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  1. 1. Rheumatology-Immunology @ The Cleveland Clinic 2004 In this issue: Letter from the Chairman • Osteoporosis: Clinical Evaluation and Treatment Through Patient Care and Clinical Research • Rheumatoid Arthritis and General Rheumatology • Taking Care of Kids • Clinical Immunology Section • Center for Vasculitis Care and Research • Scleroderma Care and Research • Research and Education Highlights • A Report from the Chairman, Gary S. Hoffman, M.D., M.S. • The Rheumatology Research Support Group • Rheumatology Newsletter Staff Directory • Department of Rheumatic and Immunologic Diseases: Selected Recent Publications 1
  2. 2. Table of Contents 3 Letter from the Chairman 4 Osteoporosis: Clinical Evaluation, Treatment and Clinical Research 6 Rheumatoid Arthritis and General Rheumatology 7 Taking Care of Kids 8 Clinical Immunology Section 10 Center for Vasculitis Care and Research 11 Scleroderma Care and Research 12 Research and Education Highlights A Report from the Chairman, Gary S. Hoffman, M.D., M.S. 13 The Rheumatology Research Support Group 14 Rheumatology Newsletter Staff Directory 15 Department of Rheumatic and Immunologic Diseases: Selected Recent Publications U.S.News & World Report The Cleveland Clinic Department of Rheumatic and Immunologic Diseases has a long history of excellence and innovation in the research and care of patients with illnesses such as arthritis, vasculitis and osteoporosis. For the past several years, U.S.News & World Report has consistently ranked the Department of Rheumatic & Immunologic Diseases among the nation’s top five rheumatology programs in a survey combining physician polling with mortality rates and other data. The Cleveland Clinic Foundation has been consistently designated as one of the top five hospitals in America by U.S.News.
  3. 3. Letter from the Chairman The Cleveland Clinic Foundation’s Department of Rheumatic and Immunologic Diseases has a long-standing commitment to excellence in patient care and training physicians for future generations. The highest quality care depends on continued progress in clinical trials, outcomes research and understanding illness at a genetic, molecular and cellular level. Both clinical and basic research hold the promise of discovering new treatment strategies and cures for our patients. The Department has grown to include individuals with expertise in all areas of clinical rheumatology. Recruitment has emphasized selection of faculty with complementary skills in the clinical, educational and research arenas. We have had the good fortune of growing in an environment that is primed for collaboration in areas related to our own commitments, which include immunology, metabolic bone disease, orthopaedics, cardiovascular medicine and surgery, pathology and imaging. We have benefited from extensive collaborative relationships with valued colleagues around the world. Opportunities for discovery are unprecedented and are likely to bear fruit in large part because of team efforts that ignore intellectual and geographic boundaries. In the following pages, you can visit with members of our Department, meet our specialty teams and collaborators, and consider how we at the “Clinic” can best serve you and your patients. Gary S. Hoffman M.D., M.S. Harold C. Schott Chair and Professor Department of Rheumatic and Immunologic Diseases Lerner College of Medicine The Cleveland Clinic Foundation 3
  4. 4. Osteoporosis: Clinical Evaluation, Treatment and Clinical Research Introduction: The Osteoporosis Team them at risk for fracture. The majority The Center for Osteoporosis and Meta- of fractures occur in patients with os- bolic Bone Disease at The Cleveland teopenia, a T-score between –1.0 and Clinic was established in 1999. Dr. –2.5. Thus the identification of the “at Chad Deal, a rheumatologist, is Head risk” population depends not only on of the Center. Dr. Miriam Delaney, As- measurement of bone mass but identifi- sociate Director of the Center, and Dr. cation of risk factors such as family Angelo Licata, Associate Director of history of an osteoporotic fracture, Clinical Trials, are endocrinologists. prevalent fracture, low body weight, All three have interests in clinical evalu- current smoking, glucocorticoid use ation, treatment and clinical trials. The and many others. The new definition Center has participated in numerous of osteoporosis by consensus is “a randomized controlled trials of drug disease characterized by low bone therapy for treatment of osteoporosis. mass and structural deterioration of Dr. Brad Richmond, a radiologist, is bone tissue, leading to bone fragility Director of Densitometry, and is in and increased risk for fracture.” This charge of 10 dedicated densitometry definition puts new emphasis on bone