, that AI and machine learning are displacing the human, we believe absolutely that this is not true. In fact, medicine, as the synthesis of biology and spirit, requires the opposite: that both the human as the source of discovery and the human as the target of healing are sacrosanct. That our use of these powerful new data-managing tools augments human capacity, rather than replaces it. That our gifts, our intuition, our values, our empathy, and our dedication to our patients are supported by these tools, but never, ever, replaced.
So that’s the background for this data-themed issue. The more information at our disposal, the more precisely we can help our patients. The machines can’t tell us what is clinically important; they can’t yet take the leaps themselves, though they can enable us to make those connections that involve creativity and intuition. We can use them to harness data, to analyze patterns, so our patients and clinicians can make better decisions together. Our cover story (Page 2) focuses on someone who is not a rheumatologist: Scott Zeger, who is helping our physicians use patterns we can see in the data to provide proactive, personalized care.
If you have a rheumatic disease, you know there are precipitating events: something the body reacts to, which sparks a cycle of autoimmunity. These events are tiny, but dramatic. Brendan Antiochos and J. Sohn, a clinician-scientist and a biophysicist, come from two very different approaches: the macro, the human level, and the micro, the molecular level. Together, they have discovered an event – a “Little Bang” – occurring at the onset of lupus (Page 8).
We are so proud of our young investigators, and are proud to highlight the work of four of them, our Greene Scholars (Page 14). What they are doing, and what our Division of Rheumatology is doing, is truly wonderful, world-class research that continuously improves our knowledge and ability to care for our patients.
Ami Shah, M.D., M.H.S.
Director, Division of Rheumatology
Co-Director, Johns Hopkins
Antony Rosen, M.D.
Vice Dean for Research
Johns Hopkins University
School of Medicine
Director, Johns Hopkins inHealth