The Rheumatology Unit of the National University of Colombia (UNAL) has a history spanning over half a century, producing many prominent rheumatologists. This article provides a description of its history to understand its trajectory, historical context, challenges, achievements, and contributions.
ReflectionsIn 1960, the Rheumatology Section at UNAL was officially approved, founded by professors Mario Peña, Humberto Lizarazo, and Fernando Chalem. In 1962, Drs. Peña, Chalem, and Lizarazo established the Rheumatology Service at San Juan de Dios Hospital. In 1963, the outpatient clinic for rheumatic patients began operating at the same hospital. Dr. Enrique Clavijo Acero became the first rheumatologist qualified through a Colombian university in 1971. By 1973, various specialty programmes at UNAL, including rheumatology, were officially approved, and the Rheumatology Unit was elevated to the status of a section.
DiscussionFor more than 50 years, the Rheumatology Unit has trained medical students and specialists, who have played a critical role in the field. It remains a vital part of rheumatology both in Colombia and the region.
ConclusionThe Rheumatology Unit at the National University of Colombia, as the first academic institution in this field within the country, celebrates over 60 years of activity and 50 years of official recognition. It has achieved numerous milestones and has been a pioneering force in rheumatology.
La Unidad de Reumatología de la Universidad Nacional de Colombia (UNAL) ha existido por más de medio siglo, y de ella se ha graduado un gran número de destacados especialistas. Se hace una descripción de su historia con el fin de comprender su trayectoria y contexto histórico, así como sus desafíos, logros y contribuciones.
ReflexionesEn 1960, la UNAL aprobó la creación de la Sección de Reumatología, fundada por los profesores Mario Peña, Humberto Lizarazo y Fernando Chalem. En 1962, los doctores Peña, Chalem y Lizarazo fundaron el Servicio de Reumatología, que se alojaba en el Hospital San Juan de Dios, y en 1963 se inició la consulta externa para pacientes reumáticos en dicho hospital. En 1971, el Dr. Enrique Clavijo Acero se convirtió en el primer reumatólogo titulado por una universidad colombiana. En 1973, la UNAL aprobó oficialmente los programas de varias especialidades, lo que permitió que la Unidad de Reumatología pasara a ser una sección.
DiscusiónEl servicio ha formado a estudiantes de medicina y especialistas durante más de 50 años, quienes han desempeñado un papel crucial en el ejercicio de la Reumatología. Esta unidad constituye un capítulo destacado en la historia de la Reumatología en nuestro país y la región.
ConclusiónLa Unidad de Reumatología de la UNAL, al ser la primera escuela de esta especialidad en el país, celebra más de 60 años de actividades y 50 años de reconocimiento oficial como unidad académica. Ha alcanzado múltiples logros y ha sido pionera en el campo.
The Rheumatology Unit at the National University of Colombia (UNAL) has existed for more than half a century and has trained many prominent rheumatologists in Colombia. It emerged during a time when the field of rheumatology was just gaining recognition, and medical practice was becoming increasingly sophisticated, particularly in Latin American countries. The specialties within the Department of Internal Medicine were beginning to establish themselves, demonstrating that the development of specialized fields significantly benefits both patients and their families, while also advancing medical knowledge.
The UNAL Rheumatology Unit, founded in 1960, began operations in 1962 and was officially established by the Higher University Council in 1973. The history of the Rheumatology Unit at UNAL represents a landmark in the development of the specialty in Colombia and the region. Soon after its founding, it expanded beyond clinical practice to train physicians as specialists, and for many years, it was the only academic center for rheumatology in Colombia. The trajectory of the UNAL Rheumatology Unit is a remarkable chapter in the history of this specialty, both nationally and regionally.1
This made it more attractive and renowned, which also reinforced the devotion to research into rheumatic diseases. Its influence went even further and was due to the celebration of multiple congresses, academic events, and conferences related to the specialty, as well as the contribution to the founding of the Colombian Association of Rheumatology (CAR), consolidating itself not only as a healthcare, academic, educational, and organizational institution. The academic unit had to face multiple challenges over time, which are linked to the history of Bogotá and Colombia, such as the closure of its main practice site, which at that time was the largest hospital in the country, or having to face changes in the health system over the years. Despite this, it has remained current and influential in the medical field of Colombia.2 Therefore, the UNAL Rheumatology Unit has contributed to the training of several generations of specialists and is an important influence at the national level that welcomes students, specialists and teaching staff from all parts of the country and region.
Currently, the UNAL Rheumatology Service serves many people with diverse socioeconomic conditions through its institutions that have agreements and through the National University Hospital of Colombia (HUN), which was built completely new and officially inaugurated on December 3, 2015.3 Its facilities are located in the National Administrative Center (CAN).
