UAB Insight Rheumatology Volume 3 - Page 3

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: /physician 3