technicians. “quality,” those factors in addition to Dr. Chad Deal bone density that are important for strength and resistance to fracture. In addition to osteoporosis, the Center sees patients with many Osteoporosis: Clinical Evaluation metabolic bone diseases, including The National Osteoporosis Found- renal osteodystrophy, transplant ation recommends a bone density bone disease, steroid osteoporosis, test in all women over the age of 65. hyperparathyroidism, osteogenesis Postmenopausal women to age 65 imperfecta and others. with risk factors may also require testing. In 1999 only one-third of Bone Deficiency: Bone Summit 2004 women in our clinics over age 65 had The Center, along with the Ortho- received a DXA (dual energy x-ray paedic Research Center, organized absorptiometry). In 2003 over two- and hosted an international conference thirds of women had a DXA. This attended by 187 participants from 12 improvement resulted from an organ- ized effort to educate physicians and practitioners in the Cleveland Clinic Dr. Angelo Licata and trainee system as well as the placement of Osteoporosis: Clinical Impact DXA centers in the Cleveland Clinic There are more than 1.5 million frac- satellite offices. In 2003 more than tures in the United States every year. 11,000 DXAs were performed. A Of the 350,000 hip fractures there is a project to develop a DXA database 20% mortality at 1-year. It is estimated that will combine bone density results that more than 10 million Americans with relevant clinical data is underway have osteoporosis, defined as a T-score and will enable clinical research and of less than –2.5, and another 34 mil- drug trials to proceed at a faster pace. lion have low bone mass that places Dr. Miriam Delaney 4
  5. 5. countries and 17 states. This Summit brought together investigators, clini- cians and industry to meet around issues of osteoporosis, skeletal repair, cell-based therapies for bone growth and skeletal imaging. Osteoporosis: Clinical Trials Numerous clinical drug trials are currently underway or completed at the Center for Osteoporosis and Metabolic Bone Disease. These include evaluation of the anabolic agent parathyroid hormone, rhPTH 1-84 and rhPTH 1-34, PTH in combi- nation with raloxifene, and PTH as a treatment in patients with low bone mass who are on TPN. Use of novel dosing of an oral bisphosphonate, ibandronate, as well as evaluation of the intravenous bisphosphonate zolendronate in men and as an agent to prevent hip fracture are also ongoing. Osteoporosis: Basic Research The Center for Osteoporosis and Metabolic Bone Disease is a multidisci- plinary clinic with participation of rheumatologists, endocrinologists and radiologists. In addition, the Center has strong ties to the Department of Biomedical Engineering, Department of Orthopaedic Surgery and the Orthopaedic Research Center where molecular mechanisms of bone forma- tion, skeletal repair and bone growth using cell based therapies are active areas of basic and clinical research. 5
  6. 6. Rheumatoid Arthritis and General Rheumatology The new biologic agents RITUXIMAB which attenuate the effect Previous pathogenic models of RA of tumor necrosis alfa have emphasized the role of the T-cell (TNF) have revolution- as a pivotal contributor to synovitis ized the treatment of and eventual joint destruction. Con- rheumatoid arthritis (RA). temporary models have demonstrated They are efficacious and the unique participation of the B- safe compared to agents of lymphocyte, particularly in lymphoid past years. The anti-TNF follicle-like structures found in drugs are particularly ef- rheumatoid synovitis. Rituximab fective when combined is a monoclonal antibody which atten- with methotrexate, result- uates B-cell activity. Small open studies ing in remission rates as in RA have suggested efficacy when it high as 37% after one is combined with cyclophosphamide year. Although this remis- or methotrexate. We are currently en- sion rate is far superior rolling patients in a large multi- to that seen with previous centered, double-blind controlled trial combination therapy, still of rituximab added to methotrexate more than half of our pa- for patients who have failed to respond Deformities such as these are tients never achieve remission. There adequately to the combination of uncommon in the modern era of rheumatology. (x-ray from is room for improvement. methotrexate and anti-TNF agents. a patient in 1979) Our group has participated in trials of EARLY ARTHRITIS CLINICS two promising new biological agents. With the introduction of agents that may be capable of inducing remission CTLA4 IMMUNOGLOBULIN and the availability of new diagnostic CTLA-4-Immunoglobulin (CTLA-4-Ig) tools, including anti-cyclic citrullinated blocks the second signal required for protein and magnetic imaging studies