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DIVISION OF RHEUMATOLOGY 2009-2010 ANNUAL REPORT INVESTIGATION TO INNOVATION IN COMPLEX AUTOIMMUNE DISEASES


CONTENTS LEADERSHIP REPORT

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CENTERS OF EXCELLENCE Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis

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Osteoarthritis

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Systemic Lupus Erythematosus and Antiphospholipid Syndrome

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Scleroderma, Vasculitis, and Myositis

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Metabolic Bone Disease and Orthopaedic Bone Health

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Pediatric Rheumatology

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PROFESSIONAL STAFF

On the cover: (Left) Jane E. Salmon, MD, has garnered an international reputation for her scientific accomplishments in systemic lupus erythematosus and antiphospholipid syndrome. Dr. Salmon’s leadership of the PROMISSE study has resulted in continued National Institutes of Health competitive funding, supporting multicenter studies at 11 academic centers across the country to investigate predictors of poor pregnancy outcomes in patients with lupus and APS. (Right) Rheumatology fellow Beverly Johnson, MD, talks with Simone Devone, a patient with the Mary Kirkland Center for Lupus Care. Ms. Devone’s visit to the Mary Kirkland Center will involve a comprehensive evaluation that will include medical assessments, as well as a discussion on the many resources available to her for support and education. On this page: Patients cared for by Jessica K. Gordon, MD, and Thomas J.A. Lehman, MD, Chief of Pediatric Rheumatology, benefit from the Division of Rheumatology’s mission to provide the highest quality patient care for people with rheumatic disease and autoimmune disorders and to pursue research that will lead to improvements in therapies and outcomes.

Department of Medicine

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Research Division

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Endowed Chairs, Professorships, and Fellowships

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2009-2010 NOTABLE ACHIEVEMENTS

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2009-2010 SELECTED PUBLICATIONS

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2009-2010 RHEUMATIC DISEASE FELLOWS

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INVESTIGATION: THE SCIENCE OF SYSTEMIC LUPUS ERYTHEMATOSUS

For more than 40 years, Hospital for Special Surgery scientists have been investigating the myriad manifestations of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) at the molecular level, bringing their findings to bear on managing SLE and APS and their complications in patients. In 1993, the Hospital became the nation’s first National Institutes of Health-sponsored Specialized Center of Research in SLE, and since then has developed one of the largest registries of adult and pediatric lupus patients in the United States, with more than 1,000 patients enrolled. Today, basic, translational, and clinical research continues in earnest with a focus on identifying immune system triggers, uncovering the role of interferon and other immune system mediators, and causes of disease activity and flares. Through the Mary Kirkland Center for Lupus Research, studies have revealed compelling

Michael D. Lockshin, MD, and Doruk Erkan, MD, MPH, rheumatologists in the Division’s Barbara Volcker Center for Women and Rheumatic Diseases, are investigating a number of critical areas, including antiphospholipid syndrome, pregnancy outcomes, and neurological function in lupus.

Alessandra Pernis, MD, is studying signaling pathways that control both physiologic and pathologic T cell responses, with a goal to gain a better understanding of the pathogenesis of autoimmune diseases like SLE and provide important information for the development of novel therapeutic regimens.

support for a central role for interferon-alpha in lupus pathogenesis and provided evidence that interferon-alpha activity is an inherited genetic trait associated with more severe lupus flares. With verification that lupus patients are at risk for accelerated atherosclerosis, we initiated investigations to examine the relationship between endothelial biomarkers of vascular inflammation and lupus disease activity in collaboration with the Division of Cardiology at Columbia University College of Physicians and Surgeons. Additionally, HSS researchers are involved in multiple clinical trials for antiphospholipid antibody positive (aPL), including difficult-to-treat APS patients, and pursuing the identification of factors that increase the risk of blood clots.


INNOVATION: ADVANCING PERSONALIZED CARE AND DISEASE PREVENTION

In 2009, there were nearly 3,000 visits to the Hospital’s Division of Rheumatology by patients with lupus. In the Mary Kirkland Center for Lupus Care, rheumatologists, fellows, nurses, social workers, physical therapists, and nutritionists work collectively on behalf of patients, providing continuity of care for their chronic conditions, offering opportunities to participate in clinical trials, and integrating knowledge gleaned from the Division’s research endeavors into therapeutic interventions and prevention programs. One such program, established by Doruk Erkan, MD, MPH, Clinical Co-Director of the Mary Kirkland Center, addresses the critical issue of cardiovascular disease in lupus and aPLpositive patients. The Cardiovascular Disease Prevention Counseling Program includes comprehensive risk assessments conducted by Virginia F. Haiduc, MD, the program’s coordinator, as well as education and tailored lifestyle recommendations. The SLE registry follows a large cohort of patients longitudinally, looking not only at aspects of their lupus, but at comorbidities as well. These include cardiovascular disease,

Every Friday morning, the Mary Kirkland Center for Lupus Care holds a multidisciplinary conference to discuss patient cases.

pregnancy history, and other autoimmune diseases family members may have. The extremely valuable database, and its corresponding bio-bank, is shared with investigators around the world, facilitating the translation of clinical science to improved health of patients with lupus here and abroad. “The complexity of disease in systemic lupus erythematosus and antiphospholipid syndrome creates management challenges that require a multidisciplinary approach for optimal patient outcomes,” says Dr. Erkan. “Our specialized disease center facilitates the comprehensive care of patients, provides highly focused training for rheumatic disease fellows, and illustrates the signficance of the ongoing integration of research.”

The Mary Kirkland Center for Lupus Care is a model of collaboration. (Photo, left) Monica Richey, MSN, NP, Nurse Coordinator, screens all new patients and manages ongoing care. (Center photo, from left) As manager of the Center, Pretima Persad, MPH, works closely with all departments so that patients receive optimal care and the services that they require; Kyriakos A. Kirou, MD, DSc, is the Clinical Co-Director of the Center; Suzy Kim, LCSW, Social Work Manager, evaluates patients for their psychosocial needs; and Erica Sandoval is the Program Associate for the Charla de Lupus (Lupus Chat) peer health education program. (Photo, right) Nutritionist Sotiria Everett, MS, RD, CDN, CSSD, and Virginia F. Haiduc, MD, consult on the dietary needs of the Center’s patients. (Opposite page) Beverly Johnson, MD, continues her evaluation of Simone Devone, a patient in the Mary Kirkland Center.


At Hospital for Special Surgery, clinicians and researchers are aligned in the pursuit of therapies that will improve the care for patients with autoimmune diseases and rheumatological disorders, continually crossing the bridge from bench to bedside. As you will read in the Division of Rheumatology’s 2009-2010 Annual Report, investigations in the laboratory combined with clinical insight carry the potential for major breakthroughs and innovations in the treatment of such complex diseases as lupus and scleroderma, and for improving the outcomes of patients with rheumatoid arthritis, osteoarthritis, and osteoporosis, while fostering a collaborative, comprehensive, and compassionate approach to care.


CENTER OF EXCELLENCE: LEADERSHIP REPORT:

A MESSAGE FROM RHEUMATOID ARTHRITIS, THE PHYSICIAN-IN-CHIEF PSORIATIC ARTHRITIS, AND CHAIRMAN, ANKYLOSING DIVISION SPONDYLITIS OF RHEUMATOLOGY

As Physician-in-Chief and Chairman of Rheumatology at Hospital for Special Surgery, I begin my tenure honored to be among the esteemed leaders who have preceded me in this role. I am particularly grateful to my predecessor, Stephen A. Paget, MD, FACR, FACP, who continues to be the model physician and master educator to whom we look for guidance and inspiration. I am also privileged to be joined by an outstanding team of clinicians, scientists, and healthcare professionals who are committed to ensuring that our patients receive the best possible care with the newest therapeutic treatments. One of my key goals will be to continue integrating our clinical, research, and education activities, emphasizing our role as a national academic leader in rheumatology. At Hospital for Special Surgery, we have many examples of the success of bringing together multiple specialties and disciplines in both science and medicine to further patient care and advance the science of autoimmune, inflammatory, and musculoskeletal diseases. The Mary Kirkland Center for Lupus Care is a case in point. The Center launched in 2009 with a strong clinical focus by experts in lupus, interwoven with researchers who comprise the Mary Kirkland Center for Lupus Research, established in 2001. This collaboration is fostering a rich educational experience for trainees, faculty, and staff; innovative clinical and translational research; valuable outcomes studies; and improved care for patients.

Patient Care Initiatives As a component of the Department of Medicine and through collaborations with the Department of Orthopaedic Surgery, the Division of Rheumatology is able to offer HSS patients comprehensive and seamless care. The Comprehensive Arthritis Program, co-led by Rheumatology and Orthopaedic Surgery, provides medical and surgical care in one setting for patients who have a systemic disease with a major musculoskeletal manifestation, as well as important educational experiences for residents and fellows. These patients are at higher risk of infection than the typical surgical patient, and are more likely to have cardiovascular disease and other co-morbidities. Perioperative medicine is a particularly significant growth area. Of the approximately 500 hip and knee arthroplasty operations performed monthly at HSS, 15 percent are patients with inflammatory rheumatic diseases such as SLE and RA. Multiple projects are underway to better understand the unique

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challenges faced by this population, including a review of the perioperative management of rheumatic disease patients by Susan M. Goodman, MD, and C. Ronald MacKenzie, MD. An extensive arthroplasty patient database, established with support of the Weill Cornell Medical College/HSS Center for Education and Research on Therapeutics, provides a source of data for research studies led by Lisa A. Mandl, MD, MPH, Dr. Goodman, and their surgical colleagues. Among the studies in progress are those defining optimal timing of TNF inhibitor administration at the time of arthroplasty in RA patients to minimize perioperative infection and flares, and a project looking at surgical outcomes and short-term complications in patients with SLE compared to non-SLE patients with avascular necrosis. Achieving the highest levels of quality care and patient safety is a high priority at Hospital for Special Surgery. In support of this mission, the Hospital has created a Quality Research Center with an innovative structure for applying research methodologies to healthcare quality issues. Under the direction of Steven K. Magid, MD, the Center brings together physicians, nurses, biostatisticians, and other healthcare professionals to work together on research in patient care quality and safety. The Quality Research Center will facilitate a system to gather and share data and data sources, and link quality outcomes with laboratory systems, demographics, and financial systems. Among its first research initiatives is a falls prevention study, based on more than 10 years of retrospective data gathered by the Nursing Department. HSS physicians will have the opportunity to propose new research projects addressing important patient safety issues and compete for support from the Quality Research Center.

Research Imperatives In further developing our disease-focused centers of excellence, we will continue to establish links among basic, translational, and clinical research investigators and providers of clinical care. Rheumatologist Steven R. Goldring, MD, Chief Scientific Officer, is advancing Special Surgery’s research mission to translate basic science findings into new ways of treating and preventing inflammatory diseases and musculoskeletal disorders. A major focus of our research efforts is the creation of disease registries that will drive improvements in patient outcomes. Among our current registries are a multicenter NIH-funded registry of


Mary K. Crow, MD, Physician-in-Chief and Chairman of the Division of Rheumatology, Hospital for Special Surgery, and the Joseph P. Routh Professor of Rheumatic Diseases in Medicine, Weill Cornell Medical College

biomarkers of pregnancy outcomes in patients with systemic lupus erythematosus and antiphospholipid syndrome led by Jane E. Salmon, MD; an Antiphospholipid Syndrome Collaborative Registry led by Doruk Erkan, MD, MPH; a Scleroderma Registry and Repository directed by Robert F. Spiera, MD, and Jessica K. Gordon, MD; and a Rheumatoid Arthritis Registry developed by Sergio Schwartzman, MD. In 2009, Special Surgery scientists were awarded more than $2.8 million in research grants through the federal stimulus package, funded by the NIH. Among them are Carl Blobel, MD, PhD, for his research on ADAM family metalloproteinases, which play critical roles in rheumatoid arthritis, and Jane E. Salmon, MD, who received a grant supplement for gene expression studies in patient samples from her multicenter study on pregnancy complications and loss in patients with SLE and APL, and a second grant to examine the role of antiphospholipid antibodies in pregnancy complications and loss using an animal model of APS. A highlight of the past year was our recruitment of Alessandra Pernis, MD, to the HSS faculty. Dr. Pernis is an outstanding immunologist whose research into lymphocyte signaling pathways has identified candidate therapeutic targets relevant to SLE and inflammatory arthritis. One of the strengths of HSS that attracted Dr. Pernis was our well-developed patient resources, which she will be accessing in order to extend her important studies from murine models to human patients. Her broad expertise and engaging and collaborative spirit have already stimulated exciting collaborations with other HSS investigators. The Hospital recently created an Osteoarthritis Initiative to establish an integrated basic, translational, and clinical research program that focuses on each stage of the disease. We are collaborating with surgeons who perform anterior cruciate ligament and total joint arthroplasty procedures to characterize the molecular and cellular composition of synovial tissue at various stages of OA and relate those results to clinical manifestations of disease. Collaborative studies between Sergio Schwartzman, MD, and investigators at The Rockefeller University are defining the molecular characteristics of anti-cyclic citrullinated antibodies (continued on page 5) produced by B cells from rheumatoid arthritis patients.

