A BRIEF HISTORY OF INDIAN RHEUMATOLOGY ASSOCIATION
The history of Rheumatology in India dates back around 62 years. The country’s first Rheumatology Clinic was started in 1959 at T.N Medical College and B.Y.L Nair hospital by late Dr. M.M Desai. Over the1960s and 1970s, there were many renowned physicians across the country who practiced Rheumatology as part of their general medical practice.
Some of the early Physicians who laid the foundation of early Rheumatology in the country were late (Prof.) M. M. Desai in Mumbai, late (Prof.) Harivaishnava from Maulana Azad Medical College and G. B. Pant and Irwin hospitals, late (Dr.) G. G. Manshramani, late (Dr.) M. N. Passey, Dr S. S. Sachdeva and Late (Brig.) N. D. Menon at the Army Hospital – all from New Delhi, late Dr S. D. Deodhar in Chandigarh and late (Prof.) Manjushree Mithra in Kolkata.
Late (Prof.) S. D. Deodhar started Rheumatology service at P. G. I Chandigarh in 1971. Prof. A.N. Chandrashekharan started the department of Rheumatology at Madras Medical College (MMC) and General Hospital Chennai in 1972. In 1973, Prof. A. N. Malaviya started Rheumatology services in the All India Institute of Medical Sciences (AIIMS), New Delhi. Later in the eighties, Prof. V. R. Joshi and Late G. H. Tilve started Rheumatology Services in Mumbai.
According to Dr. V. R. Joshi who wrote ‘A brief overview of Indian Rheumatology’, most of the leading Rheumatologists from 1980 to late 1990 were trained by the above mentioned Rheumatologists and physicians. Until 1989 there was no specific training Programme for Rheumatology and Immunology and a majority of the Rheumatologists were trained abroad, mostly in the UK.
The first independent Department of Rheumatology was started in 1975 in M.M.C Chennai under Prof. A. N Chandrashekaran. Prof. Chandrashekaran played a crucial role in laying the foundation for Rheumatology across the country. The department started by him was later upgraded to the Institute of Rheumatology in 2015 with Prof. Rajeshwari as its first Director. The first Doctorate of Medicine (DM) Rheumatology Programme, too, started at M.M.C, Chennai, in 1991.
The DM Immunology Course was started in 1989 at Sanjay Gandhi Postgraduate Institute (SGPI) Lucknow by Late (Prof) S. S. Agarwal, who was succeeded by Prof. Seetha Naik and Dr. Ramnath Misra. Now, Dr Amita Agarwal heads the department which continues to grow.
In 1984 Rheumatology services were started by Dr. U. R.K. Rao under Prof. Shantharam’s guidance at Nizam’s Institute of Medical Sciences (NIMS) in Hyderabad. Independent department of Rheumatology started in NIMS in 2000-01 by Prof. G. Narasimulu, who also started the DM Programme. Now, Prof. Liza Rajashekar heads the department.
Prof. V.S Negi started DM Rheumatology in JIPMER, Puducherry in 2009 and the department is growing. In one of the premier institutes like AIIMS (New Delhi), although Rheumatology services were available from 1973, there was no independent department. Prof. Malaviya, later Dr. Ashok Kumar and Dr Rohini Handa headed the department and expanded its growth and services under the Department of Medicine. It was only in 2015 that Prof. Uma Kumar succeeded in starting an independent department of Rheumatology, which is thriving today under her guidance.
Prof. Debashish Danda started the DM course in 2011 in C.M.C Vellore and it has become one of the finest departments of Rheumatology in the country. The DM in Pediatric Rheumatology was started in P.G.I in Chandigarh in 2014 by Prof. Surjit Singh, a stalwart of Pediatric Rheumatology in India.
Today, in addition to the DM programme, the Diplomate of the National Board (DNB) in Rheumatology programme and 2-year fellowship programs in various places all over the country are producing a good number of competent Rheumatologists. Dr. Chandrashekara started the Fellowship course almost two decades ago in Bengaluru. The trained Rheumatologists then go on to provide services across the country. In fact, a large number of remote places are served by these Rheumatology fellows (roving Rheumatologists).
Several of India’s Rheumatologists continue to receive training from Indian Rheumatologists based outside the country. Dr. V.R Joshi, Dr A.N Malaviya and Dr. Mahendranath have sent a good number of Rheumatologists to the UK for short and long term Rheumatology fellowship courses. Prof. Peter Maddison in Bath, the late Prof. Paul Bacon in Birmingham, Prof. Bhaskar Das Gupta in Southend and Prof. Terry Gibson in London helped us a lot. A special mention must be made of Bhaskar Das Gupta, who went out of the way to help our youngsters. Now, the Indo-UK Rheumatology forum is helping us with Prof. A.V Ramanan, Dr. Ira Pandey in Nottingham, Dr. Venkat in Birmingham and Dr. Kaushik Choudhary in Coventry continues to train our youngsters.
Rheumatology in the Private sector
Rheumatology in the private sector has existed since the year 1975. Even today, seventy percent of the Rheumatology services in the country are provided by individuals and the corporate sector. Late Dr. P.K. Pispati started Rheumatology services in Mumbai in 1975, Dr. K. M. Mahendranath started his independent practice in Bengaluru in 1983, Dr. S. J. Gupta started his practice in Delhi in 1986, Dr. S. Amin started in Mumbai in 1988, Dr. Bankim Desai started in Surat in 1991, Dr. Rajamani started his practice in Coimbatore and Dr. Arvind Chopra his centre in Pune, in 1996. Dr. Arvind Chopra and Dr. Chandrashekara, in Pune and Bengaluru respectively, started Rheumatology services along with laboratory, X-ray, physiotherapy and pharmacy under one roof. Such centres are now a trend and a large number of them have also become excellent training centres offering fellowship programmes.