T-cell activation in an immune re- of the hands, early diagnosis of RA sponse. Among published studies, our has been facilitated and the impetus to group participated in a pilot, dose-find- treat early and aggressively heightened. ing, double-blind placebo controlled Our group is exploring strategies that multicenter study of 214 patients. The assess the feasibility of early arthritis agent was well tolerated and proved clinics for all patients who have the po- superior to placebo when given at 2 tential to develop erosive joint disease. or 10 mgs/kg. We participated in a Phase III, multicentered, double-blind GENERAL RHEUMATOLOGY controlled trial of CTLA-4 Ig for pa- From the perspective of general tients whose response to etanercept or rheumatology, better understanding infliximab was not acceptable. CTL and efficacious treatment of fibro- A-4 Ig 10 mgs/kg was added to the myalgia (FM) is a challenge. We pre-existing anti -TNF therapy. Results participate in numerous double-blind of this trial have not yet been reported. controlled randomized multicenter trials for the treatment of FM. 6
  7. 7. Taking Care of Kids One of the unique features of pediatric tion and sharing of expertise between children with unexplained periodic rheumatology at The Cleveland Clinic pediatric and adult rheumatologists fever syndromes. Genetic mutations is that it is part of the Department specializing in these entities improve have been identified for many of these of Rheumatic and Immunologic the care of children with these rare syndromes leading to a greater under- Diseases, and not Pediatrics, as in diseases. We also share the expertise standing and more effective treatment. most academic centers in the United of the bone center in the management We work closely with The Cleve- States. There are important advantages of osteoporosis, which is often seen in land Clinic Children’s Hospital for to this arrangement. Most pediatric children with rheumatic diseases, espe- Rehabilitation. This collaboration rheumatology practices are in small cially those treated with steroids. Due enables us to use their services for units consisting of one or two physi- to the reputation of the Clinic, many rehabilitation of children with arthritis cians, thereby being limited in services of our patients are referred from states and pain syndromes, particularly and facilities offered. As part of outside of Ohio and other countries. reflex sympathetic dystrophy or severe the Department of Rheumatic and Rheumatic diseases are less com- fibromyalgia. Immunologic Diseases we share the mon in children than adults. The most There is a national shortage nursing, allied medical professionals, common chronic rheumatic disease of pediatric rheumatologists, so it logistic and research staff of the De- is juvenile idiopathic (formally rheu- is crucial to teach the principles of partment. Many rheumatic diseases matoid) arthritis with a prevalence the discipline to pediatricians and common in adults are rare in children of about 1:1000 children. Based on adult rheumatologists who may en- (including many types of vasculitis and data that radiographic joint damage counter these children in localities systemic sclerosis). Clinical coopera- is usually seen within two years of dis- where pediatric rheumatology services ease onset (earlier by MRI) are not available. Since we are part and that most children with of the Department of Rheumatic and arthritis continue with dis- Immunologic Diseases, adult rheuma- ease into adulthood, we tology fellows are exposed to pediatric treat these children aggres- rheumatology more than in most train- sively with early use of ing programs. methotrexate and new Current research projects include “biologic” medications both industry sponsored and original in children not responsive research. We participate in trials of new to methotrexate. medications for the treatment of juve- We collaborate with nile arthritis. Newer medicines for the other pediatric services treatment of juvenile arthritis are neces- at the Clinic, primarily sary since 10-20% of children do not orthopaedics, ophthalmol- respond to methotrexate or “biologic” ogy, nephrology and other agents. We actively participate in na- subspecialties necessary tional research networks, necessary for treating children with for effective research in pediatric rheumatic conditions. We rheumatology. run a common clinic with For more information, please the Section of Pediatric contact Philip Hashkes, M.D., M.Sc., Infectious Diseases in at 216/444-3250. evaluating and treating Dr. Philip Hashkes and one of his friends. 7