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LEADERSHIP REPORT:

PIONEERING SUPPORT AND EDUCATION PROGRAMS

PROFESSIONAL STAFF Adena Batterman, LCSW Manager, Rheumatoid Arthritis Support and Education Programs Suzan Fischbein, LMSW Social Work Coordinator, Myositis Support Group Suzy Kim, LCSW Social Work Manager, Rheumatology Juliette Kleinman, LCSW, ACSW Manager, VOICES 60+ Senior Advocacy Program Jillian Rose, LMSW Program Manager, LupusLine® and Charla de Lupus/Lupus Chat® My-Lan Tran, LCSW Program Manager, LANtern® Lupus Asian Network Meredith Wolrich, LCSW Social Work Coordinator, Early RA Support and Education Group

My-Lan Tran, LCSW, Juliette Kleinman, LCSW, ACSW, Jillian Rose, LMSW, and Suzy Kim, LCSW, manage a diverse scope of in-depth services for patients with rheumatic diseases.

A diagnosis of a rheumatic disease can present enormous physical, emotional, and social challenges. Individuals are confronted with the task of understanding a serious disease that is new to them, managing a host of symptoms, and choosing among complex treatment options. Hospital for Special Surgery has a longstanding commitment to providing patients, families, and communities with the support and education needed to effectively participate in decisions regarding their individual treatment. Innovative initiatives help patients cope with the implications of the diagnosis, including potential changes in independence, self-esteem, work, and family roles. In fact, the Hospital offers the largest number of rheumatology-related support and education programs of any hospital in the nation, reflecting its dedication to providing a comprehensive approach to patient care. With one of the largest rheumatology divisions in the country, and its high degree of specialization, HSS is able to provide in-depth model programs with more than 100,000 patient contacts to date, some globally. The integrated team approach of the Division continues to drive our success in supporting and educating those who are dealing with chronic illness. Through these programs, patients are able to learn about their illness and ways to most fully live their lives from both healthcare professionals and from others with the same diagnosis. “The component of peers helping peers was created because these trained veterans, so experienced in living with a serious chronic rheumatologic illness, provide models of coping and courage,” underscores Roberta Horton, LCSW, ACSW, Director, Department of Social Work Programs.

As illustrated in this advertisement, the services offered by the Department of Social Work Programs are nationally recognized for their innovative approaches to helping people cope with a rheumatic disease.

The crucial aspect of seeing the patient as a whole person in the context of his or her culture, community, language, age, family, and related factors helps to drive programmatic design and interventions, and contributes to their efficacy. Program leaders are frequent presenters at the ACR Annual Meetings, participate in national initiatives to reduce health disparities, and have an integral role in the Hospital’s Community Service Plan.

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Educational Update Our Rheumatic Disease Fellowship is dedicated to training the academic rheumatology leaders of tomorrow. With in-depth interdisciplinary training in management of both common and rare autoimmune, inflammatory, and musculoskeletal disorders, combined with a requirement for completion of a basic or clinical research project, our rheumatology fellows are competitive for faculty positions at leading academic centers. In 2009, we successfully competed for renewal of our NIH-funded T32 Rheumatology Research Training Grant, supporting trainees headed for a serious career in rheumatic disease research. Nine adult rheumatology fellows – three per year of the three-year program – and one or two pediatric rheumatology fellows are accepted as trainees and gain experience in the outpatient clinics at HSS and through rotations as rheumatology consultants at NewYork-Presbyterian Hospital and Memorial Sloan-Kettering Cancer Center. Under the direction of Anne R. Bass, MD, and Alexa B. Adams, MD, who lead the adult and pediatric programs, respectively, the fellowships focus on clinical training in the first year and investigative opportunities in the second and third years. Mentorship committees comprised of faculty members meet with fellows in their first year. Over the next two years, the committee assists the primary mentor and fellow with the design and conduct of research and with career planning. Jessica R. Berman, MD, coordinates the educational program for second-year medical residents from NewYork-Presbyterian/Weill Cornell, who devote a month to rheumatology as part of their training in internal medicine. Dr. Berman, an American College of Rheumatology Clinician Scholar Educator, has added basic musculoskeletal modules to the curriculum that incorporate joint anatomy, physical exam of the joints, and joint injections. In addition, Michael D. Lockshin, MD, MACR, is developing a course for Weill Cornell Medical College students on caring for patients with chronic illness, discussing ways in which physicians and patients interact and make decisions together.

Going Forward As part of an academic institution, the Division of Rheumatology has a clear mandate to capitalize on its capabilities in basic, translational, and clinical research to benefit patient care. The development of our centers of excellence, with our SLE and APS Center of Excellence our model, provides a structure that allows clinicians to contribute to our aggregate academic effort – teaching, research, and evidence-based patient care – and also enables our scientists to gain a better understanding of the clinical challenges faced by physicians that will help guide their research endeavors. You will learn more about these efforts, as well as our accomplishments, in the Division of Rheumatology’s 2009-2010 Annual Report that follows.

Mary (Peggy) K. Crow, MD Physician-in-Chief and Chairman, Division of Rheumatology

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(Top) As Chief Scientific Officer, Steven R. Goldring, MD, is shaping the future of basic, translational, and clinical research at Hospital for Special Surgery. (Bottom) Under the leadership of Anne R. Bass, MD, Program Director, the Hospital’s Rheumatic Disease Fellowship offers in-depth clinical and research training.


LEADERSHIP REPORT:

INFLUENCING THE WORLD OF RHEUMATOLOGY

Hospital for Special Surgery is honored to have physicians who are nationally and internationally recognized pioneers in rheumatology and share their expertise in ways that will produce positive change for the specialty and benefit patients the world over. Jane E. Salmon, MD: An Ambassador for Interdisciplinary Collaboration Hospital for Special Surgery recognizes the importance of fostering interdisciplinary approaches and the exchange of ideas to better understand and treat immune-based diseases. To that end, Dr. Jane Salmon holds leadership positions in two important organizations whose missions are to encourage and promote the sharing of education and research – the Federation of Clinical Immunology Societies (FOCIS) and the European League Against Rheumatism (EULAR).

Jane E. Salmon, MD

Dr. Salmon, Co-Director of the Mary Kirkland Center for Lupus Research at HSS, serves as Secretary-Treasurer on the Executive Committee of FOCIS – a federation of some 43 member societies representing 60,000 clinician-scientists throughout the world. FOCIS has established Centers of Excellence at qualifying institutions here and abroad to accelerate local multidisciplinary scientific and clinical innovation, education, and advocacy. Dr. Salmon, Director of the Hospital’s FOCIS Center of Excellence, emphasizes the value in being part of FOCIS. “I see its main purpose as training and stimulating young physician scientists and translational immunologists,” says Dr. Salmon. “Their annual meeting provides a venue for networking and interdisciplinary collaboration. There’s really no other place for physician-scientists who study diseases in multiple disciplines to meet. Immunologists, rheumatologists, endocrinologists, neurologists, and gastroenterologists all come together in the same room and talk to each other about common themes in disease pathogenesis and treatment.” EULAR represents the patient, health professional, and scientific societies of rheumatology of all the European nations. With some 12,000 participants at its annual meeting, the organization supports research projects in rheumatology by funding collaborative research between rheumatology groups in Europe and, more recently, in the United States. “There’s a growing recognition that there is power in numbers,” says Dr. Salmon, who is one of two Americans to serve on the EULAR Scientific Meeting Planning Committee. “The American College of Rheumatology and EULAR now have joint committees to develop disease classification, criteria for response to therapy, and guidelines for treatment. This cooperation has the potential to enhance quality of care for our patients.” Dr. Salmon’s participation on the Planning Committee also enhances recruitment of more Americans as speakers and moderators to the EULAR annual congress. “The position enables me to work with Europeans and understand their views,” says Dr. Salmon. “I see my role as an unofficial ambassador and facilitator for interdisciplinary and inter-center studies – to help share ideas and develop an international platform for rheumatology research and patient care.” 6


C. Ronald MacKenzie, MD: Advancing Ethics in Rheumatology With the appointment of Dr. Ronald MacKenzie as the new Chair of the American College of Rheumatology Ethics and Conflicts of Interest Committee, Hospital for Special Surgery is poised to expand its national influence in the field of rheumatology and ethics. The Committee, which deals with issues related to professional ethics, sets the standards for the field. Dr. MacKenzie would like to see an expansion of the discourse on ethics amongst his rheumatology colleagues. “Ethical challenges are prevalent in modern-day medicine,” says Dr. MacKenzie. “Whether arising in the daily practice of medicine, in the conduct of research, or in our educational practices, physicians need to understand the relevance ethics plays in our professional lives.” Dr. MacKenzie’s interest in bioethics grew out of a melding of his former role as Chairman of the HSS Institutional Review Board and his affinity for the humanistic aspects of medical practice. Over the years he has had the opportunity to explore a range of subjects relevant to medical ethics with a stellar group of ethicists, including Nancy Dubler, LLB, of the Albert Einstein College of Medicine, Dr. Franklin Miller of the National Institutes of Health, and Dr. Joseph Fins of the Department of Public Health, Weill Cornell Medical College. Indeed, he was selected as a Faculty Scholar in the Ethics Division of Weill Cornell as part of Dr. Fins’ bioethics training program. When Richard Menschel, Hospital board member and Chairman Emeritus, created the HSS Endowments through the Horace W. Goldsmith Foundation, he agreed to Dr. MacKenzie’s suggestion that an endowment be designated for research in ethics and medicine. Through this funding and the generosity of his patients, the endowment was transformed into the C. Ronald MacKenzie, MD, Chair in Ethics and Medicine. To date, proceeds have been used to support bioethics functions at the Medical College and have allowed Dr. MacKenzie to pursue areas of personal interest. Dr. MacKenzie has written a number of papers pertaining to a range of ethical issues, including medical professionalism, justice in the rheumatic diseases, informed consent, and conflict of interest. In addition, he has contributed chapters on ethics of clinical research to a number of major textbooks in rheumatology. Further, in July 2010 the Ethics Forum first appeared in the professional publication, The Rheumatologist. This column was initiated at the suggestion of Dr. MacKenzie and is a joint effort with members of the ACR’s ethics committee. Published quarterly, members of the ethics committee provide analysis and commentary on ethically challenging cases solicited from the practicing rheumatologic community. Dr. MacKenzie, along with other members of the American College of Rheumatology, believes that the rheumatologic community should assume a more proactive role in the definition of the ethical challenges facing the field. To this end, the committee is evaluating a comprehensive survey of ACR membership in order to ascertain physician perceptions on the ethical issues confronted in their field. Dr. MacKenzie was instrumental in the initiation of this project – the first of its kind – a goal of which is to present these findings at the ACR national meeting in 2011.

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C. Ronald MacKenzie, MD


CENTER OF EXCELLENCE:

RHEUMATOID ARTHRITIS, PSORIATIC ARTHRITIS, AND ANKYLOSING SPONDYLITIS

PROFESSIONAL STAFF Juliet B. Aizer, MD, MPH Dalit Ashany, MD Anne R. Bass, MD Adena Batterman, MSW, LCSW Coordinator, Living With Arthritis Group Stephen J. DiMartino, MD, PhD Theodore R. Fields, MD, FACP Allan Gibofsky, MD, JD, FACP, FCLM Steven R. Goldring, MD Susan M. Goodman, MD Jessica K. Gordon, MD Lionel B. Ivashkiv, MD George D. Kalliolias, MD, PhD Linda Leff, RN, BSN, BC Steven K. Magid, MD Lisa A. Mandl, MD, MPH Joseph A. Markenson, MD, FACP Charis F. Meng, MD

With the establishment of the Inflammatory Arthritis Center (IAC) one year ago, the Division of Rheumatology has strengthened its focus on furthering patient care, education, and research in rheumatoid arthritis (RA), psoriatic arthritis, and ankylosing spondylitis (AS). A comprehensive patient registry and a biorepository for the collection, storage, and processing of tissue samples are in development. Currently, a registry for patients with rheumatoid arthritis is underway, with 300 patients enrolled to date. A registry for AS is in its pilot phase and a psoriatic arthritis registry is under development. In addition, a dedicated weekly Inflammatory Arthritis Center clinic has been established for patients, incorporating a multidisciplinary conference attended by rheumatologists, fellows, social workers, and researchers for discussion of patients with diverse clinical problems. In collaboration with the scientists at The Rockefeller University, including Jeffrey V. Ravetch, MD, and Dana E. Orange, MD, researchers in the IAC are looking at anti-CCP (cyclic citrullinated peptide) antibodies, with a goal of characterizing the CCP epitopes that are targeted by the B cells from patients with RA and to identify specific B cells that are making these anti-CCP antibodies. In the area of clinical research, the IAC is conducting a pilot project to identify the value of a standardized immunization strategy for patients with RA who will be undergoing biological therapy. The driving goals of the IAC are to provide unparalleled patient care and to engender successful translational research.

Dana E. Orange, MD

The Early Arthritis Initiative

Stephen A. Paget, MD, FACP, FACR

Extensive research indicates that the earlier appropriate treatment starts for inflammatory arthritis, the less the ultimate disability. The Division’s Early Arthritis Initiative (EAI), a collaborative effort of Rheumatology, Social Work, and Nursing, and the only such program in the New York metropolitan area, is committed to the education of the community, local physicians, and individual patients. Goals include expediting rheumatology evaluation of these patients and providing ongoing support and education for patients with a new diagnosis and also for those who have been living with the disease for many years.

Edward J. Parrish, MD Sergio Schwartzman, MD Lisa C. Vasanth, MD, MS Meredith Wolrich, LCSW Coordinator, Early Arthritis Group Diana A. Yens, MD

INFLAMMATORY ARTHRITIS CENTER Sergio Schwartzman, MD, Director Oversight Committee Mary K. Crow, MD Steven R. Goldring, MD Lionel B. Ivashkiv, MD Jane E. Salmon, MD Sergio Schwartzman, MD Core Working Group Allan Gibofsky, MD, JD, FACP, FCLM Susan M. Goodman, MD George D. Kalliolias, MD, PhD Dana E. Orange, MD Sergio Schwartzman, MD

The EAI is presently working with the National Arthritis Foundation to evaluate the effectiveness of a televised and internet-based public service announcement in stimulating patients to call for a phone screening to see if their symptoms warrant evaluation for RA.