HUN is an autonomous entity with the academic regency of National University of Colombia and provides high-quality health services in a compassionate and safe manner contributing to training of socially responsible professionals. HUN investigates with scientific rigor and innovation through an interdisciplinary team with permanent overcoming and seeking excellence, sustainability, and social and environmental responsibility. It is committed to humanization in all its actions. Some processes have been established to implement phases within the framework of the Institutional and Academic Expansion Plan of the National University Hospital of Colombia. Significant progress has been made in the expansion of the HUN, which is the most critical project. This strategic megaproject has been identified as the most important for UNAL in the medium term.4
The mission of the Rheumatology Unit aligns with that of UNAL, which is to train professionals and researchers on scientific, ethical, and humanistic foundations. This training aims to foster a critical consciousness that enables individuals to act responsibly despite the demands and trends of the contemporary world, leading processes of change.
This historical document is crucial for understanding the development and transformation of the Specialty of Rheumatology in Colombia. It helps us appreciate the accumulated experience over time and contributes to the preservation of memory and knowledge within our country. Recognizing past successes and errors allows us to project these insights into the present and future. Additionally, it supports the training of specialists who remain active, informed, and critical.
ObjectiveThe objective of this article is to describe and analyze the history of the Rheumatology Unit at the Faculty of Medicine of the National University of Colombia, to comprehend its trajectory and historical context. This understanding facilitates the exploration of past events and their consequences for the present and future.
MethodsThis descriptive study includes the narration and analysis of historical events. A search was conducted in databases (PubMed and Google Scholar) and printed medical literature related to the Rheumatology Unit (National University of Colombia website and National University Hospital) up to November 11, 2023. Additionally, a review of relevant information was performed through institutional documentation (regulations, reports, records, and historical documents), as well as interviews with professors, directors, and doctors knowledgeable about the history of the service.
ReflectionsOn September 22, 1867, the National Congress of Colombia established a university originally named the Universidad Nacional de los Estados Unidos de Colombia, which later became Universidad Nacional de Colombia. The following year, in 1868, the university founded the first faculty in the country, along with others in Arts and Crafts, Engineering, Law, Natural Sciences, Literature, and Philosophy. The project to create this institution was initiated by President General Santos Acosta, a doctor and soldier, through Law 66 of September 22, 1867.
Prior to this, medicine was practiced from a generalist perspective within hospitals. However, as knowledge advanced and time progressed, the demand for specialized health and internal medicine services grew. In 1961, under the rectorship of Doctor José Félix Patiño, official residency programs were introduced. During this period, UNAL entered into agreements with North American universities to train its own faculty. This marked the beginning of a North American approach to medicine, which replaced the previously predominant European (French) model (personal interview with Professor Hugo Fajardo, August 15, 2023).1,2,5
The Rheumatology Unit was initially established and began operations at the San Juan de Dios Hospital, which was founded in 1735 and commenced operations in 1739. It became the largest hospital in the country and a center for several medical advances in Colombia. Unfortunately, the hospital faced multiple economic crises beginning in 1975,2 which eventually led to its closure in 2001.
On May 9, 1956, the Faculty of Medicine underwent reorganization. Prior to this, it was known as the Department of Medicine but was renamed the Department of Internal Medicine, a designation it retains to this day.
In 1960, the Units, previously referred to as “Academic Sections of Internal Medicine”, were officially established with their respective founders: Endocrinology (Bernard Reyes Leal), Pulmonology (Pablo Latorre), Rheumatology (Mario Peña, Humberto Lizarazo, Fernando Chalem),6,7 and Gastroenterology (Milton Arguello).
In 1962, Drs. Peña, Chalem, and Lizarazo founded the Rheumatology Service, which was based at San Juan de Dios Hospital.6 The same year, a course on Clinical, Therapeutic, and Immunology of Rheumatic Diseases was organized at the hospital, featuring lectures from international experts: Moisés Mizraji from Uruguay, Florian Delbarre from France, Frenguer from Germany, and José Drunkard Del Campo from Spain.8
In 1963, an outpatient clinic for rheumatic patients was established at San Juan de Dios Hospital.
Significant events in 1964 included the official founding of the first Rheumatology Specialty Clinic in the country, which began operating on February 1, 1964, at San Juan de Dios Hospital in Bogotá. In March, the Rheumatology Unit received academic recognition as an integral part of the Faculty of Medicine of the National University of Colombia. Dr. Mario Peña spent one year in Santiago de Chile studying with Drs. Fernando Valenzuela, Carlos Lackington, and Rodolfo Armas Cruz, the head of Internal Medicine.9
On October 8, 1966, the Colombian Association of Rheumatology (CAR) was founded by Fernando Chalem, Humberto Lizarazo, and Mario Peña from San Juan de Dios Hospital, along with Jorge Escandón (a UNAL graduate) from La Samaritana Hospital in Bogotá, Carlos Argáez Castello from San José Hospital in Bogotá, Carlos Sanín Aguirre from Medellín, and Arnold Gómez López from Cali.