  8. 8. Clinical Immunology Section nel, is part of the AIDS Clinical Trial Group (ACTG). The ACTG is a system of centers involved in clinical trials af- fording the most cutting edge research protocols for treatment as well as inves- tigations of pathophysiology and the numerous co-morbidities and toxicities found in the disease. In addition to the ACTG protocols, the multispecialty HIV clinic is involved with a number of investigator designed initiatives, which emphasize the study of HIV-associated rheumatic diseases. Since 1989, Dr. Calabrese has prospec- tively followed a cohort now of more than 400 HIV infected patients. He and his team have found that, with the intro- duction of combination antiretroviral therapy and the attendant decrease in mortality, there has been a dramatic change in the pattern of rheumatic Dr. Calabrese and Elizabeth Kirchner complications. Other projects include therapeutic and pathophysiologic stud- The Clinical Immunology Section research in HIV disease. Dr. Calabrese, ies in metabolic bone disease as well as of the Department of Rheumatic and who has a joint appointment in the studies of psychosocial issues affecting Immunologic Diseases carries out Department of Infectious Diseases, is adherence to medications. a number of programs in a wide actively involved in day-to-day patient Dr. Calabrese led a team of investi- array of immunologic conditions. care as well as research in HIV disease. gators in publishing their experience of The section, headed by Dr. Leonard He has been doing so since 1983 and performing the first successful cardiac Calabrese, concentrates its efforts was included in the 80 physicians and transplantation in an HIV-infected in three main areas, each with a com- researchers considered pioneers in the patient (Calabrese et. al. New England ponent of clinical care and research. HIV epidemic, described in Voices from Journal of Medicine 348:2319-2324, These areas are 1) immunodeficiency the Epidemic; an oral history (Oxford 2003). disorders 2) chronic viral illnesses and Press 2000). Together with Elizabeth 3) chronic fatigue syndrome. Kirchner, M.S.N., N.P., a certified HIV Chronic Viral Illness specialist, they care for a large number The Clinical Immunology Section has Immunodeficiency Disorders of patients with HIV disease within also focused increasing efforts on the Within the section, a large number the multi-specialty HIV clinic at The evaluation and treatment of patients of adults with primary and secondary Cleveland Clinic. This clinic, which infected with hepatitis C virus (HCV). immune deficiencies is evaluated brings together clinical immunologists, HCV is the most common bloodborne and treated. The main concentration infectious disease specialists, nurse prac- infection in the United States and poses of energy and resources is directed titioners, infectious disease pharmacists, a major public health problem. HCV at programs of integrated care and social workers and other allied person- infects nearly one-third of all HIV- 8
  9. 9. infected patients and is particularly aggressive in that population. In addi- tion to being a leading cause of liver disease, HCV is associated with a wide variety of extra-hepatic rheumatic and immunologic manifestations, especially vasculitis. Dr. Calabrese is interested in further understanding why only some patients are afflicted with these im- munologic complications and finding new and better therapies for both the virus as well as its immunologic mani- festations. (Vassilopoulos D, Calabrese LH. Hepatitis C virus infection and vasculitis: Implications of antiviral and immunosuppressive therapies. Arthritis and Rheumatism 46:585-597, 2002.) the HIV virion Leukocytoclastic vasculitis in a patient with hepatitis C virus infection with cryoglobulinemia Investigators from the Lerner Research Institute performing neurophysiolog- ic studies as part of a three year Department of Defense grant to investigate veterans with Gulf War Syndrome and patients with chronic fatigue syn- drome done jointly with Dr. Calabrese. 9
  10. 10. Projects Center for Vasculitis Care and Research Pathogenesis of WG. Analysis of cytokine gene polymorphisms Investigators: Yihua Zhou, DeRen Huang, Gary Hoffman Utilization of infliximab therapy with longstanding partners at the in giant cell arteritis Mayo Clinic, Johns Hopkins and Investigators: Karen Rendt, Gary Hoffman Boston University. Secondary collabo- Utilization of anti-TNF therapy rations have been developed with more in Takayasu’s arteritis than 30 other centers when it has been Investigators: Gary Hoffman, Patrick Liang necessary for large randomized con- trolled trials. During the past 10 years, Molecular and genomic analysis of vessel wall in GCA the Center and its collaborators in the Investigators: Rula Hajj-Ali, Gary Hoffman United States and abroad have led some of the first randomized controlled Wegener’s Granulomatosis Etanercept trials in vasculitis and are currently Trial (WGET) conducting randomized controlled