P U B L I C AT I O N S
O F N OT E
Meeting the
Challenges of
Vasculitis
Vasculitis, a set of
diseases characterized
by inflammation of
the blood vessels, are
relatively uncommon but
often highly challenging
to diagnose and treat.
Dr. Angelo Gaffo Vasculitis diseases
and conditions include syndromes
such as giant cell arteritis (formerly
temporal arteritis), Takayasu’s arteritis,
granulomatosis with polyangiitis,
microscopic polyangiitis, polyarteritis
nodosa, and cryoglobulinemic vasculitis.
Vasculitis causes symptoms primarily
through ischemia. “Prompt diagnosis
and treatment is necessary to prevent
irreversible organ damage caused
by blood vessel inflammation and
occlusion,” says rheumatologist Angelo
Gaffo, MD, MSPH.
Because of the variety of organ systems
that can be involved and the complexity
of manifestations, many specialists
contribute substantially to the diagnosis,
so coordination of care is essential.
The UAB Division of Clinical
Immunology and Rheumatology
is an active participant in vasculitis
registries and clinical trials that aim
at better understanding the nature
of the conditions and finding better
treatments. Current studies include
an international collaborative effort to
update and validate diagnostic and
classification criteria for vasculitis and a
multicenter, randomized, double-blind
trial of belimumab in the maintenance
of remission of granulomatosis
with polyangiitis and microscopic
polyangiitis.
Other UAB rheumatologists with
expertise in vasculitis include S. Louis
Bridges Jr, MD, Barri Fessler, MD, and
Robert Kimberly, MD.
2
The UAB Scleroderma Clinic: Management of a Complex
Multisystem Disease
UAB MEDICINE NEWS
Friends of UAB Gather at ACR Session
Stoll, MD, PhD, MSCS, assistant professor of pediatrics, UAB
The UAB Scleroderma Clinic was established 10 years
The UAB Rheumatology reception at the Annual Session of the
Division of Rheumatology; Robert Lafyatis, MD, professor
ago to provide a comprehensive approach to the diagnosis and
American College of Rheumatology was held on November
of medicine, Boston University, Boston; and Laura Hughes,
treatment of scleroderma, other fibrosing disorders, and Raynaud’s
11 at the Renaissance Hotel in Washington, DC. The gathering
MD, MPH, associate professor, UAB Division of Clinical
phenomenon. Led by rheumatologist Barri Fessler, MD, MSPH,
drew some 90 participants to hear an update on the UAB
Immunology and Rheumatology.
the clinic integrates state-of-the-art clinical care with education
Division of Clinical Immunology and Rheumatology and to
and opportunities to participate in genetic, pharmacologic, and
honor Jeffrey R. Curtis, MD, MS, MPH, the division’s first
outcomes research. The clinic efficiently coordinates patients’
recipient of the ACR’s Henry Kunkel Young Investigator Award.
multidisciplinary medical care by working closely with
Iain McInnes Delivers the 17th Cochrane Lecture, on
cardiologists and pulmonologists.
Immune Therapeutics
The clinic provides education about scleroderma and related
conditions. Support groups and educational forums for patients
Iain McInnes, PhD, director, Institute of Infection, Immunity,
and family members are held periodically. In addition, education
and Inflammation of the College of Medical, Veterinary and
of medical students, residents, fellows, and nurses occurs in both
Life Sciences of University of Glasgow, delivered the 17th
clinic and classroom. Finally, a community outreach component
informs established physicians about the latest information on
The scleroderma team, includes from left, Drs. Hughes, Danila,
Fessler, and Trojanowski.
John and Margaret Cochrane Lecture. His talk was entitled,
“Rhe umatology - Pioneering Immune Therapeutics in a New
Century,” and was presented during Medical Grand Rounds
diagnosis and treatment.
other rheumatic diseases. A group of clinicians and researchers
on November 7, 2012. McInnes is a world leader in research
is unknown, so research is critical. UAB is a member of the
in the divisions of Rheumatology and Pulmonary Medicine have
in translational and clinical research in inflammatory arthritis,
Scleroderma Clinical Trials Consortium, which allows patients
formed the UAB Connective Tissue Disease-ILD (CTD-ILD)
particularly rheumatoid arthritis and psoriatic arthritis.
access to novel therapies under investigation. Patients have had
specialty group. This group meets regularly to discuss challenging
Lowe Conference on Rheumatic Diseases
the opportunity to participate in the Scleroderma Lung Study as
patient scenarios and review medical literature. A longitudinal
The Lowe Conference on Rheumatic Diseases was held
well as trials examining the therapeutic efficacy of relaxin, type
clinical database and biospecimen repository allows the group to
October 5 to 7, 2012. Speakers included Eric Ruderman, MD,
1 bovine collagen, bosentan, and other novel agents. In an effort
perform clinical and translational research.
professor of medicine, Division of Rheumatology, Northwestern
Scleroderma’s pathogenesis and ideal treatment approach
to identify genes that influence susceptibility to scleroderma
Fessler sees patients in the Scleroderma Clinic with Martin
and predisposition for specific clinical phenotypes, the clinic
MD, MSPH, provide clinical expertise to the specialty group
sequencing project.
A Phase 3 Randomized, Double-Blind, Multicenter, Placebo-Controlled
Study to Assess the Efficacy and Safety of Lesinurad Monotherapy
Compared to Placebo in Subjects with Gout and an Intolerance
or Contraindication to a Xanthine Oxidase Inhibitor. Ardea study
recruiting for gout patients with inadequate response to Allopurinol.