Initially headquartered at San Juan de Dios Hospital, CAR relocated to a new location in Bogotá in 1975 due to the hospital's economic crisis. In November of that year, the UNAL Academic Council approved the creation of the Rheumatology Unit. This unit was incorporated into the training of undergraduate students and integrated into the Department of Internal Medicine as a teaching and research unit responsible for training rheumatology professionals. This marked the establishment of the first school of rheumatologists in the country. The training program in rheumatology at UNAL gained significant importance both nationally and internationally, being the only university in Colombia where doctors could specialize in this field for a long time.
On February 1, 1967, academic activities officially commenced at the specialized Rheumatology Unit of the National University of Colombia. At the Pan American League of Associations for Rheumatology (PANLAR) congress, studies on Sjögren's Syndrome and salivary gland biopsy were presented.10 In September, the first Postgraduate and Internship Symposium for Doctors at the National University of Colombia was held. Additionally, on December 15 and 16, the first Colombian Congress of Rheumatology took place at San Juan de Dios Hospital.
In 1968, the Rheumatology Unit at the National University of Colombia expanded its services and educational scope by including doctors from other specialties. The first fellow was from the specialty of orthopedics and traumatology. In 1968, Dr. Manuel Elkin Patarroyo began his training as a medical student at the Rheumatology Unit.
In 1969, the First Colombian Congress of Rheumatology was organized at San Juan de Dios Hospital. According to agreement 71 of 1969 from the Higher University Council, the UNAL Rheumatology Unit was authorized to confer postgraduate degrees in rheumatology. This year also marked the admission of Dr. Enrique Clavijo Acero, the first candidate to specialize in rheumatology through the UNAL Rheumatology Residency Program. Additionally, the board of directors of the Colombian Association of Rheumatology, primarily composed of doctors from the UNAL Rheumatology Unit, affiliated CAR with PANLAR9 and the International League of Associations for Rheumatology (ILAR).7,9
In 1970, Dr. Pedro Farías was admitted to the specialization program as the second candidate for the position of rheumatology specialist. Additionally, the First Colombian Congress of Internal Medicine was held in Bogotá from July 9 to 11, where work on rheumatic diseases was prominently featured, and members of UNAL received several awards.7,9
In 1971, rheumatology care was initiated at the Rehabilitation Service for hospitalized patients at the San Pedro Claver Clinic of Instituto de Seguros Sociales by Dr. Jorge Escandón, and at a dispensary by Drs. Humberto Lizarazo and Mario Peña. This same year, Dr. Enrique Clavijo Acero became the first rheumatology specialist in Colombia to be certified by a Colombian university. He subsequently joined the Santa Rosa Clinic of Caja Nacional de Previsión in Bogotá and served as a Professor of Rheumatology and Internal Medicine.
In August 1972, the II Colombian Congress of Internal Medicine was held in Bogotá, where CAR members presented the work “Epidemiology of Rheumatoid Arthritis in Colombia,” which earned the Award for Best Scientific Societies Work. That same year, Dr. Fernando Chalem was elected President, Dr. Jorge Escandón as Executive Secretary, and Dr. Humberto Lizarazo as Treasurer of the CAR board of directors for the period 1972–1973.
Three significant events occurred in 1973. First, the UNAL officially approved specialty programs. Second, the Rheumatology Unit transitioned from being a section (as per minute 8 of Agreement 33A, March 8, 1973) to a specialty program, with the authority to officially graduate doctors as specialists in rheumatology and issue diplomas11 (Fig. 1). Third, Dr. Pedro Farías completed his specialist training and joined the UNAL teaching staff. He also became a rheumatologist at Caja de Previsión Social Distrital, alongside Drs. Humberto Lizarazo and Enrique Clavijo.9
Agreement 33A of 1973: this agreement, enacted by the Higher University Council of the National University of Colombia, officially approved the establishment of the postgraduate degree program in Rheumatology. It marked a significant milestone in the development of the Rheumatology Unit, transitioning it from a section to a full-fledged specialty program authorized to confer diplomas in Rheumatology.
In 1974, Dr. Pedro Farías, the second rheumatology specialist in Colombia, received his certification as a rheumatologist.