Basic Research in Inflammatory Arthritis Investigations in the laboratories of the Division of Rheumatology are contributing to new concepts with the potential to impact patient care. Most recently, the Hospital’s scientists have identified a pathway involved in turning off inflammation that does not work properly in people with inflammatory arthritis. The finding, reported in the April 23, 2010 issue of Immunity, could lead to the development of new therapeutic approaches. This is the first study to link this pathway to rheumatoid arthritis. The researchers found that activation of the ITAM (immunoreceptor tyrosine-based activation motif) receptor set off a pathway that was dependent on calcium signaling and

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discouraged pro-inflammatory cytokine production. They also found that ITAM receptors induce IL-10, an anti-inflammatory cytokine, and other proteins implicated in the suppression of cytokines. This current study suggests that factors that contribute to inflammation in arthritis are also crippling beneficial pathways that usually serve to turn inflammation off, implicating for the first time a negative role for calcium signaling downstream of these ITAM-coupled receptors. This research increases our understanding of an indirect inhibitory mechanism that may serve as the basis for designing new approaches to therapy.

“In the 20 years or so that I have been studying regulation of inflammation, this seems to be the most potent inhibitory mechanism that we have seen.” — Lionel B. Ivashkiv, MD In other research, HSS scientists are seeking to identify potential mechanisms to control the two main characteristics of RA – chronic inflammation and joint destruction – studying the effects of a novel cytokine, Interleukin-27 (IL-27). The researchers found that IL-27 is a potent inhibitor of osteoclastogenesis and also a potent anti-inflammatory cytokine that acts by blocking the signaling of TNF-α and IL-1β in human macrophages. Their findings have been published in the February 2010 issue of Arthritis & Rheumatism and in the December 1, 2010 issue of The Journal of Immunology. The next step is to examine whether IL-27 will have a similar homeostatic effect in vivo.

Translational Research: Investigating the Synovial Molecular Fingerprints of RA Patients With the hypothesis that different subgroups of patients with rheumatoid arthritis have different molecular fingerprints, the Hospital’s scientists are conducting a study collecting synovial fluid from patients with active RA and synovial tissue samples from patients who have undergone a joint replacement, isolating CD14-positive cells to uncover their molecular fingerprint. They are comparing RA patients to each other, but also to patients with other inflammatory and non-inflammatory arthritides to see whether RA has a unique profile. Their aim is to correlate the molecular fingerprint of a given patient with his or her phenotype and response to therapy, ultimately leading to identification of novel pathogenic molecular pathways and treatment targets.

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(Top) With the establishment of the Inflammatory Arthritis Center under the direction of Sergio Schwartzman, MD, the Division of Rheumatology is advancing clinical care, research, and education in inflammatory diseases. (Bottom) George D. Kalliolias, MD, PhD, is pursuing research to identify mechanisms that could control the chronic inflammation and joint destruction that occurs with rheumatoid arthritis.


CENTER OF EXCELLENCE:

OSTEOARTHRITIS

PROFESSIONAL STAFF Juliet B. Aizer, MD, MPH Dalit Ashany, MD Mary K. Crow, MD Stephen J. DiMartino, MD Theodore R. Fields, MD, FACP Mary B. Goldring, PhD Steven R. Goldring, MD Jo A. Hannafin, MD, PhD Suzanne A. Maher, PhD

Osteoarthritis (OA) has become the focus of national attention, with physicians, scientists, rehabilitation specialists, and educators pooling their resources and expertise to tackle this growing concern. At HSS, OA is a top clinical priority, with multiple disciplines mobilizing to focus on advancing the non-surgical and surgical options for patients with OA, identifying who may be at risk for OA following an anterior cruciate ligament (ACL) injury, delaying or preventing progression to a disabling condition, and ultimately determining how we can intercede with patients in an earlier fashion to change the course of the disease. In an environment of collaboration, our work in OA is a prime example of how basic, translational, and clinical research, patient care, and education come together to foster innovation.

Lisa A. Mandl, MD, MPH

Basic Science

Joseph A. Markenson, MD, FACP

In the Laboratory of Cartilage Biology, part of the Tissue Engineering Repair and Regeneration Program, basic research is underway focused on defining the molecular and cellular mechanisms that lead to alterations in cartilage in osteoarthritis and inflammatory joint diseases. Mary B. Goldring, PhD, Senior Scientist, has recently been awarded a new Stimulus (Director’s RC4) NIH grant entitled “Defining Common Molecular Parameters for Onset and Progression of Osteoarthritis.” In models of genetic osteoarthritis and of posttraumatic osteoarthritis that occurs as a result of meniscus injury, Dr. Goldring and her colleagues are profiling the changes in gene and protein expression, and examining the different molecules in tissues from knees of patients undergoing total knee replacement to identify at what point the osteoarthritis may develop. Her group is also collaborating with a multidisciplinary team of HSS investigators to understand the role of inflammation in

Robert G. Marx, MD, MSc, FRCSC Charis F. Meng, MD Edward J. Parrish, MD Hollis G. Potter, MD Scott A. Rodeo, MD Jenny Scott, PhD Lisa C. Vasanth, MD, MS Diana A. Yens, MD

“We are trying to understand the molecular biology of the cells within the cartilage itself under normal conditions and how the activities of those cells change when cartilage is damaged.” – Mary B. Goldring, PhD patients following injury of the anterior cruciate ligament. Understanding how molecules are altered in response to mechanical and inflammatory stress may provide insight into approaches to slow cartilage damage, if not to help stimulate repair. In the Laboratory of Functional Tissue Engineering, Suzanne A. Maher, PhD, is focusing on novel solutions to treat cartilage defects before they can lead to the development of arthritis and ultimately prevent the need for a total joint replacement. The research is intended to try to help young, active patients who may have injured their knee resulting in a damaged meniscus, a local cartilage defect, or other soft tissue problems. By developing approaches that will allow intervention at a much earlier stage of the disease, she hopes to slow down the progression to osteoarthritis. Working collaboratively with orthopaedic surgeons, the researchers are seeking to design a synthetic cartilage substitute that can mechanically act like the patient’s native tissue and also integrate with the adjacent healthy tissue. They have already had a breakthrough in the laboratory, demonstrating that chondrocytes can move across to the polymer scaffold they created with very little 10


stimulus. Additionally, they have developed a method to attach the polymer to the patient’s own articular cartilage to anchor the implant. Having identified a type of bacteria that attaches to, but also attacks, the cartilage, she and her colleagues have recently been able to isolate the attachment molecule, attach it to their polymer implants, so that when implanted, the polymer sticks to the cartilage. The Division’s researchers are making use of the ACL registry of the Hospital’s Sports Medicine and Shoulder Service, which has been collecting synovial fluid and tissue samples from patients undergoing ACL reconstruction. With evidence that many patients with ACL injuries go on to develop osteoarthritis, Jenny Scott, PhD, and Mary K. Crow, MD, are in the early phases of a study to determine if synovitis is present in the tissue samples at the time of surgery; if there are any relationships between the level of synovitis following injury and how patients progress in terms of developing joint disease; and whether the synovial information might ultimately help predict the outcome.

Clinical Investigations As a member of a national multicenter trial with seven major musculoskeletal centers in the country, Lisa A. Mandl, MD, MPH, is leading a group of HSS researchers in investigating the most appropriate treatment for patients who have knee osteoarthritis and a meniscal tear. Currently, evidence does not exist to support whether surgery or a very tailored regimen of physical therapy to help strengthen the muscles of the knee produces a better outcome. In what is expected to be a landmark study, patients who are eligible for surgery based on their surgeon’s assessment are randomized to surgery or to a special physical therapy protocol and their progress will be monitored over time.

Outcomes Research Since 2007, Dr. Mandl and Robert G. Marx, MD, MSc, FRCSC, have spearheaded the establishment of a Hospital-wide total joint replacement registry. The registry is funded through a major Center for Education and Research on Therapeutics grant from the Agency for Healthcare Research and Quality. To date, over 22,000 joints have been enrolled. With such large numbers, the goal is to identify a pattern of problems with prostheses used in total knee, total hip, and shoulder replacements much sooner than would have been possible without the volume made possible by the registry. This collaborative effort between HSS and Weill Cornell Medical College is one of the most comprehensive registries in the United States focusing exclusively on total joint replacement. The data will be used to identify the predictors of satisfactory long-term outcomes and will help to determine which surgical practices and implant models are most effective.

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(Top) In the basic research laboratories of Suzanne A. Maher, PhD (left), and Mary B. Goldring, PhD, scientists are investigating the reasons behind cartilage destruction. (Center) Data provided by knee replacement patients for the total joint replacement registry will enable Lisa A. Mandl, MD, MPH, to evaluate implant success over time. (Bottom) Jenny Scott, PhD, and her colleagues are examining samples of synovial tissue from patients undergoing ACL repair to provide clues to the development of early osteoarthritis.


CENTER OF EXCELLENCE:

SYSTEMIC LUPUS ERYTHEMATOSUS AND ANTIPHOSPHOLIPID SYNDROME

PROFESSIONAL STAFF John W. Barnhill, MD Mary K. Crow, MD Doruk Erkan, MD, MPH Diana Goldenberg, MD, MPH Jessica K. Gordon, MD Suzy Kim, LCSW Kyriakos A. Kirou, MD, DSc, FACP Juliette Kleinman, LCSW, ACSW Elizabeth Kozora, PhD Michael D. Lockshin, MD, MACR Joseph A. Markenson, MD, FACP Stephen A. Paget, MD, FACP, FACR Alessandra Pernis, MD Pretima Persad, MPH Monica Richey, MSN, ANP-BC/GNP Jillian Rose, LMSW Jane E. Salmon, MD Lisa R. Sammaritano, MD Erica Sandoval Robert F. Spiera, MD My-Lan Tran, LCSW

SYSTEMIC LUPUS ERYTHEMATOSUS AND ANTIPHOSPHOLIPID SYNDROME CENTER OF EXCELLENCE Jane E. Salmon, MD, Director Oversight Committee Doruk Erkan, MD, MPH

Through the Mary Kirkland Center for Lupus Care, patients with lupus and antiphospholipid syndrome (APS) benefit from the collective expertise of the Hospital’s clinicians and scientists to develop new and more effective treatments for these conditions. This model multidisciplinary program, founded in 2009 with support from Rheuminations, Inc., is fully integrated with the Mary Kirkland Center for Lupus Research, established eight years earlier to foster basic, translational, and clinical research. As a result, Center patients have access to the latest treatments and opportunities to participate in clinical trials and translational research studies. To improve access to care, the Center created the Lupus Center Fast Track System, which facilitates prompt scheduling of patient appointments with the Center’s physicians by calling 877-SLE-CURE. Every Friday, the Mary Kirkland Center holds its Lupus Clinic and corresponding multidisciplinary conference, where the Center’s dedicated team of rheumatologists and fellows, the Center’s manager, nurse practitioner, and social worker come together to discuss the care of patients. Every month, the Center holds a multidisciplinary education conference, where physicians from psychiatry, gynecology, nephrology, dermatology, and other specialties join with rheumatologists and health professionals to discuss the numerous complexities of lupus as they relate to specific patient cases. Regular scientific meetings are also held, where researchers and clinicians gather to discuss clinical challenges. The Cardiovascular Disease Prevention Counseling Program for patients with lupus and/or antiphospholipid antibodies (aPL) addresses this population’s higher risk for cardiovascular disease compared to the general public. The comprehensive program evaluates traditional cardiac risk factors such as blood pressure, blood glucose, cholesterol levels, body mass index, diet and exercise habits, smoking status, aPL profile, and medication usage, as well as non-traditional and lupus-specific risk factors. In addition to a cardiovascular risk assessment, the program provides general education and tailored lifestyle recommendations and referrals to nutritionists, physical therapists, and a smoking cessation program. Currently, nearly 90 patients are enrolled in the program.

Research Update

Kyriakos A. Kirou, MD, DSc, FACP

Antiphospholipid Syndrome

Michael D. Lockshin, MD, MACR

Hospital for Special Surgery has one of the most significant referral and research centers in antiphospholipid syndrome in the world, currently conducting five antiphospholipid antibody studies simultaneously. The Antiphospholipid Syndrome (APS) Clinical Research Task Force, co-chaired by Doruk Erkan, MD, MPH, and Michael D. Lockshin, MD, MACR, was one of six task forces developed by the organization committee of the 13th International Congress on Antiphospholipid Antibodies (aPL) in April 2010. As part of this task force, HSS physicians are leading an international effort to conduct a well-designed APS multicenter clinical trial.

Carol A. Mancuso, MD, MPH, FACP Pretima Persad, MPH Jane E. Salmon, MD Lisa R. Sammaritano, MD

An autoimmune disorder in which the patient’s body produces antiphospholipid antibodies, APS can cause the blood to clot, resulting in a number of consequences, including pregnancy

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losses and deep vein thrombosis. While some patients with antiphospholipid antibodies may be predisposed to clots, others can have the antibodies in their blood without clots being formed. These patients do not have APS, but are called antiphospholipid antibody positive (aPL positive). While blood thinners reduce the risk of the antibody attaching to the arterial or venous wall, they do not reduce or change the nature of the potentially harmful antibodies and also increase the patient’s risk of bleeding. To reduce the risk of blood clots, HSS researchers, in conjunction with Silvia S. Pierangeli, PhD, at the University of Texas Medical Branch, are investigating whether fluvastatin, a statin drug, is beneficial and safe in reducing the risk of cardiovascular disease and blood clots in patients with APS or those who are aPL positive. Statins, most commonly used to lower cholesterol, also have anti-inflammatory and antithrombotic effects, which could lend themselves to the prevention of blood clots in patients with APS.