Lesinurad or placebo will be added to current dose of allopurinol. We are
currently enrolling participants age 19-85 with hyperuricemia of > 6.5
mg/dl on a stable dose of allopurinol for at least 2 months. NCT01510158.
PI: K. Saag, MD. Contact: Kerry Renfroe, 205.934.1444.
University Feinberg School of Medicine, Chicago; Matthew
Rheumatologists Maria Danila MD, MSc, and Laura Hughes,
study and will be participating in a multicenter whole exome
A Multicenter, Randomized, Active-Control, Phase 3B Study to Evaluate
the Cardiovascular Safety of Febuxostat and Allopurinol in Subjects
with Gout and Cardiovascular Comorbidities. Takeda study recruiting
patients with gout and cardiovascular comorbidity. This study is 5
years long and the medication will be a comparison of Allopurinol and
Febuxostat. The patients may be treated for gout, but will washout for 1
week. NSAIDS or Colchicine will be provided for prophylaxis. Enrolling
males 50 and older and females 55 and older with CV morbidities such
as MI, Angina, CVA, Revascularization procedure, TIA, PVD, Diabetes
with micro or macrovascular disease. NCT01101035. PI: K. Saag, MD.
Contact: Kerry Renfroe, 205.934.1444.
Trojanowski, MD, and also leads the CTD-ILD group.
is participating in a multicenter genome-wide association
F E AT U R E D C L INIC A L T R I A L S
on rheumatoid arthritis, Sjögren’s syndrome, and polymyositis/
Interstitial lung disease (ILD) and pulmonary arterial
dermatomyositis-associated lung disease, while pulmonologists
hypertension are the most significant causes of mortality in patients
Joao de Andrade, MD, Tracy Luckhardt, MD, and Victor
with scleroderma. ILD also may occur in association with several
Thannickal, MD, are ILD experts in the group.
continued from cover
gout treatments, and use of a novel, centralized gout clinic.
Gout experts come together in one location to provide
the specialty clinic with not only cutting-edge clinical care
rheumatology, nephrology, and cardiology to understand the
impact of genetics and environmental causes of gout.
The UAB Gout Clinic, located in the Kirklin Rheumatology
from experts but also clinical initiatives focused on quality
Clinic, includes Singh, who coleads the international team
improvement. Upcoming initiatives include patient education,
working on gout outcomes and leads one of the UAB CORT
knowledge dissemination, standardization of collection of
projects; Saag and Bridges; Jeffrey R. Curtis, MD, MS, MPH;
patient-relevant and patient-reported outcomes to improve
and Angelo Gaffo, MD, MSc.
clinical care, and collaborative research among experts in
F OR REF ERR A L S: 1- 8 0 0 - 8 2 2- 6 47 8
MEASURES OF SUCCESS
Outpatient visits
increased almost 19%
from 2011 to 2012 in
the UAB Rheumatology
clinics at The Kirklin
Clinic and UAB Hospital
Highlands. Visits JanNov 2011 numbered
12,744; visits for the
same period in 2012
were 15,105.
Khanna D, Khanna PP, Singh JA,
et al.“2012 American College
of Rheumatology guidelines for
management of gout. Part 1:
Systematic nonpharmacologic
and pharmacologic therapeutic
approaches to hyperuricemia. Part
2: Therapy and antiinflammatory
prophylaxis of acute gouty arthritis.”
Arthritis Care Res. 2012
Oct;64(10):1431-61.
Gaffo AL, Jacobs DR Jr, Sijtsma
F, Lewis CE, Mikuls TR, Saag KG.
“Serum urate association with
hypertension in young adults:
analysis from the Coronary Artery
Risk Development in Young Adults
cohort.” Ann Rheum Dis. 2012 Sep
14. Epub ahead of print.
Gaffo AL, Schumacher HR, Saag
KG, Taylor WJ, Dinnella J, Outman
R, Chen L, Dalbeth N, Sivera F,
Vázquez-Mellado J, Chou CT,
Zeng X, Perez-Ruiz F, Kowalski
SC, Goldenstein-Schainberg
C, Chen L, Bardin T, Singh JA.
“Developing a provisional definition
of flare in patients with established
gout.” Arthritis Rheum. 2012
May;64(5):1508-17.
Monach PA, Warner RL, Tomasson
G, Specks U, Stone JH, Ding L,
Fervenza FC, Fessler BJ, Hoffman
GS, Iklé D, Kallenberg CG, Krischer
J, Langford CA, Mueller M, Seo
P, St Clair EW, Spiera R, Tchao N,
Ytterberg SR, Johnson KJ, Merkel
PA. “Serum proteins reflecting
inflammation, injury and repair as
biomarkers of disease activity in
ANCA-associated vasculitis.” Ann
Rheum Dis. 2012 Sep 12. Epub ahead
of print.
Matucci-Cerinic M, Denton CP, Furst
DE, Mayes MD, Hsu VM, Carpentier
P, Wigley FM, Black CM, Fessler
BJ, Merkel PA, Pope JE, Sweiss NJ,
Doyle MK, Hellmich B, Medsger
TA Jr, Morganti A, Kramer F, Korn
JH, Seibold JR. “Bosentan treatment
of digital ulcers related to systemic
sclerosis: results from the RAPIDS-2
randomised, double-blind, placebocontrolled trial.” Ann Rheum Dis. 2011
Jan;70(1):32-8.
MOR E INF OR M AT ION: uabmedicine.org /physician
3