Cassandra Calabrese, DO, got earlier exposure to rheumatology than most aspiring physicians do. Her father, Leonard Calabrese, DO, has been a rheumatologist-immunologist at the Cleveland Clinic for decades, and she now works alongside him in the same position.
Regardless, Dr. Calabrese says as she progressed in her medical training, she knew her thinking and learning styles made her a good fit for the specialty, which handles the treatment of musculoskeletal and systemic autoimmune conditions commonly referred to as rheumatic diseases.
“I thought it was really cool early on without knowing much about it,” she says. “I was always kind of an imaginative child, and our diseases can present in so many different ways, so it really does require a good investigative mind.”
In this edited Q&A, Dr. Calabrese gives her advice for medical students and residents who may be interested in pursuing a rheumatology fellowship after completing an internal medicine residency, and shares insights about the subspecialty.
What first drew you to rheumatology?
It was the scope and breadth of really complex and puzzling diseases. In rheumatology, we’re often referred to as the detectives, or the Dr. House of medical specialties. The concept of sifting through different medical mysteries was very appealing to me.
Beyond that, our diseases in rheumatology in general span many different organs and other specialties. So I work frequently with dermatologists, pulmonologists, nephrologists and cardiologists. But depending on the patient, I really could end up working with anyone. It’s not always straightforward, which makes it very different and special.
What are some of the more common diseases and conditions you treat?
I see general rheumatology, like rheumatoid arthritis and other types of chronic inflammatory arthritis. But it’s really the whole gamut, including scleroderma, inflammatory myositis, and then my niche in infections in the setting of immunosuppression and rheumatic manifestations of infections, like Lyme arthritis and HIV and a lot of other things. I spend about 20% of my time on immune-related events.
What type of person does well in this subspecialty?
It’s not a blanket statement, but rheumatology is one of the more cerebral medical specialties. You have to like to think a lot both before and after you see a patient. It requires lots of investigating because our diseases mimic many others, and infections mimic our diseases.
So you have to really put all the pieces together. And if something doesn’t fit quite right, you have to explore that and ask for help. Lupus, for example, is what we called the great mimicker, because it can present like many other diagnoses, including infections and cancers, so it involves lots of thinking and investigating.
What advice would you give a medical student or resident who is considering rheumatology?
Start by spending a little bit of time with a rheumatologist. Shadowing and doing a clinical rotation is what I did as a third- and fourth-year student, which really solidified it for me. Exposure is really important—you want to see what they do every day.
I also recommend reading a little bit about the field. In medical school, I dug through Primer on the Rheumatic Diseases, which is one of our big books, but you could also just read through any medical school textbook’s rheum section to get a grasp for the scope of rheumatology and what it encompasses.
It’s cool to even be interested in rheumatology as a student because a lot of people don’t even know what we do. You could train in rheumatology and do anything because it encompasses a lot of things, including immunology.
How The Immune System Works is a cartoony book that I loved and still re-read to remind me of the basics. The fact that I loved that book was also a good indicator that this might be the field for me, because rheumatology and immunology are so intertwined.
What qualities should someone look for in a rheumatology fellowship?
All fellowships are great in their own way. It all depends on personal factors and what you want to learn. Rheumatology fellows often have a niche and spend a lot of their elective time in that niche, so that’s one thing you could look for. One of our fellows right now is really interested in rheum-pulmonary and interstitial lung disease in particular. So she’s working with a pulmonologist, and you can certainly do that with any specialty as a rheumatology fellow.
That may not be the same everywhere, but there are a lot of people who are boarded in rheum and something else, or have subject matter areas they’re knowledgeable about.
What do you enjoy most about your day-to-day?
I enjoy taking care of my patients, which can be challenging and tiring and gratifying. The nice thing about this field, which is another reason people gravitate towards it, is that you have a longitudinal relationship with your patients. Many of them have lifelong diseases, so you’ll get to know them and their families and take care of them for a long time.
Intellectually, I like all of the research that I do and getting to be on the front lines of a lot of new things. One example is COVID, which is a perfect example of immunology and infections overlapping. We have a big role from a research standpoint as many of our drugs are being used to treat the virus.
The other new thing we’re involved in is doing research in the growing field of immune-related adverse events, which are side effects that cancer patients receiving a new class of drugs called checkpoint inhibitors may experience. They can have autoimmune side effects from their treatment, so I also help diagnose, manage, and care for them.