(Top) Monica Richey, MSN, NP, and Pretima Persad, MPH, play key roles that enable patients in the Mary Kirkland Center for Lupus Care to receive comprehensive and coordinated care. (Bottom) Michael D. Lockshin, MD, Director of the Barbara Volcker Center for Women and Rheumatic Diseases, has been conducting pivotal work in lupus pregnancy for more than two decades.

“In neurological lupus, the brain deteriorates in a way that isn’t anything like Alzheimer’s, but in diseases like lupus people clearly lose thinking power over years. We are only now just at the beginning of trying to understand how that happens.” – Michael D. Lockshin, MD HSS researchers are also conducting a pilot study to evaluate whether an infusion drug rituximab, approved for treatment of non-Hodgkin’s B-cell lymphoma and for certain patients with rheumatoid arthritis, will reduce aPL-related clinical manifestations resistant to anticoagulants, including low platelet count, anemia, heart valve disease, skin ulcers, kidney small vessel clots, and memory problems. In addition, they are evaluating cognitive dysfunction using diffusion tensor imaging and functional magnetic resonance imaging in aPL-negative SLE versus aPL-positive non-SLE patients. Lastly, HSS rheumatologists are involved in developing a better understanding of catastrophic antiphospholipid antibody syndrome – a very rare complication that is the most severe form of APS with acute multiple organ involvement and small vessel thrombosis.

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MARY KIRKLAND CENTER FOR LUPUS CARE Doruk Erkan, MD, MPH, and Kyriakos A. Kirou, MD, DSc, FACP Clinical Co-Directors Pretima Persad, MPH Manager Monica Richey, MSN, ANP-BC/GNP Nurse Coordinator Virginia F. Haiduc, MD Coordinator, Cardiovascular Disease Prevention Counseling Program Suzy Kim, LCSW Social Work Manager, Rheumatology


CENTER OF EXCELLENCE:

SYSTEMIC LUPUS ERYTHEMATOSUS AND ANTIPHOSPHOLIPID SYNDROME (CONTINUED)

The Autoimmune Disease Registry and Repository continues to expand, with over 1,000 patients who are followed longitudinally. The data and material collected are assisting in research at HSS and around the world. For example, a West Coast genetics researcher has been looking at particular genes that may confer susceptibility to or are disease modifying genes in lupus, but has limited access to the genetic profiles of southern Europeans. The HSS database was able to provide the researcher with DNA from relevant ethnic groups. Systemic Lupus Erythematosus

The PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Syndrome and Systemic Lupus Erythematosus) study, which was initially funded by the NIH in 2003 and is now extended through 2011, continues to make headway through investigations by researchers at HSS and coinvestigators from 11 academic centers across the country. With a goal to enroll 700 patients, the PROMISSE registry now has over 590 registered, furthering the ability to investigate the range of genes and molecular pathways that can affect pregnancy in patients with lupus, and potentially, cause miscarriage and preeclampsia in healthy women. The study, which is expected to provide information to target patients at risk for poor pregnancy outcomes and enable treatments to be refined, could transform the management of pregnancies in this patient population.

“Precise disease phenotypes and clearly identified ethnic and geographical origin of patients are extremely valuable for studying genetics and defining determinants of disease manifestation in lupus.” – Jane E. Salmon, MD (Top) The scientific work of Jane E. Salmon, MD, has been instrumental in transforming the understanding of pregnancy outcomes and atherosclerosis in patients with lupus. (Bottom) By studying endothelial cells in patients with lupus, Diana Goldenberg, MD, MPH, is hoping to identify processes that are relevant to their risk of developing atherosclerosis.

Four years ago, the Division’s researchers launched the Flare study with the goal of developing biomarkers for lupus to predict the activity and severity of the disease, particularly related to kidney involvement, as well as prognosis and response to therapies. Since then, the study has followed some 90 patients and continues to recruit new patients. Patients are monitored every two to three months using SLEDAI and BILAG, validated disease activity indexes for lupus. The PCR technique is used to look at gene expression, which is compared to clinical data to see how well gene expression related to type I interferon and other gene signatures correlates with disease activity by those measures. When validated, it is hoped that those biomarkers could be used in clinical trials to better evaluate their primary outcomes. With accelerated atherosclerosis an important health threat facing patients with lupus, researchers are also looking at endothelial dysfunction – a known precursor to developing atherosclerosis. Endothelial cells in patients with lupus are thought to be a primary target of injury and until recently there has not been a satisfactory way to access the endothelium. Working with the cardiologist Paolo C. Colombo, MD, at NewYork-

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Presbyterian Hospital/Columbia University Medical Center, in a unique collaboration, HSS researchers have become the first to use a technique recently pioneered by Dr. Colombo for study of heart failure patients to study patients with lupus. The novel, very benign minimally invasive procedure samples the cells using a combination of peripheral angiocatheters and guide wires. Some 2,000 venous endothelial cells are harvested from each patient to measure endothelial gene and protein expression. The translational research project has also enabled the Hospital to assemble a matrix of collaborators, including Dr. Colombo and molecular and cell biologists at Weill Cornell Medical College, who together are tackling this very challenging and important clinical problem. The researchers are already seeing some potentially interesting pathways emerge, including type I interferon activation, inflammation, angiogenesis, coagulation, and oxidative stress pathways, that will warrant further study and exploration. Molecular mechanisms of T cell dysfunction in autoimmunity are the focus of researchers interested in elucidating the functions of IL-17 and IL-21 – two cytokines that have recently been implicated in the pathogenesis of a wide array of autoimmune diseases, including SLE, that are associated with the regulatory function of these cells. During previous studies aimed at isolating proteins interacting with Interferon Regulatory Factor 4 (IRF4), a transcription factor that is highly expressed in the immune system, the researchers cloned a novel protein that has been termed Def6. They are now studying the function of Def6 to gain a mechanistic understanding of the signaling pathways that control both physiologic and pathologic T cell responses. The long-term goals of the laboratory are to employ both murine models and translational approaches to further delineate the molecular networks responsible for lymphocyte dysfunction in autoimmune diseases. The researchers have found that mice that lack this protein spontaneously develop either lupus or RA, providing a resource to study the mechanisms of how the pathway goes awry in more detail. Since the cells are found in many different autoimmune diseases, the hypothesis is that if you block these cells you might achieve benefits in multiple autoimmune diseases. In addition to lupus, the researchers will also be looking at RA and scleroderma. As one of 20 academic institutions in the Lupus Clinical Trials Consortium, the Hospital has participated in a number of multicenter projects aimed at developing new drugs for lupus patients, including the BLISS-52 study. This Phase III, double-blind, placebocontrolled lupus clinical trial tested the medication belimumab to treat patients with lupus who have had an inadequate response to one or more of currently available drugs. Study findings show that belimumab has the potential to become the first new approved lupus drug in decades for people living with lupus. Additional studies in progress are testing the effect of monoclonal antibodies specific for interferon-alpha on lupus disease activity.

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Using the Hospital’s well-developed patient cohorts, particularly lupus and antiphospholipid antibody syndrome patients, Alessandra Pernis, MD, is investigating the role of lymphocyte signaling systems in human disease.


CENTER OF EXCELLENCE:

SCLERODERMA, VASCULITIS, AND MYOSITIS

PROFESSIONAL STAFF

Scleroderma

Anne R. Bass, MD, FACP

The Rudolf Rupert Scleroderma Research Program has grown tremendously and continues to further stimulate enormous interest in the study of scleroderma while advancing care for patients, who benefit from access to cutting edge clinical trials and valuable education programs.

Mary K. Crow, MD Stephen J. DiMartino, MD Suzan Fischbein, LMSW Jessica K. Gordon, MD Kyriakos A. Kirou, MD, DSc, FACP Michael D. Lockshin, MD, MACR Steven K. Magid, MD Charis F. Meng, MD Stephen A. Paget, MD, FACP, FACR Robert F. Spiera, MD

SCLERODERMA, VASCULITIS, AND MYOSITIS CENTER OF EXCELLENCE Robert F. Spiera, MD, Director

With approximately 140 patients now enrolled, the Scleroderma Registry – a prospective, observational, longitudinal clinical database and biobank – is providing biological specimens for a number of basic research studies to further elucidate the pathophysiology of scleroderma, develop biomarkers of disease activity, and understand predictors of outcome. Using gene expression profiling with microarray on the skin and peripheral blood cells of patients with scleroderma, research is underway to determine whether changes in gene expression seen in the skin are reflected in peripheral blood mononuclear cells. Current studies utilizing registry samples include investigations looking at the activation of the type I interferon pathway in scleroderma and mediators of angiogenesis.

“We have recently completed the longest and largest single center prospective Phase IIa clinical trial of a potential new treatment for diffuse systemic sclerosis.” – Robert F. Spiera, MD Our researchers have recently completed the first, longest, and largest single center prospective Phase IIa clinical trial of imatinib mesylate (Gleevec®), a tyrosine kinase inhibitor, in the treatment of diffuse systemic sclerosis. Most patients were able to tolerate the medication, and a signal of potential efficacy was seen with decreased thickness of the skin and improved parameters of pulmonary function over one year of treatment. An extension phase of this trial is ongoing that makes continued treatment with imatinib available to patients in the original study. The investigators caution that these experiments have so far been an open label experience, but they believe that the promising results of this early phase trial warrant further study with a randomized, controlled trial. Additional investigation of the use of tyrosine kinase inhibitors is ongoing at HSS, with the start of a pilot study exploring the use of nilotinib in diffuse scleroderma. While similar to imatinib in many ways, nilotinib may offer an improved side effect profile, most notably less edema. An industry-sponsored trial of dasatinib, a broader tyrosine kinase inhibitor, is examining the safety and efficacy of that agent in treating interstitial lung disease in patients with diffuse systemic sclerosis. A multicenter, double-blind, placebo-controlled trial investigating the use of oral treprostinil (an oral prostacyclin analogue) for the treatment of digital ulcers associated with systemic sclerosis is also in progress. It is hoped that DISTOL-1 (Digital Ischemic Lesions in Scleroderma Treated with Oral Treprostinil Diethanolamine) will show improvement in blood flow in lower limbs and fingers resulting in a reduction in ischemic pain and Raynaud’s phenomenon, and promote healing of digital ulcers and other ischemic wounds. After 20 weeks of treatment, patients are eligible for continued treatment in an open-label extension phase of the program. 16


HSS will also be joining other sites in the Pulmonary Hypertension Assessment and Recognition of Outcomes in Scleroderma (PHAROS) multicenter registry, which will follow patients with newly diagnosed pulmonary hypertension to understand risk factors for this manifestation of scleroderma. Patient care and education are important goals of the scleroderma program, many offered in collaboration with the Scleroderma Foundation. HSS is the site for the New York Chapter’s biannual patient education forum presented by distinguished clinicians from all over the world. The Hospital is also the site for the chapter’s monthly support group meetings, and our physicians serve as speakers at various Scleroderma Foundation Tristate Chapter events.

Vasculitis The Hospital served as a site for the landmark study recently published in The New England Journal of Medicine demonstrating that rituximab therapy was at least as effective as daily cyclophosphamide treatment for induction of remission in severe ANCA-associated vasculitis and may be superior in relapsing disease. The RAVE (Rituximab for ANCA-Associated Vasculitis) multicenter trial validated an important option for the treatment of patients with diseases such as Wegener’s granulomatosis and microscopic polyangiitis, for whom the side effect profile of cyclophosphamide is unacceptable, and this trial may be pivotal in defining the state of the art for the treatment of this condition. HSS will also be a site for PEXIVAS, an international, multicenter trial evaluating the role of plasmapheresis in severe ANCA-associated vasculitis. Other clinical trials are in development for polymyalgia rheumatica and large vessel vasculitis, including Takayasu’s arteritis and giant cell arteritis.

Myositis Our myositis program continues to grow, with between 60 and 80 patients seen regularly. These patients and those from the community benefit from an HSSsponsored monthly support and education group – one of the largest in the northeast. Its mission is to enhance coping, reduce isolation, and increase understanding of the inflammatory myopathies by creating a community for those affected by this rare illness. The Hospital also served as a site for the recently concluded RIM (Rituximab in Myositis) trial – an international, multicenter, NIH-sponsored trial to evaluate the effectiveness of rituximab in improving the symptoms of adults and children diagnosed with dermatomyositis and adults diagnosed with polymyositis. 17

(Top) Robert F. Spiera, MD, Director of the Scleroderma, Vasculitis, and Myositis Center of Excellence, and (bottom) Jessica K. Gordon, MD, who just completed fellowship training at HSS, are collecting clinical information and biological materials on patients with scleroderma to learn more about the disease. They have been involved in a number of clinical trials to define better therapies for this population.


CENTER OF EXCELLENCE:

METABOLIC BONE DISEASE AND ORTHOPAEDIC BONE HEALTH

PROFESSIONAL STAFF Juliet B. Aizer, MD, MPH Dalit Ashany, MD Richard S. Bockman, MD, PhD Steven R. Goldring, MD Lionel B. Ivashkiv, MD Joseph M. Lane, MD Martin Nydick, MD Linda A. Russell, MD

(Top) With the establishment of the Metabolic Bone Diagnosis and Treatment Service, Linda A. Russell, MD, is developing a program to evaluate bone quality in patients undergoing orthopaedic surgery. (Bottom) Joseph M. Lane, MD, is a tireless advocate on behalf of women at risk for osteoporosis and a renowned researcher in the field of prevention and treatment of diseases that affect bone health.