In 1975, on the initiative of doctors Fernando Chalem and Jorge Escandón, Fundación Instituto de Reumatología e Inmunología was created (whose name was later changed to Fundación Instituto de Reumatología Fernando Chalem), which served low-income patients without social security, and fellows from the UNAL Rheumatology program began rotations.
The journal Acta Médica Colombiana was established as the official publication of the Colombian Association of Internal Medicine. Dr. Fernando Chalem, who founded the journal, served as Editor-in-Chief until 1996. Dr. Jorge Escandón succeeded him and held the position until 1997.12
In 1980, Dr. Antonio Iglesias Gamarra became the third rheumatologist to graduate in Colombia. The following year, Dr. Rafael Valle graduated as the fourth rheumatologist in the country.
In 1983, the Rheumatology Section of the Santa Fe de Bogotá Foundation was created by Drs. Fernando Chalem Benattar and Jorge Escandón Sorzano, under the academic auspices of Escuela Colombiana de Medicina, now known as Universidad del Bosque.7
In 1986, Dr. Cilia Rojas and Dr. Álvaro Sánchez advanced several laboratory tests that had not previously been performed in Colombia, due to the absence of ready-to-use reagents. For instance, antinuclear antibodies were first tested using substrates from HEp-2 cell lines, a technique previously conducted with mouse tissue at the Institute of Immunology of Dr. Elkin Patarroyo. This year also saw the establishment of the First Rheumatology Laboratory, which operated at San Juan de Dios Hospital until its closure in 2001. The laboratory served bacteriology students from institutions such as Pontificia Universidad Javeriana, Colegio Mayor de Cundinamarca, and Universidad del Norte de Barranquilla. Additionally, Dr. Álvaro Sánchez and Dr. Joaquín Vríera, a dermatology resident, conducted the first capillaroscopy studies (personal conversation with Dr. Cilia Rojas, November 7, 2023).
In 1988, Drs. Federico Rondón and Mario Díaz received their degrees in rheumatology.
In 1989, Dr. Rafael Valle established the Rheumatology Service at the Military Hospital. This year also marked the initiation of the publication of the first Rheumatology yearbook by the CAR, with Dr. Álvaro Sánchez serving as its president. In the same year, Drs. Rita Sierra and Noemí Casas earned their degrees as rheumatologists. Dr. Noemí Casas, along with Drs. Mario Díaz and Federico Rondón, started the Colsanitas Rheumatology Service. Dr. Rita Sierra, after completing her studies, helped establish The Rheumatology Unit of the University Hospital of Cartagena with Drs. Álvaro Moreno and Lacides Padilla, as per University Agreement Number 23 of December 1997, formalizing it as an academic and administrative unit.9
In 1990, Drs. Jorge Rueda, Rubén Mantilla, and Orlando Villota received diplomas in rheumatology. The following year, Dr. Jorge Rueda established the Rheumatology Unit at the Valle de Lili Foundation in Cali, with Dr. Herman González joining later. At the Rheumatology Service of UNAL, internal medicine fellows from Universidad del Valle began their internships. Drs. Javier Ramírez and Gloria Vásquez graduated from the UNAL Program in 1991. Dr. Gloria Vásquez settled in Medellín, where she contributed to the development of the academic program at CES University.
In 1993, Drs. José Félix Restrepo and Renato Guzmán graduated as rheumatologists. That year also marked the beginning of the Revista Colombiana de Reumatología, the official journal of the CAR. This publication evolved from the Asociación Colombiana de Reumatología Bulletin, which was created in 1971 and published quarterly. It was later succeeded by The Rheumatology Yearbook from 1989 to 1992. The initial editors included Fernando Chalem,13 Mario Peña, and Jorge Escandón, followed by Drs. José Félix Restrepo and Gerardo Quintana, who is currently the Editor-in-Chief. Dr. Quintana graduated as a rheumatologist from UNAL in 2005. Table 2 lists additional rheumatologists who graduated from the UNAL Rheumatology program.
In 2002, the Colombian Foundation for the Support of Rheumatic Patients (FUNDARE) was established by Dr. Fernando Chalem and Mrs. Josefina Bernat. FUNDARE is a private non-profit organization dedicated to advocating for the rights of rheumatic patients and is part of the Arthritis and Rheumatism International network.9
Since 2002, several alumni of the UNAL program have served as presidents of the CAR, including Mario Díaz, Elías Forero, María José Jannaut Peña, Javier Ramírez, Paul Méndez, Andrés Fernández, Carlos Toro, and Diana Gil. These doctors have also contributed to the education of physicians in rheumatology across other institutions and programs in Colombia.