Investigators: Gary Hoffman, John Stone Carol Langford, M.D., M.H.S. Director, Center for Vasculitis trials using biologic agents. Unprece- (PI- Hopkins) Care and Research dented studies are ongoing with agents Wegener’s Granulomatosis Genetic Reposi- that block TNF, IL1 and B cell propa- tory, (WGGER) The Department includes the Center gation. Linked to clinical trials are Investigators: Gary Hoffman, Jeffrey Edberg for Vasculitis Care and Research which studies that evaluate the genetic predis- (PI-UAB), John Stone (Hopkins) was initiated by Dr. Hoffman, who position and susceptibility to a variety Search for Infectious Etiology of served as its Director through 2004. of vasculitides. In collaboration with Wegener’s Disease Dr. Carol Langford, from the National colleagues at the University of Al- Investigators: Gary Hoffman, Herbert Vir- Institutes of Health, assumed responsi- abama, the first genetics repository gin, (Wash U- PI), John Stone (Hopkins) bility as Director of the Center in using immortalized cell lines has been August 2004. Several other faculty established and will be made available Short Term Cyclophosphamide followed within the Department have special to geneticists throughout the United by alternative therapy in WG Investigators: Alexandra Villa Forte, expertise in vasculitis and participate States to further evaluate disease sus- Gary Hoffman in providing care for vasculitis patients ceptibility profiles. All of these studies and enrolling patients in multicenter are NIH funded or investigator initiated Rituximab in ANCA-Associated Vasculitis studies. The Center enjoys numerous and funded with industry partners. Investigators: John Stone (Hopkins), visiting faculty, on sabbatical, from Listed at left is a sample of recent Ulrich Specks (Mayo) – PIs; Gary Hoffman, Carol Langford, site PIs throughout the world who come to and ongoing studies. study and participate in clinical trials Vasculitis Clinical Research Consortium and basic research. Extensive collabo- Investigators: Peter Merkel (PI-BUMC), rations with other departments have Carol Langford, site PI; Gary Hoffman, been established to bring complemen- site co-PI tary skills to both service and research, Vasculitis Outcome Measures e.g., Dr. Stanley Hazen, Dr. Marie- Investigators: Gary Hoffman, site Luise Brennen, (Diagnostic Cardi- co-PI Development and Validation; ology and Cell Biology), Dr. Tom Carol Langford, site PI Hamilton and Dr. Rula Hajj-Ali (Immunology), Dr. Richard Prayson Utility of rituximab in HCV-associated cryoglobulinemia (Pathology), Drs. Kosmorsky, Perez, Investigators: Leonard Calabrese, Perry and Lowder (Ophthalmology), The Center has derived great benefits from multi- diciplinary collaborations, such as in studies of Carol Langford Dr. Rob Lorenz (ENT) and others. surrogate markers. Pictured are Drs. Hazen and The Center also has thrived be- Brennen (Diagnostic Cardiology) and Drs. Gota Surrogate markers of disease activity cause of collaborative relationships and Hoffman (Rheumatology). in vasculitis Investigators: Gary Hoffman, Stanley Hazen, Marie-Luise Brennen, Carmen Gota 10
  11. 11. Scleroderma Care and Research Dr. Soumya Chatterjee directs sclero- derma research in the Department of Rheumatic and Immunologic Diseases. He joined the Department in January 2004. Dr. Chatterjee trained in rheumatology in England before moving to the United States in 1996. Formerly, he was a rheumatology fac- ulty member at Wayne State University, where his mentor, Dr. Maureen Mayes, inspired his interest in scleroderma. Dr. Chatterjee has been involved Scleroderma and severe Raynaud’s vasospasm in the following research projects: 1. An NIH/NIAMS sponsored ran- 4. Dr. Chatterjee is establishing a scle- domized, double-blind, placebo- roderma database that will collect data controlled multi-center phase II trial on patients who are followed by CCF of oral type I bovine collagen (CI) physicians in internal medicine and the as a toleragen in scleroderma. various sub-specialties. Data will be used to conduct epidemiologic, translational 2. A double-blind, randomized, and outcomes research and help in placebo-controlled study of 122 recruitment of patients for future trials. patients at 17 centers in Europe and North America, to assess the effect 5. Endothelial dysfunction plays a CREST variant of scleroderma of Bosentan on the prevention of important role in the pathogenesis ischemic digital ulcers in systemic of vasculopathy in scleroderma. Dr. sclerosis (RAPIDS 1). Chatterjee is collaborating with the basic scientists at the CCF Lerner 3. A double-blind randomized Research Institute to evaluate the placebo-controlled study looking at microcirculation in scleroderma and the efficacy of Bosentan in patients the effect of various pharmacologic with interstitial lung disease associated interventions on microcirculatory with systemic sclerosis [BUILD-2]. blood flow. Bosentan, an orally active dual endothelin receptor antagonist, has been shown to antagonize the deleterious effects of endothelin, e.g., vasoconstriction, hypertrophy, fibrosis and inflammation. It is FDA-approved for the treatment of severe pulmonary arterial hypertension (PAH). 11