Throughout Hospital for Special Surgery, basic scientists, clinical diagnosticians, and medical disciplines are focused on the prevention and treatment of osteoporosis, Paget’s disease, and related bone disorders, as well as preserving the quality of bone and bone healing. Recognizing the importance of screening orthopaedic surgery candidates for metabolic bone diseases, HSS has recently established the Metabolic Bone Diagnosis and Treatment Service – the first of its kind in the country – to evaluate the quality of bone of patients who are undergoing spinal fusion. Studies have shown that decreased bone density is an independent risk factor for instrument failure in spinal fusion operations, and patients with weakened bones may have poor postoperative outcomes that can lead to hospital readmissions and reduced quality of life. Despite the high number of elderly patients undergoing spine care and the high incidence of osteoporosis and/or osteomalacia – significant risk factors for fractures in this population – a large portion of spine surgeons who responded to a multicenter survey published in The Spine Journal said that they do not perform routine osteoporosis/osteomalacia workups. The results of the survey revealed a need for increased awareness among spine specialists throughout the country regarding osteoporosis screening and treatment. The new Metabolic Bone Diagnosis and Treatment Service formalizes a screening process that includes a bone density scan and baseline laboratory tests, including vitamin D levels. If intervention is required to improve the quality of bone before surgery, our physicians work closely with the Hospital’s Spine Center to identify the best treatment plan. HSS expects to expand the program to include patients undergoing other types of orthopaedic surgery, such as hip revision, which can require bone grafting. In addition, a registry is under development to monitor patients long-term. In an NIH-funded study, HSS researchers have been seeking to define a new complication of bisphosphonates related to subtrochanteric and femoral shaft fractures, which are occurring in relatively young, active women who have been taking bisphosphonates for more than five years. They are finding that a drug holiday allows the bone to remodel itself and to repair microdamage. They are also working aggressively to understand the pathophysiology of these fractures through biopsy. Researchers are also pursuing a study on the effect of bisphosphonates on biochemical bone markers in patients with teriparatide treatment, and continue to expand the Seymour Cohn Metabolic Bone Registry to identify methods to prevent and repair fragility fractures that result from osteoporosis and other metabolic bone disorders. In 2009, the Hospital joined the PROMOTE (Promoting Medication for Osteoporosis with Education) study, a collaboration between NewYork-Presbyterian/Weill Cornell and Teachers College, Columbia University, which will evaluate the effectiveness of tailored telephone education for increasing rates of post-fracture adherence to oral bisphosphonates.

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CENTER OF EXCELLENCE:

PEDIATRIC RHEUMATOLOGY

The Division of Pediatric Rheumatology continues to find new and effective therapeutic treatments for children with rheumatic diseases, including systemic lupus erythematosus (SLE), juvenile inflammatory arthritis, uveitis, scleroderma, and dermatomyositis. In particular, the Division’s physicians have seen marked success with a regimen of cyclophosphamide and rituximab in the treatment of childhood SLE, with long-term follow-up of more than 20 patients achieving excellent outcomes. Care of the pediatric rheumatology patient needing infusion therapy has been facilitated by the availability of a dedicated pediatric infusion unit located on the same floor as the practice.

PROFESSIONAL STAFF Thomas J.A. Lehman, MD, FAAP, FACR Chief Alexa B. Adams, MD Theresa T. Lu, MD, PhD Emma Jane MacDermott, MD, MRCPI Lillian Mendez Amy Silverman, LCSW

The Division’s Transition Clinic continues to facilitate the shift of pediatric rheumatology patients as they reach adulthood into the Hospital’s adult rheumatology care programs. During quarterly transition clinics, the pediatric rheumatologists formally review the case history of their patients with the adult rheumatologists followed by an introduction of the patient to his or her new doctor and a tour of the adult rheumatology facility to make the move as seamless as possible. In collaboration with the Robert Wood Johnson Medical School-UMDNJ, Department of Pediatrics, the Division’s researchers have been involved in a number of studies, including examining the burden of childhood-onset arthritis; cognitive impairment and the impact of SLE on issues related to attendance and the various aspects of school performance; and the role of visual functionality as a result of JIA-associated uveitis and its complications.

Training Pediatric Rheumatologists With one of the largest and most comprehensive Pediatric Rheumatology Fellowship Training Programs in the country, Hospital for Special Surgery is helping to address the shortage of highly trained pediatric rheumatologists. The three-year program – one of only 15 certified pediatric fellowship programs in the United States – currently has five fellows in training and has graduated more than 20 fellows. The program, which was recently accredited by ACGME for another four years, draws fellows from within the United States and around the world. The fellowship provides one year of clinical training and two years dedicated solely to research. In the Division’s Continuity Clinic, fellows see a wide range of patients with autoimmune diseases referred to the Hospital from pediatricians and pediatric orthopedists in the tri-state area and beyond. Most recently, the Division acquired its own ultrasound equipment, with the Hospital’s Department of Radiology and Imaging providing attending rheumatologists and fellows with weekly tutorials in ultrasound imaging that has become a formal component of the fellowship curriculum. The Division considers the education of pediatric rheumatologists a worldwide priority and continues to teach doctors from around the world, including Japan, Spain, and Italy, who can then incorporate the most up-to-date knowledge in the field when caring for their patients.

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(Top) Thomas J.A. Lehman, MD, not only continues to advance treatment for children with rheumatic diseases, but is also committed to training pediatric rheumatologists who go on to practice throughout the U.S. and abroad. (Bottom) As the Associate Program Director for the Pediatric Rheumatology Fellowship, Alexa B. Adams, MD, is helping to enhance the training of fellows through their participation in the Transition Clinic and by ensuring they have protected research time as well.


PROFESSIONAL STAFF

DEPARTMENT OF MEDICINE Physician-in-Chief and Director of Medicine Mary K. Crow, MD Physicians-in-Chief Emeriti Charles L. Christian, MD Stephen A. Paget, MD, FACP, FACR Physicians Emeriti Irwin Nydick, MD William C. Robbins, MD Ernest Schwartz, MD Rheumatology Faculty Practice Theodore R. Fields, MD Coordinator Administrative Director Department of Medicine Laughlin Rice Rheumatology Fellowship Program Anne R. Bass, MD, FACP Director Thomas J.A. Lehman, MD, FAAP, FACR Director, Pediatric Rheumatology Fellowship Program Alexa B. Adams, MD Associate Director, Pediatric Rheumatology Fellowship Program Systemic Lupus Erythematosus and Antiphospholipid Syndrome Center of Excellence Jane E. Salmon, MD Director Inflammatory Arthritis Center of Excellence Sergio Schwartzman, MD Director Scleroderma, Vasculitis and Myositis Center of Excellence Robert F. Spiera, MD Director Attending Physicians Richard S. Bockman, MD, PhD (Endocrinology) Barry D. Brause, MD, FACP Chief, Infectious Disease Mary K. Crow, MD Physician-in-Chief

Theodore R. Fields, MD, FACP Allan Gibofsky, MD, JD, FACP, FCLM Lawrence J. Kagen, MD Thomas J.A. Lehman, MD, FAAP, FACR Chief, Pediatric Rheumatology Michael D. Lockshin, MD, MACR Steven K. Magid, MD Joseph A. Markenson, MD Stephen A. Paget, MD, FACP, FACR Francis Perrone, MD (Cardiovascular Disease) Jane E. Salmon, MD James P. Smith, MD (Pulmonary Medicine) Harry Spiera, MD Associate Attending Physicians Anne R. Bass, MD, FACP Harry Bienenstock, MD Lisa R. Callahan, MD (Primary Care Sports Medicine) Brian C. Halpern, MD (Primary Care Sports Medicine) Lionel B. Ivashkiv, MD C. Ronald MacKenzie, MD Carol A. Mancuso, MD, FACP Jordan D. Metzl, MD (Primary Care Sports Medicine) Martin Nydick, MD (Endocrinology) Sergio Schwartzman, MD Robert F. Spiera, MD Richard Stern, MD Assistant Attending Physicians Alexa B. Adams, MD (Pediatric Rheumatology) Juliet Aizer, MD, MPH Dalit Ashany, MD Laura V. Barinstein, MD John W. Barnhill, MD Jessica R. Berman, MD Matthew L. Buchalter, MD Gina DelGiudice, MD Stephen J. DiMartino, MD, PhD Doruk Erkan, MD, MPH Rebecca L. Florsheim, MD Richard A. Furie, MD Jacobo Futran, MD Flavia A. Golden, MD Susan M. Goodman, MD 20

Marci A. Goolsby, MD (Primary Care Sports Medicine) Jessica K. Gordon, MD Stewart G. Greisman, MD Wesley Hollomon, MD Michael I. Jacobs, MD (Dermatology) James J. Kinderknecht, MD (Primary Care Sports Medicine) Osric S. King, MD (Primary Care Sports Medicine) Kyriakos A. Kirou, MD, DSc, FACP Mary J. Kollakuzhiyil, MD Aileen L. Love, MD Emma Jane MacDermott, MD, MRCPI (Pediatric Rheumatology) Lisa A. Mandl, MD, MPH Jaqueline M. Mayo, MD Alia Menezes, MD Charis F. Meng, MD Andrew O. Miller, MD (Infectious Disease) Dana E. Orange, MD Sonal S. Parr, MD Edward J. Parrish, MD Jill M. Rieger, MD Linda A. Russell, MD Lisa R. Sammaritano, MD Ariel D. Teitel, MD Lisa C. Vasanth, MD, MS Mary Beth Walsh, MD Amber L. Wheeler, MD Arthur M. F. Yee, MD, PhD Diana A. Yens, MD Christine M. Yu, MD Florence Yu, MD Wendy S. Ziecheck, MD Physicians to Ambulatory Care Center Bento R. Mascarenhas, MD Lakshmi Nandini Moorthy, MD Alana C. Serota, MD Hendricks H. Whitman III, MD David A. Zackson, MD Fellows in Rheumatic Disease Sabeen Anwar, MD Elana Bernstein, MD Soumya Chakravarty, MD, PhD Kun Chen, MD, PhD


Fellows in Rheumatic Disease (continued) Lindsy Forbess, MD Diana Goldenberg, MD, MPH Jessica K. Gordon, MD Suhail Hameed, MBBS Arundathi Jayatilleke, MD, MS Beverly Johnson, MD Susan Kim, MD Alana Levine, MD Ora Singer, MD Weijia Yuan, MB Fellows in Pediatric Rheumatology Risa Alperin, MD Julie Cherian, MD Christina Mertelsmann-Voss, MD Nancy Pan, MD Anusha Ramanathan, MD RESEARCH DIVISION Steven R. Goldring, MD Chief Scientific Officer Lionel B. Ivashkiv, MD Associate Chief Scientific Officer and Director of Basic Research Robert N. Hotchkiss, MD Director of Clinical Research Senior Scientists Carl P. Blobel, MD, PhD Adele L. Boskey, PhD Mary K. Crow, MD Mary B. Goldring, PhD Jo A. Hannafin, MD, PhD Lionel B. Ivashkiv, MD Alessandra Pernis, MD Scott A. Rodeo, MD Jane E. Salmon, MD Associate Scientists Theresa T. Lu, MD, PhD Suzanne A. Maher, PhD Carol A. Mancuso, MD, FACP

Lionel B. Ivashkiv, MD, Associate Chief Scientific Officer, and the David H. Koch Chair for Arthritis and Tissue Degeneration Research, has made major inroads in the study of pathways involved in cytokine production in inflammatory disease.

