September 18, 2019
2 min read

Rheumatology in the Blink of an Eye

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I am feeling rather nostalgic at the moment. Perhaps it’s just because summer is drawing to a close and autumn is on its way. No? Perhaps it’s because this is a banner year of nostalgia as one of my favorite books, The House of God by Samuel Shem — which I have read three times — is now celebrating its 40th anniversary. No! Please, this isn’t true.

Even more nostalgic is the fact that this year marks a half century since the Woodstock Festival, which when I ponder this seems like it went by in the blink of an eye. In total, time stands still for no one — not even the rheumatologist.

Leonard H. Calabrese, DO
Leonard H.

I am counting my blessings, however, as I have witnessed so many incredible things that at the outset of my career were not even glimmers of reality. My 37-year run practicing HIV medicine and research and the privilege to continue caring for my small cadre of patients is certainly one of them. I am on record as saying, repeatedly, that my lessons in life have been shaped largely through the lens of HIV.

Yet another tectonic advance I have been privileged to have participated in during my early days of research is the development of the same biologic therapies that we all now use routinely and take for granted. This past month we have been afforded yet another incredible drug — upadacitinib (Rinvoq, AbbVie) — a member of a class of drugs whose pathway was totally unknown when I trained.


Lastly, it is hard for me to contain my excitement over having the privilege to participate in yet another new field of incredible scientific fascination and clinical importance with our ongoing work in the emerging field of immune-related adverse events from cancer immunotherapy. Again, totally unforeseen and unpredicted when I was coming up, yet here we are.

Despite all the excitement happening in the rheumatology field, I am unfortunately asked on increasing occasion a question that comes out something like “Doc, when are you going to retire?” To be honest, this question kind of irritates me to hear because it makes me reflect on my own mortality. Furthermore, it forces me to reflect on where I have been, where I am and where I still want to go. I have developed a pat answer for this question, however, as I now generally respond, “Retire from what?”.

I am a student of the Japanese concept of ikigai, which means “a reason for being” and is usually used to indicate the source of value in one’s life or the things that make one’s life worthwhile. It is a concept steeped in answering such questions as knowing what you love to do, what you are good at and what is important about this to the world at large. It is the ultimate bonus when you also do this as your profession and get paid to do it: For me, it’s being a rheumatologist.

Indeed, my career in rheumatology has gone by in the blink of an eye. But it’s my ikigai and I am not going anywhere as long as it stays fun. Why should this be surprising? I still love all the music from Woodstock, after all.

Please share your ikigai with me through Twitter at @LCalabreseDO or email me at

Disclosure: Calabrese reports serving as an investigator and a consultant to Horizon Pharmaceuticals.