  12. 12. Research and Education Highlights A Report from the Chairman, Gary S. Hoffman, M.D., M.S. Education is a cornerstone of The In addition, all residents in the Cleveland Clinic’s overall mission, Clinic’s Internal Medicine program and members of our department are rotate through the Department of extremely active in multiple areas of Rheumatic and Immunologic Diseases. medical education. Several of our Department members are playing physicians serve the American College a vital role in the new Cleveland Clinic of Rheumatology, performing work Lerner College of Medicine of Case on behalf of the Board of Directors and Western Reserve University. Drs. many committees, including medical Leonard Calabrese, Chad Deal and education, annual meeting planning, Brian Mandell are deeply involved professional meeting planning, work- in providing the immunology and force training and research. A number musculoskeletal curriculae. of our faculty and one of our fellows Research is a crucial component repeatedly serve in “Meet the Profes- of our mission. The department is one sor” sessions during the national ACR of four major medical centers across annual meeting. the country involved in a Vasculitis Members of our faculty are fre- Clinical Research Consortium, part quently invited visiting professors both of the NIH’s Rare Diseases Clinical nationally and internationally. Our Diseases Network. The consortium physicians also have provided literature is fostering and facilitating clinical beyond that linked to research, serving investigation in the vasculitides, which as journal reviewers, journal and book has been a major area of interest in authors and sitting on numerous edito- our department. rial boards. Currently, the department’s research A key goal of the department in- group is recruiting for numerous cludes training the next generation clinical trials. Several areas of interest of rheumatologists. Consequently, include rheumatoid arthritis in adults we emphasize our faculty’s role in and children, osteoporosis, HIV, hepa- being leaders in medical education titis C, cryoglogulinemia, scleroderma, at a departmental, institutional and giant cell Arteritis, Wegener’s granulo- international level. matosis, microscopic polyangiitis and Our two-year fellowship accom- Takayasu’s arteritis. Translational re- modates five to six fellows (two to search is ongoing in vasculitis, especially three per year). An option for a third in regards to studies of surrogate post-graduate year is available and markers of disease activity, pathogen Co-directors of Rheumatology linked to aquiring either an MPH or discovery, genetic profiles of susceptible Education, Drs. Brian Mandell, MSc degree. Fellows have rotations patients and gene expression analyses of Abby Abelson, and Karen Rendt in metabolic bone disease, pediatric targeted vessels in an attempt to identify rheumatology, orthopaedics, spine, substrate vulnerability to disease. podiatry, the vasculitis clinic and musculoskeletal radiology. We offer Dr. Hoffman, chairman of the a one-year vasculitis fellowship for Department of Rheumatic and Im- exceptional board-eligible or board- munologic Diseases, can be reached certified rheumatologists who have directly at 216/445-6996 or 800/553- a primary interest in clinical or basic 5056, ext. 56996. science research aspects of inflamma- tory vascular disease. 12
  13. 13. The Rheumatology Research Support Group The Rheumatology Research Support Group (RRSG) helps develop, plan and administer all clinical research projects within the Department of Rheumatic and Immunologic Diseases. RRSG includes Debora J. Bork, Research Administrator; Sonya Crook, R.N., Research Nurse; Tiffany Clark, C.N.P., Research Nurse Practitioner; Sharon Farkas, R.N., Research Nurse; Eliza- beth Kirchner, C.N.P., Research Nurse Practitioner. The research nurses in the RRSG are experts in clinical research, having been involved in clinical trials for many years. They can take a study from start to finish. During the study, they plan and implement patient re- cruitment strategies, educate potential study participants, schedule and per- form patient visits and complete data collection forms. Tiffany Clark, C.N.P., is a co- From left to right: Sonya Crook, Sharon Farkas, Debora Bork and Tiffany Clark (Elizabeth Kirchner not pictured) investigator and study coordinator for the vasculitis research projects in the Department. Elizabeth