ENDOWED CHAIRS, PROFESSORSHIPS, AND FELLOWSHIPS IN RHEUMATOLOGY Named Chairs and Professorships Franchellie M. Cadwell Chair Sergio Schwartzman, MD

Virginia F. and William R. Salomon Chair in Musculoskeletal Research Carl Blobel, MD, PhD

Collette Kean Research Chair Jane E. Salmon, MD

St. Giles Research Chair Steven R. Goldring, MD

David H. Koch Chair for Arthritis and Tissue Degeneration Research Lionel B. Ivashkiv, MD

Starr Chair in Mineralized Tissue Research Adele L. Boskey, PhD

Korein-Wilson Professorship in Orthopaedic Surgery Thomas P. Sculco, MD

Named Fellowships Charles L. Christian Research Fellowship Lisa A. Mandl, MD, MPH

C. Ronald MacKenzie, MD Chair in Ethics and Medicine supporting Wayne Shelton, PhD

Ira W. DeCamp Fellowship in Musculoskeletal Genetics Mary B. Goldring, PhD

Stephen A. Paget, MD Chair in Rheumatology Stephen A. Paget, MD, FACP, FACR Benjamin M. Rosen Chair in Immunology and Inflammation Research Mary K. Crow, MD Joseph P. Routh Professor of Rheumatic Diseases in Medicine Mary K. Crow, MD

Assistant Scientists Qui (Julia) Guo, PhD Xiaoyu Hu, MD, PhD Kyriakos A. Kirou, MD, DSc, FACP Inez Rogatsky, PhD

21

William T. Morris Fellowship in Pediatric Rheumatology Theresa T. Lu, MD, PhD Robert and Gillian Steel Fellowship in Musculoskeletal Research Inez Rogatsky, PhD Immunology and Inflammation Fellowship Victor Guaiquil, PhD


2009-2010 NOTABLE ACHIEVEMENTS

Rheumatologists at HSS are regularly cited for their professional achievements and outstanding contributions to patient care, research, and education. They hold leadership positions and are on numerous committees of national and international organizations and professional societies, and serve as editors and on editorial boards of the major peer-reviewed journals in the field. AWARDS AND SPECIAL RECOGNITION Mary K. Crow, MD Joseph P. Routh Professor of Rheumatic Diseases in Medicine Honorary Member, Interurban Clinical Club Paul J. Bilka Endowed Lecturer, Mayo Foundation, Rochester, MN Invited Speaker, Ninth International Congress on Systemic Lupus Erythematosus

Michael D. Lockshin, MD, MACR Ira M. Goldstein Memorial Lecture, New York University, New York

Doruk Erkan, MD, MPH Invited Speaker, New Jersey Rheumatology Association Annual Conference Invited Speaker, Fourth Greek-Turkish Rheumatology Days, Athens, Greece

Carol A. Mancuso, MD, FACP K24 Career Development Award, National Heart, Lung and Blood Institute

Theresa T. Lu, MD, PhD Distinguished Teacher Award, Cornell University Graduate School of Medical Sciences

Xiaoping Qing, MD, PhD The S.L.E. Lupus Foundation Research Award

Steven R. Goldring, MD Invited Speaker, European Workshop of Rheumatology Research, Bamberg, Germany Visiting Professor and Speaker, University of Massachusetts Medical Center

Laura Robbins, DSW Charles B. Harding Award for Distinguished Service, Arthritis Foundation Jane E. Salmon, MD Pfizer Visiting Professor in Rheumatology, University of Kentucky Invited Speaker, Opening Plenary Session, 2010 European League Against Rheumatism Meeting Laura J. Haddad Lectureship, Georgetown University Hospital Invited Speaker, Ninth International Congress on Systemic Lupus Erythematosus

Jessica K. Gordon, MD Arthritis Foundation Fellowship Award in Inflammatory Arthritis National Scleroderma Foundation Award Charles L. Christian Musculoskeletal Research Award Finalist, Department of Medicine Fellow Award George D. Kalliolias, MD, PhD The S.L.E. Foundation Research Award Thomas J.A. Lehman, MD, FAAP, FACR Main Oration, Indian Society of Pediatric Rheumatology, Nagpur, India

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LEADERSHIP POSITIONS Alexa B. Adams, MD Member, Pediatric Scholarly Oversight Committee, NewYork-Presbyterian Hospital/Weill Cornell Medical Center Member, Patient Services Committee, New York Chapter, Arthritis Foundation Juliet B. Aizer, MD, MPH Member, CARE 2010 Development Group, American College of Rheumatology Member, Medical Knowledge Self Assessment Program (MKSAP 16) Committee, Rheumatology Section, American College of Physicians

Theresa T. Lu, MD, PhD, a basic researcher trained in pediatric rheumatology, is studying how lymph node vascular growth and function is altered in chronic inflammatory states such as lupus.

Anne R. Bass, MD, FACP Chair, Training Resources Subcommittee of the Committee on Workforce and Training, American College of Rheumatology

Doruk Erkan, MD, MPH Co-Chair, Abstract Review Committee, Antiphospholipid Syndrome, Annual Scientific Meeting, American College of Rheumatology Co-Chair, Antiphospholipid Syndrome Clinical Research Task Force Member, Catastrophic Antiphospholipid Syndrome Task Force Member, Abstract Review Committee, 13th International Congress on Antiphospholipid Antibodies, Galveston, Texas Member, Executive Committee, New York Rheumatism Association Member, Thrombotic Storm Classification Committee, National Thrombotic Storm Meeting Mentor, Clinical and Translational Research Career Development Award, Einstein-Montefiore Institute for Clinical and Translational Research Member, Grant Review Committee, Annual Scientific Grant Application, Dutch Arthritis Foundation Member, Medical and Scientific Committee, New York Chapter, Arthritis Foundation

Adena Batterman, LCSW Member, Practice Committee, Association of Rheumatology Health Professionals Barry D. Brause, MD, FACP Member, Committee on Infections, Member, Internship Recruitment Committee, NewYork-Presbyterian Hospital/Weill Cornell Medical Center Mary K. Crow, MD Chair, Scientific Advisory Board, Alliance for Lupus Research Chair, Grand Opportunities Study Section, National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases Board of Trustees, Arthritis Foundation, New York Chapter Scientific Advisory Board, Arthritis National Research Foundation Member, Review Committee, Scleroderma Foundation Member, Special Emphasis Panel, Autoimmunity Centers of Excellence, National Institutes of Health, National Institute of Allergy and Infectious Diseases

Theodore R. Fields, MD, FACP Member, Abstract Selection Committee: Quality Measures and Innovations in Practice Management and Care Delivery, American College of Rheumatology Rebecca L. Florsheim, MD Medical Volunteer, Association of Haitian Physicians Abroad, Port-au-Prince, Haiti (continued on page 24)

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2009-2010 NOTABLE ACHIEVEMENTS

LEADERSHIP POSITIONS (CONTINUED)

Michael D. Lockshin, MD, MACR Member, Organizing Committee, and Speaker, 13th International Congress on Antiphospholipid Antibodies, Galveston, Texas

Allan Gibofsky, MD, JD, FACP, FCLM Chair, U.S. Committee for the International Treat-to-Target Rheumatoid Arthritis Initiative Consultant, Arthritis Advisory Committee, Food and Drug Administration

Theresa T. Lu, MD, PhD Panelist, Careers in Pediatric Rheumatology Research Session, American College of Rheumatology Member, Medical and Scientific Committee, New York Chapter, Arthritis Foundation Member, Childhood Arthritis and Rheumatology Alliance Ad Hoc Member, Study Section on Atherosclerosis and Inflammation of the Cardiovascular System, National Institutes of Health Member, Study Section on Juvenile Arthritis, National Chapter, Arthritis Foundation Grant Reviewer: Arthritis Foundation; Lupus Research Institute; and Wellcome Trust

Mary B. Goldring, PhD Fourth Vice President, Orthopaedic Research Society Steven R. Goldring, MD Co-Chair, Organizing Committee, “Post-Traumatic Arthritis of the Knee: A Model for the Study of Osteoarthritis,” co-sponsored by Hospital for Special Surgery and the Arthritis Foundation Chair, Basic Science Program Committee, Annual Meeting, American College of Rheumatology

C. Ronald MacKenzie, MD Chair, Committee on Ethics and Conflict of Interest, American College of Rheumatology

Kyriakos A. Kirou, MD, DSc, FACP Member, Medical and Scientific Committee, and Planning Committee, Stavros Niarchos International Fellowship Exchange Program, New York Chapter, Arthritis Foundation

Steven K. Magid, MD Member, Medical Informatics, Academic Medical Center Clinical Systems Collaborative Member, Chief Medical Information Officer Leadership Group, DVT/VTE Academic Collaboration, and Outcomes Advisory Board, Eclipsys Member, Medical Informatics of New York Member, Practice Improvement Module Development Committee’s Quality of Care Subcommittee, American College of Rheumatology

Thomas J.A. Lehman, MD, FAAP, FACR Member, Collaborative Study Group, Pediatric Rheumatology Member, Medical Council, Lupus Foundation of America Medical Advisory Board, Juvenile Scleroderma Chapter, Scleroderma Foundation Medical Advisory Board, Russian Children’s Welfare and Raynaud’s Association Consultant, Arthritis Drugs Advisory Committee, Department of Health and Human Services, Food and Drug Administration Grant Reviewer: Canadian Arthritis Society; March of Dimes; Veterans Administration; Lupus Foundation of America; National Institute of Arthritis and Musculoskeletal and Skin Diseases, Department of Health and Human Services, Pediatric Rheumatology RFA Study Section; American College of Rheumatology; and Food and Drug Administration Orphan Drug Development Office

Carol A. Mancuso, MD, FACP Data and Safety Monitoring Board and Antiasthma Herbal Medicine Intervention, Mount Sinai School of Medicine Member, National Center for Complementary and Alternative Medicine Lisa A. Mandl, MD, MPH Member, Young Investigator Subcommittee, Committee on Research, American College of Rheumatology Member, Translational Research Advisory Committee Study Section, National Institutes of Health Study Section, Arthritis Foundation

24


Joseph A. Markenson, MD Member, Research and Education Foundation Fundraising Committee, American College of Rheumatology Stephen A. Paget, MD, FACP, FACR Consultant, The Rockefeller University Hospital Member, National Scientific Advisory Council Member, American Federation for Aging Research The research collaborations of Kyriakos A. Kirou, MD, DSc, Clinical CoDirector of the Mary Kirkland Center for Lupus Care; Mary K. Crow, MD, Physician-in-Chief and Chairman of the Division of Rheumatology; and Jane E. Salmon, MD, Director, Systemic Lupus Erythematosus and Antiphospholipid Syndrome Center of Excellence, have resulted in important contributions to the care of patients with lupus.

Laura Robbins, DSW Chair, Osteoarthritis Alliance Leadership Group, Arthritis Foundation Jillian Rose, LMSW Invited Facilitator, ARHP Networking at Noon, Diversity and Cultural Issues Roundtable, Annual Scientific Meeting, American College of Rheumatology Member, Multicultural Initiative Strategic Planning Committee, Hispanic/Latino Work Group, National Institute of Arthritis and Musculoskeletal and Skin Diseases Member, Professional Development Subcommittee on Eliminating Health Disparities in Lupus, American College of Rheumatology

Robert F. Spiera, MD President, New York Rheumatism Association Member, Executive Committee and Abstract Selection Committee – Vasculitis, New York Rheumatism Association Member, International Network for the Study of Systemic Vasculitis Member, Annual Meeting Planning Committee, American College of Rheumatology Member, Medical Scientific Committee and Scleroderma Clinical Trials Consortium, Arthritis Foundation Member, Medical Advisory Board, Scientific Advisory Board, and Grant Reviewer, Vasculitis Foundation

Linda A. Russell, MD Chair, Patient Services Committee; Member, Board of Governors; and Member, Medical Scientific Committee, New York Chapter, Arthritis Foundation Women’s Health Advisor, Advisory Board, Columbia University Medical Center Board of Directors, Burke Rehabilitation Hospital

My-Lan Tran, LCSW Member, Multicultural Initiative Strategic Planning Committee, Asian/Pacific Islander Work Group, National Institute of Arthritis and Musculoskeletal and Skin Diseases

Jane E. Salmon, MD Secretary-Treasurer and Member, Centers of Excellence Committee, Federation of Clinical Immunology Societies Member, Scientific Programme Committee, European League Against Rheumatism Member, Roundtable to Discuss Opportunities for Clinical Research and Committee on Biomarker Development and Validation in SLE, National Institute of Arthritis and Musculoskeletal and Skin Diseases Member, Advisory Committee for North American Rheumatoid Arthritis Consortium Scientific Councilor, The Henry Kunkel Society Member, Klemperer Award Committee, New York Academy of Medicine Course Director, Rheumatology Annual Review Course, New York Rheumatism Association

Arthur M. Yee, MD, PhD Advisory Board, Lupus Asian Network Member, Medical and Scientific Committee, New York Chapter, Arthritis Foundation

25


2009-2010 NOTABLE ACHIEVEMENTS

EDITORIAL APPOINTMENTS

Michael D. Lockshin, MD, MACR Editor, Arthritis & Rheumatism Reviewer: The New England Journal of Medicine, Journal of Clinical Investigation, Journal of Immunology

Anne R. Bass, MD, FACP Reviewer: American Journal of Medicine, Arthritis Care & Research Section Editor, MKSAP 16, Rheumatology

Theresa T. Lu, MD, PhD Editor, Arthritis & Rheumatism Reviewer: Journal of Experimental Medicine, Journal of Clinical Investigation, Blood, Journal of Immunology, Arthritis & Rheumatism

Barry D. Brause, MD, FACP Reviewer: Journal of the American Medical Association, Journal of Bone and Joint Surgery, Journal of Intensive Care Medicine, Mayo Clinic Proceedings

C. Ronald MacKenzie, MD Deputy Editor, HSS Journal: The Musculoskeletal Journal of Hospital for Special Surgery Author, Quarterly Column – Ethics Forum, The Rheumatologist, American College of Rheumatology

Mary K. Crow, MD Associate Editor, Annals of the Rheumatic Diseases Doruk Erkan, MD, MPH Advisory Editor, Arthritis & Rheumatism Editorial Board, HSS Journal: The Musculoskeletal Journal of Hospital for Special Surgery Review Committee, Journal of Obstetric and Gynecology Research

Carol A. Mancuso, MD, FACP Reviewer: Journal of Asthma and Clinical Immunology, Journal of Clinical Epidemiology, Arthritis Care & Research, Arthritis & Rheumatism, Chest, Clinical Orthopaedics and Related Research

Theodore R. Fields, MD, FACP Advisory Editor, Arthritis & Rheumatism Reviewer, Arthritis Care & Research

Lisa A. Mandl, MD, MPH Reviewer: Arthritis & Rheumatism, Osteoarthritis and Cartilage, Journal of Rheumatology, International Journal of Clinical Practice, Annals of the Rheumatic Diseases, Scandinavian Journal of Rheumatology, Journal of the American Geriatrics Society

Kyriakos A. Kirou, MD, DSc, FACP Scientific Reviewer: American Journal of Pathology, Arthritis & Rheumatism, Arthritis Research and Therapy, Clinical and Experimental Immunology, Clinical Immunology, Journal of Investigative Medicine, Annals of the Rheumatic Diseases