Drs. Antonio Iglesias Gamarra (2014), Rafael Valle Oñate (2016), and Federico Rondón Herrera (2022) have received the Master of Pan-American Rheumatology Award from PANLAR. Additionally, Drs. Yimy Medina (2019) and Gerardo Quintana (2022) were honored with the PANLAR Innovation Award for Fostering Excellence in Pan-American Rheumatology.
Table 1 summarizes the key events in the history of the UNAL Rheumatology Service.
Key historical events of the Rheumatology Unit of The National University of Colombia.
| Date | Event |
|---|---|
| 1960 | Approval of the academic section of Rheumatology of the Department of Internal Medicine of UNAL, founders: Drs. Mario Peña, Humberto Lizarazo, Fernando Chalem |
| 1962 | Doctors Peña, Chalem, and Lizarazo established the Rheumatology Service |
| 1963 | The outpatient Rheumatology Clinic commenced its operations at San Juan de Dios Hospital |
| 1964 | Dr. Mario Peña traveled to Santiago, Chile, for one year to conduct studies in rheumatology |
| 1966 | The Colombian Association of Rheumatology was founded on October 8, 1966, and obtained legal status on May 19, 1967. The founders included Drs. Fernando Chalem, Humberto Lizarazo, and Mario Peña from San Juan de Dios Hospital; Dr. Jorge Escandón, a UNAL graduate from Hospital Samaritana in Bogotá; Dr. Carlos Argáez Castello from San José Hospital in Bogotá; Dr. Carlos Sanín Aguirre from Medellín; and Dr. Arnold Gómez López from Cali. The association's headquarters were located at San Juan de Dios Hospital until 1975 |
| 1966 | Approval by the UNAL Academic Council for the establishment of the Rheumatology Unit, which was created to train undergraduate students and to function as both an Internal Medicine unit and a teaching and research center for the training of rheumatologists. It was the first rheumatology training school in the country |
| 1967 | Dr. Enrique Clavijo Acero was admitted as the first postgraduate student in the specialty of Rheumatology. First Colombian Congress of Rheumatology at the San Juan de Dios Hospital |
| 1968 | The UNAL Rheumatology Unit began receiving doctors from other specialties for practical training, starting with the first cohort from orthopedics and traumatology |
| 1969 | Dr. Enrique Clavijo was the first postgraduate student admitted as a candidate for specialization in Rheumatology |
| 1970 | At the First Colombian Congress of Internal Medicine in Bogotá, abstracts on rheumatic diseases presented by members of UNAL received several awards |
| 1971 | Dr. Enrique Clavijo Acero becomes the first rheumatology specialist in Colombia, receiving his official certification |
| 1973 | Official approval of the UNAL Rheumatology specialty program for the graduation of specialists, as established by Act 8 of Agreement 33A dated March 8, 1973 |
| 1974 | Dr. Pedro Farías obtains the title of the second rheumatology specialist in Colombia |
| 1975 | The Institute of Rheumatology and Immunology, named after Dr. Fernando Chalem, is established. It provided care for low-income patients without social security and hosted students from the UNAL Rheumatology program |
| 1975 | The Journal Acta Medica Colombiana is established as the official publication of the Colombian Association of Internal Medicine. Dr. Fernando Chalem was both the founder and the first editor of the journal |
| 1980 | The third rheumatologist to graduate in Colombia, Dr. Antonio Iglesias Gamarra, is officially recognized with the title of rheumatologist |
| 1981 | Dr. Rafael Valle Oñate, who is the fourth rheumatologist in Colombia, is officially awarded the title of rheumatologist |
| 1983 | The Rheumatology Section of the Santa Fe de Bogotá Hospital Foundation in Bogotá is established by Fernando Chalem Benattar and Jorge Escandón Sorzano |
| 1989 | The Rheumatology Service at the Military Hospital is established by Dr. Rafael Valle |
| 1989 | Doctors Álvaro Moreno and Lacides Padilla established the Rheumatology Unit at the University Hospital of Cartagena, with the agreement formalized on December 23, 1997 |
| 1989 | Doctors Noemi Casas, Mario Díaz, and Federico Rondón established the Colsanitas Rheumatology Clinic |
| 1991 | Dr. Jorge Rueda established the Rheumatology Unit at the Valle de Lili Foundation in Cali |
| 1991 | Dr. Gloria Vásquez graduated as a rheumatologist from UNAL and contributed to the development of academic programs at CES University |
| 1993 | The publication of the Colombian Journal of Rheumatology, the official organ of the Colombian Association of Rheumatology, began. The initial editors were Drs. Fernando Chalem, Mario Peña, and Jorge Escandón |
| 1996 | The Colombian Association of Osteoporosis and Mineral Metabolism (ACOMM) was founded, with Dr. Fernando Chalem serving as its first president |