Kirchner, C.N.P., has with study sponsors and a consultant involved in the Vasculitis Clinical Re- provided clinical research support for providing advice regarding study search Consortium, a part of NIH’s HIV studies, including those sponsored design and operational issues. Rare Diseases Clinical Diseases Net- by the AIDS Clinical Trials Group The group has many ongoing work. The Department Chairman is (ACTG). Her contributions include clinical trials in several different sub- also the founder of the International collaborative relationships with col- specialty areas including rheumatoid Network for the Study of Systemic leagues in Infectious Diseases and the arthritis in adults and children, osteo- Vasculitides. Basic and translational ACTG unit at the Case Western Re- porosis, scleroderma, large vessel research has focused on immune serve University School of Medicine. vasculitis, microscopic polyangitis, susceptibility profiles, target organ Debora Bork provides administra- Wegener’s granulomatosis, cryoglobu- vulnerability in vasculitis, as well as tive oversight for the entire Depart- linemia and hepatitis. The Department biochemical mediators and surrogate ment’s research efforts. She is a liaison is one of four major medical centers markers of vessel injury. 13
  14. 14. Staff Directory Gary Hoffman, M.D., M.S. Chad Deal, M.D. Daniel Mazanec, M.D. Chairman, Department of Head, Center for Osteoporosis Cleveland Clinic Spine Institute, Rheumatic & Immunologic and Metabolic Bone Disease Rheumatic and Immunologic Diseases. Professor and Office: 216/444-6575 Diseases Harold C. Schott Chair, in Specialty Interest: Office: 216/444-6191 Rheumatic & Immunologic Osteoporosis, metabolic Specialty Interest: Diseases bone disease Medical spine Office: 216/445-6996 Specialty Interest: Vasculitis Miriam Delaney, M.D. Karen Rendt, M.D. Associate Head, Center for Program Co-Director, Matthew Bunyard, M.D. Osteoporosis & Metabolic Rheumatic and Immunologic Senior Staff Physician Bone Disease Diseases Office: 216/445-3460 Office: 216/444-9654 Office: 216/445-4236 Specialty Interest: General Specialty Interests: Osteoporo- Specialty Interests: Vasculitis, rheumatology sis, transplant bone disease, systemic lupus erythematosus, metabolic bone disease, disor- rheumatoid arthritis, psoriatic ders of calcium homeostasis, arthritis, other inflammatory steroid osteoporosis arthritides, other autoimmune illnesses Leonard Calabrese, D.O. Vice Chairman, Department of Philip Hashkes, M.D., M.Sc. Raymond Scheetz, M.D. Rheumatic & Immunologic Head, Section of Pediatric Senior Staff Physician Diseases. Professor and Rheumatology Office: 216/444-5625 R.J. Fasenmyer Chair in Office: 216/445-8525 Specialty Interests: Metabolic Clinical Immunology Specialty Interests: Pediatric joint disease, rheumatoid Office: 216/444-5258 rheumatology, drug therapy arthritis, lupus, relapsing Specialty Interests: AIDS, of arthritis, periodic fever polychondritis, myositis vasculitis, myositis, chronic syndromes fatigue syndrome William Wilke, M.D. Anna Koo, M.D. Senior Staff Physician John Joseph Carey, M.D. Senior Staff Physician Office: 216/444-5624 Clinical Associate Office: 216/444-3247 Specialty Interests: Drug treat- Office: 216/445-6996 Specialty Interests: Therapeu- ment of rheumatoid arthritis, Specialty Interests: General tic apheresis, general giant cell arteritis, polymyalgia rheumatology and metabolic rheumatology rheumatica, fibromyalgia, bone disease chronic fatigue syndrome, Sjogren’s syndrome Carol Langford, M.D., M.H.S. Soumya Chatterjee, M.D., M.S. Director, Center for Vasculitis Abby Abelson, M.D. Senior Staff Physician Care and Research Associate Staff Physician Office: 216/444-9945 Office: 216/445-6056 Office: 216/839-3840 Specialty Interests: Specialty Interest: Vasculitis Specialty Interests: General Scleroderma, rheumatoid rheumatology, metabolic arthritis, lupus, myositis bone disease Brian Mandell, M.D., Ph.D. John Clough, M.D. Program Co-Director, Rula Hajj-Ali, M.D. Senior Staff Physician Rheumatic and Immunologic Clinical Associate Office: 216/444-5627 Diseases. Professor of Office: 216/444-9643 Specialty Interests: Systemic Medicine, Vice Chairman of Specialty Interests: General lupus, immune deficiency Medicine for Education rheumatology, vasculitis disease, rheumatoid arthritis Office: 216/445-6580 Specialty Interests: Vasculitis, cyrstal induced arthritis, systemic lupus, myositis, multisystem involvement from autoimmune disease 14
