Rheumatism has its origins in ancient Greek. 'Rheuma' means 'bad energy flows' in ancient Greek. It implies that unhealthy fluids circulate throughout the body, attacking it and causing pain. This aligns with modern medical explanations.
Rheumatism is an autoimmune disease where immune cells lose the ability to differentiate between self and non-self, attacking normal cells instead. It's as if an army meant to fend off enemies is instead attacking its own forces. When rheumatism manifests in the joints, it’s called rheumatoid arthritis; when it appears in the salivary glands or tear glands, it's known as Sjögren's syndrome; and when it occurs in the skin, it’s referred to as dermatomyositis.
Professor Kim Wan-wook of Seoul St. Mary's Hospital’s Rheumatology Department said in an interview with ChosunBiz on the 25th, "The number of rheumatism patients in the country is rapidly increasing, and recently, many patients in their 20s are visiting hospitals. Fortunately, with over 20 types of targeted therapies now available, what was once an intractable disease is at a stage where complete remission is possible, with no symptoms remaining."
Professor Kim Wan-wook is a 26-year expert in rheumatology and is considered one of the top specialists in the country. He graduated from the Catholic University of Korea College of Medicine in 1992 and obtained his master's and doctoral degrees in internal medicine from the same university. Since 1999, he has been a professor at the Catholic University of Korea College of Medicine and has cared for over 2,000 patients. He is well-known not only for treating patients but also as a 'researching physician' seeking new treatment methods for rheumatism. He has been selected twice for the leader research program supported by the National Research Foundation of Korea, receiving research funding of 18 billion won over 20 years, thus actively conducting research.
The causes of rheumatism are varied. Both environmental and genetic factors can cause rheumatism. Notably, aging is a significant factor, which explains the recent increase in the number of rheumatism patients in the country. The number of patients with rheumatoid arthritis, a representative rheumatic disease, increased by 4.1% from 244,768 in 2020 to 254,778 in 2022. Medical expenses also rose by 14.1% during this period, from 293.6 billion won to 334.8 billion won, due to the increasing number of expensive targeted therapies.
Infectious diseases that activate the immune system can also trigger rheumatism. A representative example is COVID-19. When infected by the virus, the body’s immune cells activate to protect the body. During this process, autoimmune cells that attack the body’s own cells are also activated. In fact, there are studies indicating that the probability of developing rheumatism increased by 25% after the COVID-19 pandemic.
Professor Kim noted the surge in rheumatism patients is due to the increase in immune disorders caused by the COVID-19 pandemic and the advancement of testing technologies. He stated, "Recent advancements in science and technology have introduced many testing methods that can detect autoimmune diseases," adding that blood tests can simply check for the presence of autoantibodies that trigger autoimmunity.
Thanks to this, it has become possible to assess the likelihood of developing rheumatism even before symptoms appear. Generally, symptoms manifest 3 to 4 years after autoantibodies are detected. Rheumatism has, in a sense, a kind of latent period. If bacteria or viruses infect the individual or the immune system is activated for other reasons during this period, rheumatism will develop.
Professor Kim explained, "When autoantibodies are present, merely consuming health supplements that enhance immunity can significantly increase the likelihood of developing rheumatism," emphasizing that how one manages health during this period determines the prognosis for rheumatism patients.
He stated that rheumatism should now incorporate prevention-centered management. By managing patients where autoantibodies are detected, it is possible to increase the rates of complete remission rather than treating after symptoms have appeared.
Complete remission is different from a cure. A cure means that all symptoms have disappeared, and no further medication or treatment is needed, while complete remission refers to the state of maintaining health by not having symptoms persist with the appropriate treatment or medication. Acquired immune deficiency syndrome (AIDS) is a representative example. Currently, even AIDS patients can maintain health for life if they adhere to their medication.
Professor Kim explained, "Most people naturally possess a small number of autoimmune cells, so no matter how advanced medical technology becomes, a cure is impossible," while adding, "However, through proactive preventative measures, we can raise the rate of complete remission to over 35%."
The reason Professor Kim emphasizes preventive management is due to the efficacy of the targeted therapies that have recently been released. Until the early 2000s, rheumatism treatment involved a cocktail therapy that mixed various types of anti-rheumatic drugs. However, cocktail therapy has limitations, as it modulates multiple immune systems simultaneously, leading to relatively reduced treatment efficacy and increased side effects. It does not accurately identify the causes of rheumatism, suppressing all suspected immune systems indiscriminately. In other words, it is like carpet bombing a wide area without precisely knowing where the enemy is.
Beginning in the 2010s, targeted therapies akin to guided missiles that selectively attack only the enemy were developed. With advancements in diagnostic technology, it has become possible to accurately pinpoint the different causes of rheumatism for each patient. Professor Kim stated, "Targeted therapies are so effective that their rates of complete remission can reach up to 90%, fundamentally changing the landscape of rheumatism treatment," adding that there are now over 20 types of targeted therapies available for most patients.
Currently, in the country, cocktail therapy is still used as the standard treatment for up to 6 months after symptoms manifest. This is due to the high cost of targeted therapies. The monthly cost of targeted therapies in the country amounts to 1 million won. Because of their high price, it is a significant burden to use them on early-stage patients. However, there are opinions emerging abroad that suggest targeted therapy should begin within 3 months of rheumatism diagnosis, as the earlier the treatment is initiated, the greater the likelihood of achieving complete remission.
Professor Kim went further, stating that starting targeted therapy after autoantibodies are detected during screening could improve patients' prognoses. This would be akin to eliminating the enemy before they can launch an attack. He remarked, "Research results abroad have already shown that preventive management with targeted therapies is highly effective," stressing that there is a need to adopt this in South Korea.
Professor Kim expressed hope that his current research could expedite the introduction of preventive management for rheumatism. He is seeking new targets for the development of rheumatism targeted therapies and is also conducting research aimed at easily identifying the diverse causes of rheumatism for each patient.
Professor Kim stated, "Since I work at a university hospital, I see many patients across the country who have failed treatment. It’s not that there are no options for these patients; I want to be a physician who can provide them with alternatives."
He plans to create guidelines using artificial intelligence (AI) to select targeted therapies that suit each patient. He believes that this will minimize costs and enable effective rheumatism management from early on. Professor Kim stated, "If we create targeted therapy guidelines using AI, it will greatly aid in implementing preventive management and personalized medical care for each patient."