Women in Rheumatology
It is heartening to see a large number of women Rheumatologists in India and to see their numbers grow. Today, four departments of Rheumatology, that are considered to be some of the best in the country, are headed by women. Dr. Amita Aggarwal at S.G.P.G.I in Lucknow, Dr. Vineeta Shobha at St. Johns Medical College in Bengaluru, Dr. Liza Rajashekhar at NIMS in Hyderabad and Dr. Uma Kumar ate AIIMS in New Delhi, head the departments that are world-class. Until recently, Dr. Rajeshwari headed the first institute in Rheumatology in India, in Chennai. Credit must be paid to Dr. Vineeta Shobha for initiating a large number of collaborative studies and publications, which have been published in international journals and have served to solidify India’s mark in World Rheumatology.
Pediatric Rheumatology
Pediatric rheumatology is emerging out of the shadow’s of adult rheumatology and expanding. Surjit Singh, Amita Aggarwal, Sujatha Sawhney and Raju Khoobchandani cultivated the speciality initially. Later Priyanka Pal, Suma Balan, Sathish Kumar, Anand Rao, Ravichandran, Nutan Kamath, Aruna, Nandini and many others helped the speciality grow. Their annual conference attracts a good number of international speakers apart from the national crowd. Now almost all the big cities can boast the availability of pediatric rheumatology services.
Our Annual Conferences
The annual conference of the IRA, the IRACON, was attended by a few dozen delegates before 1990. Today, they have grown over the years to attract a huge number of attendees from across India and overseas, showcasing the depth and reputation of Indian Rheumatology globally. Apart from being an important annual academic and scientific event in our calendars, they have also become memorable annual social gatherings that every member of the IRA looks forward to.
IRA Chapters
IRA was formed in 1963 with head office in Mumbai. The headquarters was subsequently moved to New Delhi and a new constitution was formed under Dr. S. J. Gupta’s guidance. Guidelines for the management of Rheumatoid Arthritis with Dr. V.R Joshi and Dr. Ramnath Misra, and Dr. Ashok Kumar, for the management of Systemic Lupus Erythematosus (SLE) were initiated during the presidentship of Dr K.M Mahendranath. There was a generational shift in 2001 when Mahendranath became the president of the IRA. This shift marked the start of a phase which saw all-round growth in academic and scientific activities, increase in resources and globalisation of Indian Rheumatology, all of which have continued till date under successive presidents and office bearers of the IRA.
We have very active city chapters like New Delhi, Hyderabad, Mumbai, Ahmedabad, and Bengaluru (KRA). The Karnataka Rheumatology Association (KRA) started Advanced Rheumatology courses which saw the presence of Rheumatology giants like Prof. Peter Maddison, Prof. Robert Lahita, Prof. Ralph Schumacher, Prof. Paul Emery, Prof. Joe Adu, Prof. Paul Bacon, Prof. David Scott, Dr. Colin Pease and many others. Prof. Carol Black, the then president of Royal College of Physicians, London, attended IRACON 2002 in Bengaluru.
KRA awarded travelling fellowships in the names of Profs A.N Chandrashekaran, Prof A.N Malaviya and Prof. V.R Joshi and Late Prof. Deodhar. KRA also conducted the first Indo-UK British Society of Rheumatology (BSR) meeting in Bengaluru. Dr. Kausik Chaudhary of Coventry, UK, and Dr. B.G. Dharmanand played a prominent role in organising the event.
Dr. V. Krishnamurthy organised the APLAR Congress in Chennai, in 2015, which was a grand success. Dr. P.K Pispati, Dr. R. Handa and Dr D. Danda have served as the Presidents of the APLAR. Due to the efforts of Dr. Danda who is the current President of the APLAR, a good number of Indian Rheumatologists were recognised by the APLAR forum and awarded as APLAR Masters.
Indian Rheumatology and the Army
Late (Brig) N. D. Menon started Rheumatology services in the Indian Army in the early 1980s, to be followed by late Lt. Col. Achuthan in the 1990s. However, it is Lt. Gen. Ved Chaturvedi who took Rheumatology to new heights in the Army Medical Services. He also organised IRACON in 2007 in Khajuraho, which was another first, as it marked our first annual conference to be conducted outside the metropolitan cities, clearly a herculean task.
A bright future ahead for Indian Rheumatology
The IRA today has nearly 1500 members. It also has special interest groups in i) Vasculitis, ii) Fibromyalgia, iii) Pediatric Rheumatology iv) Patient Education and others. Indian Rheumatology Association’s Vasculitis Core Group, IRAVAS, has produced multiple world-class papers and contributed significantly to the understanding of Vasculitis. This was initiated by late Prof. Bacon along with Prof. Ramnath Misra, Prof. D. Danda, Dr. K. M. Mahendranath, late Dr. Sivakumar and others. Prof. Justin Mason at the Imperial College London presently mentors the group and Dr. Aman Sharma from Chandigarh plays a key role in its activities. There are a huge number of people who have contributed to IRAVAS, but due to paucity of space, I am unable to mention all their names.
The pandemic, over the last year, challenged us all and cast a shadow on the organisation’s academic activities; we had to cancel our annual conference scheduled to take place in Indore, along with many other meetings. But the present office bearers, led by Dr. Alakendu Ghosh, adapted to the new normal and successfully conducted many webinars with both national and international faculty.
The IRA has played a significant role in the development and spread of Rheumatology in the country. Its academic activities have attracted international attention. IRA has an excellent journal and every member of the IRA has contributed to its growth to reach its present status. We indeed have a long journey ahead of us, but not as nearly long as the one we have already traversed. Long live IRA!
Dr. K. M. Mahendranath