Hooked on Rheum with Ellen M. Gravallese, MD
I was in my fourth year at Columbia Medical School and was planning to become a hematologist. Columbia had an affiliation with a community hospital in Cooperstown, New York, and it was arranged for me to spend a month there as a visiting student. Unfortunately, there was only one rotation available that month: Rheumatology.
I recall saying emphatically, “I’m not going to do rheumatology.” But a friend convinced me that it would be great experience to spend time at the Bassett Hospital so, reluctantly, I went ahead with it.
At that time, I was paired one-on-one with a young physician named Dr. Gary Hoffman, one of only two rheumatologists at the hospital. My time there was inspiring. Dr. Hoffman was a fabulous clinician. He was also really curious, which spoke to my interest in disease mechanism. He worked continuously with me to prepare talks about mechanism of rheumatic diseases and he also had me work up every new patient that walked in the door. It was an incredible experience.
The best part was that for the entire subsequent year, he sent me follow-up information on all of the new patients I had seen, because — as he stated — rheumatology is a continuous journey, and you need to follow your patients over time to understand disease trajectory.
I went on to pursue a combined program in medicine and pathology. While doing pathology, I met another great mentor, Dr. Joseph Corson. He had a particular interest in the synovium and, over time, he had collected a number of cases and samples of synovial diseases. In reviewing these cases, my interest in rheumatology was rekindled.
Dr. Corson also had boxes of slides from autopsies he had performed on patients with rheumatoid arthritis. There were over 180 autopsies, and hundreds of slides from each patient. I went through all of them. It was a fascinating review of RA in the pre-treatment era, as these cases went back as far as the 1940s.
I was so excited because I found about 46 cases of vasculitis and some of these patients had inflammation in the aorta that was clinically relevant, with aortic insufficiency or rupture. When I presented this finding to Dr. Corson, he stated, “Well, of course, there is aortitis in RA, doesn’t everyone know that?” Dr. Corson may have been the only person who knew this. One of my first published papers as a rheumatologist was to summarize the findings of those cases.
Ellen M. Gravallese, MD
Past President, 2019-2020
American College of Rheumatology
Chief, Division of Rheumatology, Inflammation and Immunity
Brigham and Women's Hospital