| 2002 | Mrs. Josefina Bernat de Hurtado, in collaboration with Dr. Fernando Chalem, established FUNDARE, a private, non-profit organization dedicated to protecting and advocating for the rights of rheumatic patients |
| 2012 | Dr. Álvaro Sánchez Contreras was named Master of Rheumatology by PANLAR |
| 2014 | Dr. Antonio Iglesias Gamarra was named Master of Rheumatology by PANLAR |
| 2015 | The National University Hospital of Colombia (Hospital Universitario Nacional), an institution of the National University of Colombia, was officially inaugurated on December 3, 2015 |
| 2016 | Dr. Rafael Valle Oñate was named Master of Rheumatology by PANLAR |
| 2019 | PANLAR Innovation Award: unified and standardized method of joint physical examination to incorporate to clinimetry and determine the activity of rheumatoid arthritis in PANLAR countries by Dr. Yimy F. Medina |
| 2022 | PANLAR Innovation Award: Dr. Gerardo Quintana for his work on Radiographic Remission, Fractal Geometry, and Artificial Intelligence in Rheumatoid Arthritis: RaFAI-RA |
| 2022 | Named Master of Rheumatology by PANLAR: Dr. Federico Rondón Herrera |
| PANLAR (Pan American League of Associations for Rheumatology).UNAL (Universidad Nacional de Colombia) |
List of additional rheumatologists graduated from the Rheumatology Unit at The National University of Colombia.
| Juan Carlos Londoño | Néstor Leonardo Spinel Bejarano |
| Abel González | Diana Rocio Gil Calderón |
| Diego Luis Saaibi | Danny Alexis Gómez Mora |
| Marlio Charry | Alejandro Junca Ramírez |
| Luis R. Zúñiga | Daniel Jaramillo Arroyave |
| María José Jannaut | Carlos Ernesto Arteaga Unigarro |
| Carmen María Arango | Kelly Patricia Vega Castro |
| Philippe Chalem | Neil Smith Pertuz Charris |
| Elías Forero | Vibian Angelica Coy Urrea |
| César Jiménez | Diego Javier Martínez Lozano |
| Carlos Cañas | Marvin Leonel Peña Altamar |
| Samanda Adriana Rojas Villarraga | Huberth Fernando Vela Lozada |
| Paul Alejandro Méndez Patarroyo | José Alex Casallas Osorio |
| Andrés Ricardo Fernández Aldana | Luis Javier Cajas Santana |
| José Bernardo Martínez Vergara | Jorge Armando Abella Pinzón |
| Yenny Soraida Valero Morales | Eybar Alfonso Díaz Ibarra |
| Alain Jasaf Bautista Ramírez | Renan Alberto Morales Abaunza |
| María Claudia Diaz Jiménez | Carlos Andrés Calderón Cordero |
| Paola Ximena Coral Alvarado | María Isabel Narváez Reyes |
| Fausto Antonio Álvarez Fernández | Orfa Yaneth Motta Quimbaya |
| John Jairo Medina Siuffi | Alexis Javier Atuesta Rodríguez |
| Carlos Enrique Toro Gutiérrez | Yised Natalia Prieto Rayo |
| Jimi Lesgardo Mejía Vallejo | Manuela Rubio Rivera |
| Uriel Panqueva Martínez | Daniel Eduardo Medina Torres |
| Fabián Alberto Ramírez Rubio | José Alexander Yate Cruz |
| Vladimir Valderrama Castaño | Henry Fabián Cárdenas Sánchez |
| Carlos Darío Ochoa Rojas | |
| Edgar Alfonso Peñaranda Parada |
The UNAL Rheumatology Unit has faced several significant challenges since its inception. The most notable was the closure of San Juan de Dios Hospital. For over 135 years, the UNAL Faculty of Medicine had a strong partnership with this hospital for training students in health-related fields. After 39 years of collaborative history, the closure of San Juan de Dios Hospital left the Rheumatology Unit without its primary site for education and research. In 2001, the Faculty of Medicine lost its dedicated clinical practice facility, forcing faculty, students, directors, and administrators to seek alternative institutions for clinical training.5,13 This challenging situation persisted until the opening of the Hospital Universitario Nacional (HUN) de Colombia in 2016, which provided significant relief. The HUN has become pivotal at local, regional, and national levels. Its planned expansion in multiple phases represents a major project for UNAL and is considered a key initiative for the Faculty of Medicine.14
Another challenge faced by the UNAL Rheumatology Unit is maintaining high quality and staying at the forefront of technological advances in rheumatology practice. This includes keeping pace with advancements in procedures and therapeutic technologies. The UNAL Rheumatology Unit is also focused on advancing institutional services, health services, and research. Until recently, it was the only rheumatology school in Colombia offering multiple specialization programs in the field. As such, it faces ongoing challenges in maintaining its leading position in the advancement of rheumatological procedures and therapeutic technologies. Addressing these challenges is crucial for ensuring the continued excellence and relevance of the unit's programs and services.
