Laying the Foundation of Rheumatology at AIIMS, New Delhi

Anand N. Malaviya, MD, FRCP (Lond.), ‘Master‘-ACR & APLAR
Consultant Rheumatologist, A&R Clinic and Visiting Senior Consultant, ISIC Superspeciality Hospital, New Delhi

How did the rheumatology services at AIIMS start?

In 1968 Prof. KL Wig, the HoD Medicine and Director, AIIMS envisioned a division of Clinical Immunology in his department, which led to a worldwide advertisement for a trained Clinical Immunologist for the position of Assistant Professor in the Department. Exactly then, I had just completed a 4-year Fellowship in Clinical Immunology from the New England Medical Centre in Boston, USA under the tutelage of Professor Robert Schwartz, who discovered ‘Chemical Immunosuppression’, the discovery that paved the way for future organ transplants.

Prof. V Ramalingaswamy, HoD Pathology at AIIMS was the designated ‘Expert’ to identify a Clinical Immunologist. Seeing AIIMS’s advertisement in ‘India News,’ a popular bulletin from the Indian Embassy in the USA, I applied for this position. Luckily, Prof. Ramalingaswamy was impressed by my 2 latest publications and recommended my appointment even without an interview. That’s how I joined the Department, as an Assistant Professor, in September 1968 and started my journey to establish a division of Clinical Immunology.

Early days and key figures in the division of clinical immunology?

With the help of Prof. Ramalingaswamy’s Department of Pathology, and Prof. LN Mohaparta’s Department of Microbiology, I set out to develop a Clinical Immunology Laboratory to perform tests for the various auto antibodies as none of those tests were available anywhere in the country at that time. Clinical Immunology had to be developed without any imports of equipment, chemicals, reagents, or diagnostic kits as India was a closed economy. Once our lab was established, we started diagnosing more cases of autoimmune diseases from all over the country, improving their care, and thus the division of Clinical Immunology became fully functional and started flourishing from 1970 onwards under the leadership of Prof Dr. MMS Ahuja, HoD Medicine at that time.

With the help of several visiting Clinical Immunologists (Professors Senga Whittingham and Ian Mackay from Melbourne, Prof TE Feltkamp from ‘Serum Institute’, Denmark, Prof John Holborow from London, Prof Stratis Avrameas from Paris, France among others) a fully functioning Clinical Immunology laboratory was finally established on the 4th floor of the Teaching Block. All the reagents needed for the tests were prepared in-house with the help of 3 laboratory technicians and ample support from AIIMS’s ‘Animal House’. The help provided by Dr. UN Bhuyan (Department of Pathology), Dr. Ramesh Kumar (Department of Microbiology), and Dr. NK Mehra (Department of Transplant Immunology and Immunogenetics), was invaluable, without which this would not have been possible.

How did the department evolve to clinical rheumatology?

AIIMS, New Delhi was the first institution in the country to start performing autoantibody tests (by IIF) using kits and reagents that were developed in-house (ANA, Anti-dsDNA test on Crithidia luciliae, ANCAs, Anti-thyroid microsomal, anti-gastric parietal cell, and anti-GBM antibodies). By the 1980s, some of these tests were switched over to the ELISA test, and soon the technique was mastered by the then Clinical Fellow in Clinical Immunology, Dr. Ramnath Misra (who later became HoD, Department of Clinical Immunology, SGPGI, Lucknow). As the number of cases referred, diagnosed, and managed by us increased, a separate Immunology Clinic was started in the afternoons twice a week. A full-time Senior Resident was given to our section in the mid-1980s and Dr. Ram Raj Singh was the first person in this position. By the early 1990s, the clinic was flooded with so many patients of all varieties of systemic autoimmune diseases that the name of this specialty was changed to Clinical Immunology & Rheumatology Services. And today, I am happy and feel proud to see a separate department of Clinical Immunology & Rheumatology at AIIMS, New Delhi, and many other institutions across the country. For this achievement, the current HoD Prof. Uma Kumar’s herculean efforts deserve special mention.

By 1994, we had more than 250 publications, 2 Ph.D. theses, and more than 30 MD theses (one of the most notable among them is Prof. Bhaskar Dasgupta of Giant Cell Arteritis fame)from the Department.

Do you feel the vision you had for this field has come true?

We still have a long way to go. Though my own trainees such as Dr. Ashok Kumar, Dr. Ramnath Misra, Dr. Rohini Handa, Dr. Amita Agarwal, and other colleagues in India have carried the torch ahead and trained many more doctors in this field, access to structured training needs to be improved. I feel all teaching institutions in the country should have this specialty now. Other institutes and centers should also work to teach and train and strengthen the advocacy of this unique branch of internal medicine.