JMarshall Weeks 1-2

This summer I am working with Dr. Michael Lockshin in the Rheumatology department at the Hospital for Special Surgery. Dr. Lockshin specializes in lupus and specifically lupus pregnancies. The HSS is in fact developing a lupus center where several attending physicians will be available for pregnancy counseling. For the past two weeks, I have been following Dr. Lockshin on his office visits. I have seen a wide range of patients all with some sort of autoimmune disease. The two major diseases that I have encountered so far are lupus and rheumatoid arthritis. It is interesting because these diseases, as well as Sjogren's syndrome and antiphospholipid syndrome are all extremely closely related differing only on the predominant antibodies found in the patients' blood samples and the main manifestations of the diseases. However, during my short time here I have noticed that even within the individual diseases the way they manifest in each patient differs quite significantly. For example, I saw a few patients where their main symptoms were merely rashes, while others had siginificant joint pains and deep tissue involvement. Also, the rheumatology department deals with a number of cases that can't. E specifically diagnosed but are definitely autoimmune in nature. In addition to office visits, I have attended a number of meetings and conferences within the department. As an engineer, one thing I have noticed is that with these diseases not enough is known for a cure or for therapies that work across the board. While some of the newer therapies now work to treat the disease mechanism, the majority of the therapies and drugs used treat symptoms and downstream effects of disease rather than the cause. Because of this, there is not one cocktail of drugs that works for every patient. Also, these diseases are known to go into remission for long periods of time but the. Can suddenly flare with no warning. Dr. Locks him describes his field as those able to work the most with uncertainty and I am starting to agree with him.