Additionally, the development and integration of “Omics” technologies present another area of challenge. “Omics” encompasses a collection of scientific fields dedicated to the comprehensive exploration of molecular functions, interactions, and regulations within broader biological systems. These fields include genomics, transcriptomics, proteomics, and metabolomics, each focusing on the detailed analysis of specific types of biological molecules within organisms or biological systems.
Contributions and achievements: The UNAL Rheumatology Service has been instrumental in training undergraduate and graduate students for over 50 years. Graduates of the UNAL Rheumatology program have significantly influenced the practice of rheumatology and have held important administrative, managerial, and leadership positions. Notably, UNAL alumni have been foundational in establishing new training programs and centers dedicated to professional education and patient care.
In terms of patient care, the primary objective of the service, UNAL graduates have enhanced the quality of life for individuals with rheumatic diseases by providing specialized and high-quality medical care. They have also contributed to the development of numerous clinical practice guidelines and research projects focused on advanced therapies and up-to-date diagnostic methods. Many graduates have received recognition and awards for their contributions.
The Rheumatology Service has been a vital part of the academic training of medical students, rheumatology residents, and other healthcare professionals, significantly contributing to the development of future doctors and specialists in rheumatology.
Both the Faculty and UNAL graduates have played a key role in the establishment of various scientific societies, including the Colombian Association of Rheumatology (CAR) and the Colombian Association of Osteoporosis and Mineral Metabolism. They have actively participated in these and other national and international medical societies, often holding executive positions (Table 1).
UNAL graduates have pioneered the founding of care centers for patients with rheumatic diseases, such as FUNDARE in Colombia (Table 1). They have also been instrumental in establishing academic centers including Fundación Santa Fe de Bogotá, Hospital Militar Central de Bogotá, the Rheumatology Unit at Fundación Valle de Lili, the Rheumatology Unit at Hospital Universitario de Cartagena, and several private institutions. Additionally, they have been crucial in the creation of journals for the dissemination of internal medicine and rheumatology knowledge, such as the Acta Medica Colombiana, the official journal of the Colombian Association of Internal Medicine, and have participated in various editorial committees.8
In the research field, the UNAL Rheumatology Unit has participated in multiple clinical and scientific investigations to advance the knowledge and treatment of rheumatic conditions. Their contributions range from the publication of original studies in medical journals, clinical practice guidelines, recommendations, and consensuses to collaboration in clinical trials.
An objective that the UNAL Unit has recently had is interdisciplinary collaboration in different health problems, which is why it makes a close alliance with other medical services and specialties to provide comprehensive care to patients and to promote prevention, optimal and early treatment, as well as self-management of rheumatic disorders.
The alliance and collaboration of Dr. Eric Matteson with the UNAL Unit is highlighted. Dr. Matteson, for several years the chief of rheumatology at the Mayo Clinic University, Rochester, Minnesota, USA, has been a volunteer advisor and ally in the realization of several research products and events of the unit. In addition to the reception as a Research and Clinical Practice Fellow by one of the Professors, Dr. Yimy F. Medina graduated as a rheumatologist from the UNAL Rheumatology Service in 2006. The Mayo Clinic University program has been the nationally important rheumatology training program in the United States of America,15 and for a long time, it was the only place in the country where doctors could train in rheumatology. Our UNAL Rheumatology Service has this and other affinities.
Current events and future perspectives: The Rheumatology Service is at the forefront of clinical practice in rheumatology, research, and education. Procedures such as videocapillaroscopy, musculoskeletal ultrasound, and autoimmune diseases are a priority for education and service. They must be performed by a rheumatology specialist. The service performs biopsies on its patients (muscle, salivary gland, sural nerve). It is beginning to participate in evidence-based clinical standards for the management of rheumatic diseases. The clinical standard in Systemic Lupus Erythematosus is an innovative product. The new topics that fellows have the opportunity to study are clinical and molecular pharmacology, evidence-based medicine, clinical immunology, diagnostic imaging applied to rheumatology, the subjects of directed clinical pathology, dermatology, orthopedics and physiatry. Likewise, multidisciplinary collaboration meetings are held for the study of interstitial lung disease, Nephrology-Rheumatology and Dermatology-Rheumatology.