Stephen A. Paget, MD, FACP, FACR Editorial Board, Rheumatology News Advisory Editor and Co-Editor, Arthritis & Rheumatism Associate Editor, Clinical and Experimental Rheumatology Reviewer: Annals of the Rheumatic Diseases, Arthritis Care & Research, Arthritis & Rheumatism, Clinical Rheumatology, Journal of Rheumatology, Mayo Clinic Proceedings

Thomas J.A. Lehman, MD, FAAP, FACR Scientific Advisory Board, APLAR Journal of Rheumatology Scientific Advisory Board, International Journal of Rheumatic Diseases Reviewer: Arthritis & Rheumatism, Journal of Rheumatology, Journal of Pediatrics, Pediatrics, Clinical and Experimental Rheumatology, The Lancet, The European Journal of Pediatrics, Pediatric Nephrology, Pediatric Research, Drugs and Therapeutics, Scandinavian Journal of Rheumatology, BioMedNet, Journal of Experimental Medicine, Pediatrics International, Arthritis Research & Therapy, American Journal of Gastroenterology, Lupus, Journal of Immunology, Journal of Adolescent Health

Lisa R. Sammaritano, MD Reviewer: The American Journal of Medicine, American Journal of Perinatology, Arthritis & Rheumatism, Arthritis Care & Research, Southern Medical Journal, The Journal of Rheumatology, The Journal of Clinical Investigation, Mayo Clinic Proceedings, Scandinavian Journal of Rheumatology, Thrombosis and Haemostasis – Lupus, Nature Reviews Rheumatology Peer Reviewer, Up-to-Date Rheumatology Andrew M.F. Yee, MD Contributing Editor, The Medical Letter

26


2009-2010 SELECTED PUBLICATIONS

PEER-REVIEWED JOURNALS Akman HO, Davidzon G, Tanji K, MacDermott EJ, Larsen L, Davidson MM, Haller RG, Szczepaniak LS, Lehman TJA, Hirano M, DiMauro S. Neutral lipid storage disease with subclinical myopathy due to a retrotransposal insertion in the PNPLA2 gene. Neuromuscular Disorders. 2010 Jun;20(6):397-402. Epub 2010 May 14. Under the leadership of Steven K. Magid, MD, the Hospital’s new Quality Research Center is creating an innovative structure for applying research methodologies to healthcare quality issues and will integrate the numerous quality research initiatives taking place throughout HSS.

Angeles-Han ST, Griffin KW, Lehman TJA, Rutledge JR, Lyman S, Nguyen JT, Harrison MJ. The importance of visual function in the quality of life of children with uveitis. Journal of the American Association for Pediatric Ophthalmology and Strabismus. 2010 Apr; 14(2):163-8. Epub 2010 Mar 17. Aringer M, Crow MK, Smolen JS. Clinical applications of IFN-α blockade in systemic lupus erythematosus. International Journal of Clinical Rheumatology. 2009; Vol 4, No. 6, pp 617-619.

Chen K, Fields T, Mancuso CA, Bass AR, Vasanth L. Anakinra’s efficacy is variable in refractory gout and pseudogout: report of eleven cases. Seminars in Arthritis & Rheumatism, posted online 5/24/10.

Azar L, Erkan D. Real world experience with antiphosphatidylserine antibodies. Lupus. 2010 Apr; 19(4):521. Bang H, Chiu Y, Memtsoudis SG, Mandl LA, Gonzalez Della Valle A, Marx RG, Mazumdar M. Hip and knee arthroplasties: trends and disparities revisited. The American Journal of Orthopedics. [In press].

Chibnik LB, Mandl LA, Costenbader KH, Schur PH, Karlson EW. Comparison of threshold cutpoints and continuous measures of anti-cyclic citrullinated peptide antibodies in predicting future rheumatoid arthritis. Journal of Rheumatolgy. 2009 Apr; 36(4):70611. Epub 2009 Feb 17.

Barbhaiya M, Keles FG, Erkan D, Lockshin MD. A cross sectional analysis of patients referred for evaluation of APS. Lupus. 2010 April; 19 (4):521.

Combe B, Schwartzman S, Massarotti E, Keystone E, Luitejns K, van der Heijde D. Incremental benefit of open-label certolizumab pegol and MTX in rheumatoid arthritis patients following doubleblind placebo + MTX treatment out to two years. Arthritis & Rheumatism. 2009; 60: S 623, 1668.

Berman JR, Lazaro D, Fields TR, Paget SA, et al. The New York City Rheumatology Objective Structure Clinical Examination: Five-year data demonstrates its validity, usefulness as a unique rating tool, objectivity and sensitivity to change. Arthritis & Rheumatism 2009; 61:1686-93.

Crow MK. Developments in the clinical understanding of lupus. Arthritis Research & Therapy. 2009; 11:245.

Bockman RS. First it’s rickets, then it’s not: the sodium-phosphate transporter 2a knockout mystery. Endocrinology. 2010; 151:45994601.

Crow MK. Interferon-alpha: a therapeutic target in systemic lupus erythematosus. Rheumatic Disease Clinics of North America. 2010; 36:173-86.

Cervera R; CAPS Registry Project Group (Erkan D). Catastrophic Antiphospholipid Syndrome (CAPS): Update from the CAPS registry. Lupus. 2010; 19(4):412-418.

Crow MK. Long Interspersed Nuclear Elements (LINE-1): potential triggers of systemic autoimmune disease. Autoimmunity. 2010; 43:7-16.

Chandra A, Wormser GP, Klempner MS, Trevino RP, Crow MK, Alaedini A. Anti-neural antibody reactivity in patients with a history of Lyme borreliosis and persistent symptoms. Brain, Behavior, and Immunity. 2010; 24:1018-1024.

(continued on page 28)

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2009-2010 SELECTED PUBLICATIONS

PEER-REVIEWED JOURNALS (CONTINUED)

Goldring MB, Goldring SR. Articular cartilage and subchondral bone in the pathogenesis of osteoarthritis. Annals of the New York Academy of Sciences. 2010 Mar; 1192(1):230-7.

Crow MK. Type I interferon in organ-targeted autoimmune and inflammatory diseases. Arthritis Research & Therapy. 2010 Aug 25; 12(Suppl):55.

Goldring SR. Needs and opportunities in the assessment and treatment of osteoarthritis of the knee and hip: the view of the rheumatologist. The Journal of Bone and Joint Surgery. 2009 Feb; 91 Suppl 1:4-6.

Dugar A, Farley ML, Wang AL, Goldring MB, Goldring SR, Swaim BH, Bierbaum BE, Burstein D, Gray ML. The effect of paraformaldehyde fixation on the delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) measurement. Journal of Orthopaedic Research. 2009 Apr; 27(4):536-9.

Goldring SR. Periarticular bone changes in rheumatoid arthritis: pathophysiological implications and clinical utility. Annals of the Rheumatic Diseases. 2009 Mar; 68(3):297-9.

Efthimiou P, Kukar M, MacKenzie CR. Complementary and alternative medicine in rheumatoid arthritis: no longer the last resort! HSS Journal: The Musculoskeletal Journal of Hospital for Special Surgery. 2010; 6(1):108-111.

Goodman S. Measuring methotrexate polyglutamates. Clinical and Experimental Rheumatology. In press. Goodman S, Mackenzie CR. Perioperative management of patients with connective tissue diseases. HSS Journal: The Musculoskeletal Journal of Hospital for Special Surgery. In press.

Erkan D. Risk quantification in antiphospholipid syndrome. Women’s Health (London, England). 2010; 6(2):179-182.

Gordon JK, Magid SK, Maki R, Fleischer M, Berman E. Elevations of creatine kinase in patients treated with imatinib mesylate (Gleevec). Leukemia Research. 2010 Jun; 34(6):827-9. Epub 2009 Dec 5.

Erkan D, Barbhaiya M, George D, Sammaritano LR, Lockshin MD. Moderate versus high-titer persistently anticardiolipin antibody positive patients: are they clinically different and does hightiter anti-{beta}2-glycoprotein-I antibody positivity offer additional predictive information? Lupus. 2010; 19(5):613-9. Epub 2009 Nov 24.

Gordon JK, Magro CM, Lu T, Schneider R, Chiu A, Solomon G, Furman RR, Bass A, Erkan D. Overlap between systemic lupus erythematosus and Kikuchi-Fujimoto disease: a clinical pathology conference held by the Department of Rheumatology at Hospital for Special Surgery. HSS Journal: The Musculoskeletal Journal of Hospital for Special Surgery. 2009 Sep; 5(2):169-77.

Erkan D, Kozora E, Lockshin MD. Cognitive dysfunction and white matter abnormalities in antiphospholipid syndrome. Pathophysiology. 2010 May 14. [Epub ahead of print]. Erkan D, Lockshin MD. Non-criteria manifestations of antiphospholipid syndrome. Lupus. 2010; 19:424-427.

Gordon JK, Spiera RF. Targeting tyrosine kinases: a novel therapeutic strategy for systemic sclerosis. Current Opinion in Rheumatology. 2010 Nov; 22(6):690-695.

Firoz EF, Kamino H, Lehman TJA, Orlow SJ. Morphea, diabetes mellitus type I, and celiac disease. Pediatric Dermatology. 2010 Jan 1; 27(1):48-52. Review.

Haiduc I, Richey M, Tzakas S, Konstantellis L, Erkan D. Cardiovascular disease prevention counseling program for systemic lupus erythematosus and antiphospholipid antibody (aPL) positive patients. Lupus. 2010; 19(4):520.

Furst DE, Keystone EC, Fleischmann RM, Mease P, Breedveld FC, Smolen J, Kalden JR, Braun J, Bresnihan B, Bermester GR, De Benedetti F, Dorner T, Emery P, Gibofsky A, Kavanaugh A, Kirkham B, Schiff MH, Sieper J, Singer N, van Riel PLCM, Weinblatt M, Weisman MH, Winthrop K. Updated consensus statement on biological agents for the treatment of rheumatic diseases. Annals of the Rheumatic Diseases. 2009; 69:2-29.

James DE, Nestor BJ, Sculco TP, Ivashkiv LB, Ross FP, Goldring SR, Purdue PE. The relative timing of exposure to phagocytosable particulates and to osteoclastogenic cytokines is critically important in the determination of myeloid cell fate. The Journal of Immunology. 2010 Jul 15; 185(2):1265-73. Epub 2010 Jun 11.

Gibofsky A, Yazici Y. Treatment of rheumatoid arthritis: strategies for achieving optimal outcomes. Annals of the Rheumatic Diseases. 2010; 69:941-942.

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Ji JD, Park-Min KH, Shen Z, Fajardo RJ, Goldring SR, McHugh KP, Ivashkiv LB. Inhibition of RANK expression and osteoclastogenesis by TLRs and IFN-gamma in human osteoclast precursors. The Journal of Immunology. 2009 Dec 1; 183(11):7223-33. Epub 2009 Nov 4.

Lyman S, Dunn WR, Spock C, Bach PB, Mandl LA, Marx RG. Validity of same-side re-operation after total hip and knee arthroplasty using administrative databases. Journal of Knee Surgery. 2009; 22:17-20. Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG. Epidemiology of anterior cruciate ligament reconstruction, trends, readmissions and subsequent knee surgery. Journal of Bone and Joint Surgery. 2009; 91:2321-8.

Kara FM, Doty SB, Boskey AL, Goldring SR, Zaidi M, Fredholm BB, Cronstein BN. Adenosine A(1) receptors regulate bone resorption in mice: adenosine A(1) receptor blockade or deletion increases bone density and prevents ovariectomy-induced bone loss in adenosine A(1) receptor-knockout mice. Arthritis & Rheumatism. 2010 Feb; 62(2):534-41.

Mancuso CA, Gaeta TJ, Fernandez JL, Peterson MG, Birkhahn RH, Melniker LA, Allegrante JP. Perceived access to ambulatory care predicts short-term repeat emergency department visits for asthma. American Journal of Respiratory and Critical Care Medicine. 2010; 181:A3123.

Kariuki SN, Franek BS, Kumar AA, Arrington J, Mikolaitis RA, Utset TO, Jolly M, Crow MK, Skol AD, Niewold TB. Trait-stratified genome-wide association study identifies novel and diverse genetic associations with serologic and cytokine phenotypes in systemic lupus erythematosus. Arthritis Research & Therapy. 2010 July 26; 12:R151.

Mandl LA, Costenbader KH, Simard J, Karlson EW. Is birthweight associated with risk of rheumatoid arthritis? Data from a large prospective cohort study. Annals of the Rheumatic Diseases. 2009; 4: 514-8.

Kariuki SN, Kirou KA, MacDermott EJ, Barillas-Arias L, Crow MK, Niewold TB. Cutting edge: autoimmune disease risk variant of STAT4 confers increased sensitivity to IFN-alpha in lupus patients in vivo. The Journal of Immunology. 2009; 182:34-8.

Mandl LA, Hotchkiss R, Adler R, Lyman S, Daluiski A, Wolfe S, Katz J. Injectable hyaluronan for the treatment of carpometacarpal osteoarthritis: an open label pilot trial. Current Medical Research and Opinion. 2009; 25:2103-2108.

Kariuki SN, Moore JG, Kirou KA, Crow MK, Utset TO, Niewold TB. Age- and gender-specific modulation of serum osteopontin and interferon-alpha by osteopontin genotype in systemic lupus erythematosus. Genes & Immunity. 2009 Jul; 10(5):487-94. Epub 2009 Apr 2.

Markenson JA. Rheumatic manifestations of endocrine diseases. Current Opinion in Rheumatology. 2010; 22:64-71.

Katz PP, Yelin EH, Lockshin MD. The child, grown, becomes independent. Arthritis & Rheumatism. 2009 Dec; 60(12):3523.

