Past and present: Women in reumathology

On December 17th, 1937 something happened to Nanna Svartz. Something she would never forget. She was appointed as full professor of medicine at Karolinska Hospital in Stockholm. 

This was a remarkable event at the time. No woman had previously been trusted with a chair in any of the three universities in Sweden. She didn’t trust herself either because she had seven male opponents and lots of critics. 

But she made it. King of Sweden, Gustav V signed her authorization and Dr. Svartz became a significant (and feared) figure in Swedish and international medicine for almost 50 years. 

An amazing and incredible life that we bring to you today. 

Are you ready? Let’s begin! 

On the first years of her life, Nanna lived with her parents and her four siblings in the city of Västerås, about 100km east of Stockholm. She was the youngest one and she saw how all her siblings died of tuberculosis when she was 10 years old. 

That’s something that changed her forever, as she realized that her family would now depend on her. So, she focused on her studies, and she graduated with high qualifications at the girl’s local school. 

That was just the beginning. Secondary schools only admitted boys so her parents moved to Stockholm. She studied in one of the best private schools. 2 years later she graduated with honors and had a boyfriend that also wanted to study medicine. 

She was accepted in Karolinska where she studied with another 19 students, 18 of them were men. She never minded about it, rather she studied a lot to finish medicine school as soon as possible and marry her boyfriend Nils Malmberg. 

She accomplished that in 1918 with 28 years old. 

During the next few years, Nanna became a dedicated family doctor, always making new friends, even exiled Germans during the nazi regime. 

To keep being able to practice medicine, she had to make a doctoral thesis. This requisite made her be interested on fermentation dyspepsia, and she obtained a little lab where she started to investigate and examining olfactory stool samples to identify microorganisms that absorbed iodine in the crop.

She wrote it in French and approved the exam in 1927. That way she obtained her title of teacher and restarted her clinical work on the department. 

One year later she realized she was pregnant. She didn’t want to mix work and family life, so she focused on working for some scientific projects. When her daughter was one year old, she came back to her department. 

She decided to explore the etiology of rheumatoid arthritis. 

Looking at the microscope, she was very impressed because of the similar look of the intestinal synovial tissue when it’s swollen. She injected some of that synovial tissue on rabbits and she saw how some of them developed swollen joints and lameness.

During the 3rd Congress of Rheumatology of the International League of Associations for Rheumatology (ILAR), she presented all her discoveries, and everyone got really impressed. 

When her mentor, Israel Homgren, was about to retire, him and some other colleagues convinced her to present her application as a teacher. And she achieved it. 

With a great work capacity and an excellent gift for leadership, Nanna became part of the Board Committee of the new Karolinska Hospital. 

She was firmly convinced that RA had a bacterial etiology. Thanks to one of her friends, Gerhard Domagk, she decided so combine the symptomatic effect of aspirin with the one for sulfapyridine. When she accomplished that, thanks to the pharmaceutical company called Pharmacia, the results where a complete success. 

Sulfapyridine improved RA and was used for decades. It was even more efficient in pacients with ulcerative colitis.

During the 70’s the use of sulfapyridine was banned, but British rheumatologists brought it back in 1980 by doing cutting-edge tests.

Nanna’s career as a rheumatologist started in 1941, and since that moment she made lots of changes. Until that moment, rheumatology was part of internal medicine. But Nanna was decided to create specialized departments in university hospitals.  

She became a board member of the Swedish Society of Rheumatology funded in 1946. However, she left a little while after because she didn’t get choose as a president. In 1966 she came back to the society as an honor member. At that time, she already was the co-founder of the European Alliance of Associations for Rheumatology. 

Besides that, she visited as many countries as she could to make new friends and create new contacts. Thanks to that, she created the International Society of Internal Medicine (ISIM). Nowadays they keep celebrating those meetings with 63 members. Nanna assisted to all of them and even participated as a commentator until the age of 90. 

We cannot forget that she became personal doctor for the King Gustav V, treated ambassadors and presidents, along with other high class Swedish families. 

Despite all her success, Nanna suffered from anxiety. Nevertheless, that wasn’t an obstacle for her. She became a model for the next generation of academical women. 

She was determined to do the same or a better job than men. She even preferred to dress as a man, with white shirt and black tie. An ambitious woman with the necessity of having full control of everything, being a promoter of rheumatology in Sweden and of internal medicine all over the world. 

Her memory is still alive with the Nanna Svartz Award and the Nanna Svartz conference awarded every year by the Swedish Society of Rheumatology.

Nanna Svartz opened the door so that many women can study medicine and can be professionally recognized. 

Among all of them, we want to highlight the great work and professionality of Dr. Loreto Carmona, Rheumatologist and Clinical Researcher. Also, she is the Head of InMusc (Institute of Musculoskeletal Health, by his signs in Spanish), in the city of Madrid, Spain. 

At this moment she’s involved in several European projects: the SQUEEZE Project and the SPIDERR Project. 

The first one is focused on squeezing all the existing therapies in rheumatoid arthritis so they can apply the best treatment to every single patient. 

9 European countries bringing out all their studies and models while Dr. Carmona adds them to the clinical practice on a chronical care model. 

“We are studying the European health systems and seeing how they are affecting patients with rheumatoid arthritis”, explains Dr. Carmona when we ask her more about the Squeeze Project. “It is beautiful. I am learning so many things. Because what I say in Spain does not have sense in Greece. Their patients don’t have to go through primary attention first, for example”. 

Also, she says that what she likes the most is to be able to speak about basic science with nurses, sociologists, etc. Very versatile and enriching. 

The Spiderr project is about AI and symptom checkers. 

“When someone has a problem related to a rheumatic disease, for example musculoskeletal pain, they want to know how to give them proper care”, explains. “We can put a spider on the Internet where users can get to some conclusions. For example, if you have a high probability of suffering disease or if you should visit your specialist”. 

There’s also a fascinating part called “The Digital Twins”. It is very helpful, so the rheumatologist is able to know what to do with a complicated patient. An enormous data base where you can do some test and find someone with the same symptoms than the patient they are treating. 

We’ve been collaborating with Dr. Loreto Carmona for over 3 years. And we hope it carries on for a long time. 

Working with her is synonym of efficiency, simplicity and professionality. 

Dr. Carmona has the incredible capacity of transforming something very complex in something clear and easy to understand. That’s her personal touch. 

For this new rheumatic diseases course, Dr. Carmona commented five new numbers talking about cardiovascular risks, menopause and ChatGPT. 

Say that again? 

Yes, exactly what you read. 

Discover “Clinical Collection on Rheumatic Diseases”, a new CMC program with EULAR’S official content. It is accredited with 1,3 credits for 8 teaching hours.