Research contributions and interdisciplinary collaboration: The UNAL Rheumatology Unit has been actively involved in advancing the knowledge and treatment of rheumatic conditions through numerous clinical and scientific investigations. Their contributions include publishing original research in medical journals, developing clinical practice guidelines, and participating in clinical trials.
A recent objective of the UNAL Unit has been to enhance interdisciplinary collaboration. The unit has formed close alliances with other medical services and specialties to provide comprehensive patient care, promote prevention, ensure optimal and early treatment, and support self-management of rheumatic disorders.
A notable collaboration is with Dr. Eric Matteson, formerly the Chief of Rheumatology at the Mayo Clinic, Rochester, Minnesota, USA. Dr. Matteson has served as a volunteer advisor and partner on several research projects and events organized by the UNAL Unit. Additionally, Dr. Yimy F. Medina, a UNAL graduate, was accepted as a Research and Clinical Practice Fellow at the Mayo Clinic, highlighting the strong ties between the two institutions. The Mayo Clinic has long been a leading program for rheumatology training in the United States, and this connection underscores the significance of the UNAL Rheumatology Service's international affiliations.15
Current developments and future perspectives: The Rheumatology Service is at the forefront of clinical practice, research, and education in rheumatology. Key procedures such as videocapillaroscopy and musculoskeletal ultrasound for the management of autoimmune diseases are prioritized for both educational and clinical purposes. These procedures are crucial and must be performed by rheumatology specialists. The service also conducts various biopsies, including those of muscle, salivary glands, and sural nerves, using techniques such as blinded procedures or ultrasonography.
A noteworthy area is ultrasonography in rheumatic diseases. Dr. Enrique Calvo, a professor at UNAL, has significantly contributed to the field by training multiple generations of physicians at UNAL and other universities. This legacy continues with the education provided by Dr. Javier Cajas, who instructs students in the application of ultrasonography for rheumatic conditions.
Currently, the service is developing evidence-based clinical standards for managing rheumatic diseases, including innovative guidelines for Systemic Lupus Erythematosus and recommendations for physical exercise in patients with rheumatic conditions. Fellows have the opportunity to explore advanced topics within the curriculum, such as clinical and molecular pharmacology, evidence-based medicine, clinical immunology, and diagnostic imaging applied to rheumatology. Additional areas of study include clinical pathology, dermatology, orthopedics, and physiatry. Moreover, the service facilitates multidisciplinary collaboration meetings to address complex cases, including interstitial lung disease, and fosters integration between Nephrology-Rheumatology, Dermatology-Rheumatology, and other specialties.
Future objectives: Several key themes outline our future objectives. One major goal is the integration of artificial intelligence (AI) into rheumatology practice. We aim to design an AI application to interpret radiographic indices in rheumatoid arthritis and compare its accuracy with human evaluations, establishing its validity and consistency. The challenge lies in expanding AI applications beyond radiographic analysis to include laboratory work, imaging, and pharmacology. This includes evolving AI with machine learning and deep learning techniques.
Additionally, we plan to pursue research using omics to identify circulating biomarkers and predict the behavior of rheumatic diseases. The integration of AI, advanced technology, and education are crucial areas for our future development.
Another focus for the coming years is to define the role of diagnostic aids, particularly ultrasound, in the early diagnosis, monitoring, and prognosis of rheumatic diseases. We aim for our unit to lead in this area. Moreover, we are committed to advancing patient-centered care through innovative approaches, aiming to achieve significant improvements in morbidity and mortality outcomes.
ConclusionThe Rheumatology Unit of the National University of Colombia is celebrating more than 60 years of activities and 50 years of its official recognition as an academic unit by The National University of Colombia and has accomplished multiple important achievements. The UNAL Rheumatology Service is the first rheumatology school founded in Colombia and has been a pioneer in the practice, education and research of this specialty. It is a clinical and research unit with great adaptability, as demonstrated by the challenges it has faced in the past and present, but which is also preparing for the challenges of the future.
CRediT authorship contribution statementY.F. Medina: conceptualization, methodology, data collection, analysis, manuscript writing, and final approval of the submitted version.
A.I.: data analysis, manuscript writing, and final approval.
Ethical considerationsThis manuscript does not involve human participation, and the authors confirm that it was conducted in accordance with the World Health Organization (WHO) ethical guidelines, as outlined in the Declaration of Helsinki for research involving human subjects. No individuals participated directly in this study, as it is based solely on secondary data. The authors also declare that informed consent is not applicable, as the study is a reflective analysis utilizing only secondary data.
FundingNone declared.
We would like to express our gratitude to Dr. Cilia Rojas and Professor Hugo Fajardo for their contributions to this manuscript.