Martinez-Martinez LA, Aguilar-Valenzuela R, Doan E, Papalardo E, Gonzalez EB, Murphy V, Seif A, Erkan D, Pierangeli SS. Elevated cytokines and chemokine levels antiphospholipid antibody positive patients. Lupus. 2010; 19(4);508.

Kirou KA, Kalliolias GD. A new tool for detection of type I interferon activation in systemic lupus erythematosus. Arthritis Research & Therapy. 2010 August 26; 12:138.

Mavragani CP, Crow MK. Activation of the type I interferon pathway in primary Sjogren’s syndrome. Journal of Autoimmunity. 2010 July 29.

Koolaee RM, Singer O, Bass A, Winchester R, Seshan S, Erkan D. Hepatitis C- and HIV- induced hypersensitivity vasculitis. HSS Journal: The Musculoskeletal Journal of Hospital for Special Surgery. 2010; 6(1).

Mavragani CP, La DT, Stohl W, Crow MK. Association of the response to TNF antagonists with plasma type I interferon activity and interferon-beta/alpha ratios in rheumatoid arthritis patients: a post-hoc analysis of a predominantly Hispanic Cohort. Arthritis & Rheumatism. 2010; 62:392-401.

Lehman TJA. Should the FDA warning about malignancy in children treated with TNF blockers change the way we treat children with Juvenile Idiopathic Arthritis? Arthritis & Rheumatism. 2010 Aug; 62(8):2183-4.

McHugh KP, Shen Z, Crotti TN, Flannery MR, O’Sullivan RP, Purdue PE, Goldring SR. The role of cell-substrate interaction in regulating osteoclast activation: potential implications in targeting bone loss in rheumatoid arthritis. Annals of the Rheumatic Diseases. 2010 Jan; 69 Suppl 1:i83-85. Review. (continued on page 30)

29


2009-2010 SELECTED PUBLICATIONS

PEER-REVIEWED JOURNALS (CONTINUED)

Rudominer RL, Roman MJ, Devereux RB, Paget SA, et al. Independent association of rheumatoid arthritis with increased left ventricular mass but not with reduced ejection fraction. Arthritis & Rheumatism. 2009; 60 (1) 22-9.

Memtsoudis SG, Ma Y, Gonzalez Della Valle A, Gaber-Baylis LG, MacKenzie CR, Sculco TP. Perioperative outcome after unilateral and bilateral total knee arthroplasty. Anesthesiology. 2009 Dec; 111(6):1206-16.

Schulte DJ, Yilmaz A, Shimada K, Fishbein MC, Lowe EL, Chen S, Wong M, Doherty TM, Lehman TJA, Crother TR, Sorrentino R, Arditi M. Involvement of innate and adaptive immunity in a murine model of coronary arteritis mimicking Kawasaki disease. Journal of Immunology. 2009 Oct 15; 183(8):5311-8.

Moorthy LN, Peterson MG, Baratelli MJ, Hassett AL, Lehman TJA; International SMILEY Collaborative Group. Preliminary cross-cultural adaptation of a new pediatric health-related quality of life scale in children with systemic lupus erythematosus: an international effort. Lupus. 2010 Jan; 19(1):83-8. Epub 2009 Nov 24. Moorthy LN, Peterson MG, Hassett AL, Baratelli M, Lehman TJA. Impact of lupus on school attendance and performance. Lupus. 2010 Apr; 19(5):620-7. Epub 2010 Jan 11.

Silverman G, Schwartzman S, Townsend M, Su Z, Holweg C, Read S, Yocum D, Lal P. Identification of biomarkers for enhanced benefit to rituximab in rheumatoid arthritis: role of autoantibodies and inflammatory markers. Arthritis & Rheumatism. 2009; 60:S 628, 1680.

Moorthy LN, Peterson MG, Hassett AL, Lehman TJA. Burden of childhood-onset arthritis. Pediatric Rheumatology Online Journal. 2010 Jul 8; 8(1):20.

Singer O, Gibofsky A. Review of disease modifying antirheumatic drug use in rheumatoid arthritis. International Journal of Advances in Rheumatology. 2009; 6:120-129.

Mushtaq S, Goodman SM, Scanzello CR. Perioperative management of biologic agents used in treatment of rheumatoid arthritis. American Journal of Therapeutics. 2010 March 5.

Smolen J, Aletaha D, Bijlisma JWJ, Breedveld FC, Boumpas D, Burmester G, Combe B, Cutolo M, deWit M, Dougados M, Emery P, Gibofsky A, Gomez-Raino J, Haraoui B, Kalden J, Keystone EC, Kvein TK, MacInnes I, Martin-Mola E, Montecucco C, Scholes M, van der Hiejde D. Treating rheumatoid arthritis to target: recommendations of an international task force. Annals of the Rheumatic Diseases. 2010.

Ortel TL, Kitchens CS, Pericak-Vance MA, Erkan D, James AH, Kulkarni R, Brandao L, Hahn S, Vance J. Thrombotic Storm: a severe, rapidly progressive thrombotic disorder. Lupus. 2010; 19(4):530.

Stein EM, Strain G, Sinha N, Ortiz D, Pomp A, Dakin G, McMahon DJ, Bockman R, Silverberg SJ. Vitamin D insufficiency prior to bariatric surgery: risk factors and a pilot treatment study. The Clinical Journal of the Society for Endocrinology (Oxford). 2009 Aug; 71(2):176-83. Epub 2008 Nov 5.

Penack O, Henk E, Suh D, King CG, Smith OM, Na IK, Holland AM, Ghosh A, Lu SX, Jenq RR, Liu C, Murphy GF, Lu TT, May C, Scheinberg DA, Gao DC, Mittal V, Benezra R, van den Brink MR. Depletion of vascular endothelial progenitor cells inhibits inflammation. Journal of the National Cancer Institute. 2010; Epub May 12.

Stone JH, Merkel PA, Spiera RF, Seo P, Langford CA, Hoffman GS, Kallenberg CGM, St. Clair EW, Turkiewicz A, Tchao NK, Webber L, Ding L, Sejismundo L, Mieras K, Weitzenkamp D, Ikle D, Seyfert-Margolis V, Mueller M, Brunetta P, Allen NB, Fervenza FC, Geetha D, Keogh KA, Kissin EY, Monach PA, Peikert T, Stegeman C, Ytterberg SR, Specks U. Rituximab versus cyclophosphamide for the induction of remission in ANCAassociated vasculitis. The New England Journal of Medicine. 2010 Jul 15; 363(3):221-32.

Perna M, Roman MJ, Alpert DR, Crow MK, Lockshin MD, Sammaritano LR, Devereux RB, Cooke JP, Salmon JE. Relationship of asymmetric dimethylarginine and homocysteine to vascular aging in SLE patients. Arthritis & Rheumatism. 2010; 62:1718-22. Pierangeli S, Erkan D. Antiphospholipid syndrome treatment beyond anticoagulation: are we there yet? Lupus. 2010; 19(4):475-485.

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Taylor P, Manger B, Alvaro-Gracia J, Johnstone R, Gomez-Reino J, Eberhardt E, Wolfe F, Schwartzman S, Furfaro N, Kavanaugh A. Patient perceptions concerning pain management in the treatment of rheumatoid arthritis. The Journal of International Medical Research. 2010; Jul-Aug; 38(4):1213-24.

BOOK CHAPTERS Lehman TJA. A Clinician’s Guide to Rheumatic Diseases in Children. Oxford Press, New York, 2009. MacKenzie CR, Paget SA. Perioperative Care of the Rheumatic Disease Patient. In Rheumatology. Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME and MH Weisman (Eds). Projected date of publication 2010, Elsevier.

The Young Investigator Subcommittee of the American College of Rheumatology Committee on Research. Rheumatology fellows’ perception on training and careers in academia: The American College of Rheumatology Fellow Research and Academic Training Survey. Arthritis Care and Research. 2009; 61:266-273.

MacKenzie CR, Paget SA. Ethics in Clinical Trials. In Rheumatology. Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME and MH Weisman (Eds). Projected date of publication 2010, Elsevier.

Thurlings RM, Boumans M, Tekstra J, Vos K, van Westing DM, van Baarsen LG, Bos C, Kirou KA, Gerlag DM, Crow MK, Bijlsma H, Verweij CL, Tak PP. The relationship between the type I interferon signature and the response to rituximab in rheumatoid arthritis. Arthritis & Rheumatism. 2010 Aug 18. [Epub ahead of print].

MacKenzie CR, Paget SA. Management of the Rheumatic Disease Patient in the Surgical Setting. In Current Diagnosis & Treatment: Rheumatology. 3rd ed. Imboden J, Hellmann D, Stone J. Projected date of publication 2010.

Trotter A, Bhayani N, Florsheim R, Novak RM. Implementing universal oral HIV screening in an urban emergency department – do demographic characteristics impact acceptance of testing? Clinical Infectious Diseases. 2010 January 15; Vol. 50, No. 2: pp. 283-283.

Sammaritano LR. Management of the Patient With Rheumatic Disease During and After Pregnancy. In Targeted Treatment of the Rheumatic Diseases. Weisman MH, Weinblatt M, Louie JS, Van Vollenhoven R (Eds). Philadelphia: Saunders (Elsevier); 2009 (1st edition):420-439.

Tzeng T, Chyou S, Tian S, Webster B, Carpenter AC, Guaiquil VH, and Lu TT. CD11chi dendritic cells regulate the reestablishment of vascular quiescence and stabilization after immune stimulation of lymph nodes. Journal of Immunology. 2010; 184:4247-4257.

Sammaritano LR. Rheumatologic Manifestations of Pregnancy. In Rheumatic Disease Clinics of North America. Markenson J, ed. In press. Spiera RF, Paget SA. Polymyalgia Rheumatica and Temporal Arteritis. In Cecil’s Textbook of Medicine. 24th edition. In press. 2010.

Vasanth LC, Foo LF, Potter HG, Adler RS, Finzel KC, Pavlov H, Mandl LA. Using magnetic resonance angiography to measure abnormal synovial blood vessels in early inflammatory arthritis: a new imaging biomarker? Journal of Rheumatology. 2010 Jun; 37(6):1129-35. Epub 2010 Apr 1.

Spiera RF, Spiera H. Why is Sjögren’s So Hard to Diagnose? In The Sjögren’s Syndrome Handbook, 4th edition. Wallace DJ (Ed). Oxford University Press, Inc. 2010.

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HOSPITAL FOR SPECIAL SURGERY

2009-2010 RHEUMATIC DISEASE FELLOWS

(Seated) Sabeen Anwar, MD, and Kun Chen, MD, PhD (Standing, left to right) Weijia Yuan, MB, Suhail Hameed, MBBS, Anne R. Bass, MD, Beverly Johnson, MD, Stephen A. Paget, MD, Lindsy Forbess, MD, Arundathi Jayatilleke, MD, MS, Alana Levine, MD, and Jessica K. Gordon, MD (Not pictured) Diana Goldenberg, MD, MPH, and Ora Singer, MD

ACADEMIC LEADERSHIP

2009-2010 FELLOWS IN RHEUMATIC DISEASE

2010 GRADUATE AWARDS

Mary K. Crow, MD Physician-in-Chief and Chairman, Division of Rheumatology

2010 Graduates Sabeen Anwar, MD Kun Chen, MD, PhD Jessica K. Gordon, MD Suhail Hameed, MBBS Ora Singer, MD

Division of Rheumatology Award for Teaching Excellence Stephen A. Paget, MD, FACP, FACR

Anne R. Bass, MD Director, Rheumatology Fellowship Program Thomas J.A. Lehman, MD, FAAP, FACR Director, Pediatric Rheumatology Fellowship Program Alexa B. Adams, MD Associate Director, Pediatric Rheumatology Fellowship Program

First Year Fellows Elana Bernstein, MD Soumya Chakravarty, MD, PhD Susan Kim, MD

Fifth Year Fellow Diana Goldenberg, MD, MPH

FELLOWS IN PEDIATRIC RHEUMATOLGY

Third Year Fellows Arundathi Jayatilleke, MD, MS Weijia Yuan, MB

Risa Alperin, MD Julie Cherian, MD Christina Mertelsmann-Voss, MD Nancy Pan, MD Anusha Ramanathan, MD

Second Year Fellows Lindsy Forbess, MD Beverly Johnson, MD Alana Levine, MD

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Charles L. Christian, MD Award for Excellence in Musculoskeletal Research Jessica K. Gordon, MD Imatinib Mesylate (Gleevec速) Treatment of Patients with Diffuse Cutaneous Systemic Sclerosis: Changes in Histopathology and Gene Expression


DIVISION OF RHEUMATOLOGY HOSPITAL FOR SPECIAL SURGERY 535 EAST 70TH STREET NEW YORK, NY 10021 www.hss.edu The 2009-2010 Annual Report of the Division of Rheumatology is produced by the Division of Rheumatology and the Education Division of Hospital for Special Surgery.

About Hospital for Special Surgery Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopaedics, rheumatology, and rehabilitation. HSS is nationally ranked No. 1 in orthopaedics, No. 3 in rheumatology, and No. 16 in neurology by U.S. News & World Report. HSS has also received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center and has one of the lowest infection rates in the country. For the last three years HSS has received the HealthGrades Joint Replacement Excellence Award. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College, HSS provides orthopaedic and rheumatologic patient care at NewYork-Presbyterian Hospital/ Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Cornell Medical College. The Hospital’s research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases.

Š 2010 Hospital for Special Surgery. All rights reserved.

Division of Rheumatology 2009-2010 Annual Report  

As you will read in the Division of Rheumatology’s 2009-2010 Annual Report, investigations in the laboratory combined with clinical insight...