  15. 15. Department of Rheumatic and Immunologic Diseases: Selected Recent Publications Calabrese LH, Albrecht M, Young J, McCarthy Hashkes PJ, Friedland O, Jaber L, Cohen HA, Liang P, Tan-Ong M, Hoffman GS. Takayasu’s P, Haug M, Jarcho J, Zackin R. Successful car- Wolach B, Uziel Y. Decreased pain threshold in arteritis: vascular interventions and outcomes. diac transplantation in an HIV-1-infected patient children with growing pains. J Rheumatol J Rheumatol 2004;31:102-106. with advanced disease. N Engl J Med 2004;31:610-613. 2003;348:2319-2324. Maksimowicz-McKinnon K, Hoffman GS. Hoffman GS, Calabrese LH. Vasculitis 2003: Ed- Crohn’s disease plus Takayasu’s arteritis: more Hoffman GS, Cid MC, Hellmann DB, et al. A itors. Clinical and Experimental Rheumatology than coincidence? Ann Med Interne multicenter, randomized, double-blind, placebo- 2003;21(6)(Suppl 32):S1-S139. 2003;154:75-76. controlled trial of adjuvant methotrexate treatment for giant cell arteritis. Arthritis Rheum Hoffman GS, Thomas-Golbanov CK, Chan J, Vassilopoulos D, Younossi ZM, Hadziyannis E, 2002;46:1309-18. Akst LM, Eliachar I. Treatment of subglottic Boparai N, Yen-Lieberman B, Hsi E, Villa-Forte stenosis, due to Wegener’s granulomatosis, with A, Ball E, Kimberly RP, Calabrese LH. Study of Gota C, Calabrese LH. Induction of clinical au- intralesional corticosteroids and dilation. J host and virological factors of patients with toimmune disease by therapeutic Rheumatol 2003;30:1017-1021. chronic HCV infection and associated laboratory interferon-alpha. Autoimmunity 2003;36:511- or clinical autoimmune manifestations. Clin Exp 518. Hoffman GS, Calabrese LH, Liang P. Vasculitis. Rheumatol 2003;21(Suppl 32):101-111. In: Smolen JS, Lipsky PE, eds. Targeted therapies Maksimowicz-McKinnon K, Bhatt DL, Cal- in rheumatology. London; New York: Martin Vassilopoulos D, Niles JL, Villa-Forte A, Arroliga abrese LH. Recent advances in vascular Dunitz; 2003:583-601. AC, Sullivan EJ, Merkel PA, Hoffman GS. Preva- inflammation: C-reactive protein and other in- lence of antineutrophil cytoplasmic antibodies in flammatory biomarkers. Curr Opin Rheumatol Hoffman GS. Large-vessel vasculitis: unresolved patients with various pulmonary diseases or mul- 2003;16:18-24. issues. Arthritis Rheum 2003;48:2406-2414. tiorgan dysfunction. Arthritis Rheum 2003;49:151-155. Hajj-Ali RA, Furlan A, Abou-Chebel A, Cal- Hoffman GS, Markel PA, Brasington RD, abrese LH. Benign angiopathy of the central Lenschow DJ, Liang P. Anti-tumor necrosis Vassilopoulos D, Calabrese LH. Rheumatic as- nervous system: Cohort of 16 patients with clini- factor therapy in patients with difficult to treat pects of human immunodeficiency virus infection cal course and long-term followup. Arthritis Takayasu’s arteritis. Arthritis Reum 2004; and other immunodeficient states. In: Hochberg Rheum 2002;47:662-669. 50:2296-2304. MC, ed. Rheumatology. 3rd ed. Edinburgh; St. Louis: Mosby; 2003;2:1115-1129. Deal C. The use of intermittent human parathy- Langford CA, Sneller MC. Biologic therapies in roid hormone as a treatment for osteoporosis. the vasculitides. Curr Opin Rheumatol Zhou Y, Huang D, Farver C, Hoffman GS. Rela- Curr Rheumatol Rpts 2004;6:49-58. 2003;15:3-10. tive importance of CCR5 and antineutrophil cytoplasmic antibodies in patients with We- Kifor O, Moore FD, Delaney M, Garber J, Langford CA, Talar-Williams C, Barron KS, gener’s granulomatosis. J Rheumatol Hendy GN, Butters R, Gao P, Cantor T, Kifor I, Sneller MC. Use of a cyclophosphamide induc- 2003;30:1541-1547. Brown EM, Wysolmerski J. “Autoimmune” Fa- tion methotrexate maintenance regimen for the milial Hypocalciuric Hypercalcemia (FHH) treatment of Wegener’s granulomatosis: ex- Caused by Blocking Autoantibodies to the Cal- tended follow-up and rate of relapse. Am J Med Recent Books and Symposia: cium-Sensing Receptor (CaR). J Clin Endocrinol 2003;114;463-9. Hoffman GS, Weyand CM, eds. Inflammatory Metab 2003;88:60-72. Diseases of Blood Vessels. New York: Marcel Langford CA, Balow JE. New insights into the Dekker, Inc.; 2002. Delaney MF, Hurwitz S, Shaw J, LeBoff MS. immunopathogenesis and treatment of small ves- Bone density changes with once-weekly rise- sel vasculitis of the kidney. Curr Opin Nephrol Hoffman GS, Stone JH, eds. Proceedings of dronate in postmenopausal women. J Clin Hypertens 2003;12:267-72. the 10th International Vasculitis and ANCA Densitom 2003 Spring;6(1):45-50. Workshop. Cleve Clinic J Med; 2002; Langford CA. Wegener’s granulomatosis: current 69(Suppl 2):SII1-192. Furspan PB, Chatterjee S, Freedman RR. In- and upcoming therapies. Arthritis Res Ther creased tyrosine phosphorylation mediates the 2003;5:180-191. cooling-induced contraction and increased vascu- lar reactivity of Raynaud’s disease. Arthritis Robinson MR, Lee SS, Sneller MC, Lerner R, Rheum 2004;50:1578-1585. Langford CA, Talar-Williams C, Cox TA, Chan CC, Smith JA. Tarsal-conjunctival disease associ- Hashkes PJ. Profile of a pediatric rheumatology ated with Wegener’s granulomatosis. practice in Israel. Clin Exp Rheumatol Ophthalmology 2003;110:1770-1780. 2003;21:123-128. 15
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