Richard Bucala, MD, PhD, is a rheumatologist, pathologist, and epidemiologist, and serves as chief of Rheumatology, Allergy & Immunology.
Rheumatic disease is an umbrella term for conditions that affect the joints, tendons, muscles, and ligaments. Thirty percent of patients over the age of 65 suffer from a rheumatologic disorder, mostly from degenerative arthritis, Dr. Bucala notes.
“It’s a major reason for why older patients are not able to do all the things that they would like to do. At Yale, we offer multidisciplinary specialty care. A rheumatic disease can affect several organ systems. So, we aspire to have patients come in and see rheumatology but also any associated specialists, from cardiology to dermatology to pulmonology to gastroenterology, in one day” Dr. Bucala says. “This way, all the information and knowledge is put together in one place at one point in time. This allows the physician team to provide the best assessment and information and ultimately therapy for the patient.”
Gathering this information comprehensively allows the medical providers to provide the most accurate and fastest diagnosis and to offer the most advanced treatments, he adds.
“Because most of the diseases we take care of are chronic, there are no easy or ready cures. We aim to prevent the progression of disease so that patients can maintain their function and their lifestyles to the extent that they can,” he says.
Personalized, precision medicine is key to the rheumatology specialty, he adds. “We understand that in rheumatology, there is a particular expression of disease which often is unique to patients. So, we need to know our patients well and to understand their symptoms in the best possible way so we can apply the most specific therapies, which will be effective and with the least toxicity,” Dr. Bucala says.
Dr. Bucala’s research focuses on developing immunotherapies that are tailored to a patient’s genetic makeup. “We study why certain genetic attributes allow people to, for instance, have a mild infection or combat influenza or another type of infection,” he says. “Our work has allowed us to identify patients who are at high risk for having more severe joint destruction in arthritis or more severe renal and central nervous disease in lupus, for instance. We've also developed particular therapies, so-called ‘biologic therapies,’ that target particular pathways, which are the same pathways that are expressed by a person's genetic susceptibility.”
