The Vasculitis Clinical Research Consortium (VCRC)-Vasculitis Foundation (VF) Fellowship is a mentored training program of up to two years for physician-investigators who have indicated a commitment to vasculitis and wish to pursue a period of specialized training with an emphasis on clinical and/or translational patient-oriented clinical investigation. The trainee will undertake the Fellowship a VCRC-affiliated site in North America that has an established distinct clinical and research program in vasculitis and availability of senior faculty mentors. There is no core curriculum for the VCRC-VF Fellowship. Fellowships are tailored to the individual Fellow, depending on the fellow’s interests, background, and type of Fellowship (a one-year clinical Fellowship, or a two-year research/clinical Fellowship), and the unique resources and opportunities at the host institution. Being named a VCRC-VF Fellow is neither dependent on, nor a guarantee of, funding support for the Fellow by the VCRC-VF.
There are two principal goals of the VCRC-VF Fellowship:
The eligibility criteria for the VCRC-VF Fellowship are as follows:
Contact either Carol McAlear, VCRC Project Manager, or Peter A. Merkel, MD, MPH, VCRC Director.
Click here for details about the fellowship
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Peter C. Grayson, MD, MSc is the founder and principal investigator of the Translational Program in Vasculitis at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), established in 2013, and is the associate program director of the NIAMS Rheumatology Fellowship Training Program. Dr. Grayson completed his VCRC Fellowship (2009-2011) at Boston University Medical Center, with Peter A. Merkel, MD, MPH as his mentor. Dr. Grayson serves as the representative to a major international collaboration to develop novel diagnostic and updated classification criteria in several forms of systemic vasculitis. His research focus includes biomarker discovery and development through gene expression profiling and other genomic techniques, disease classification, clinical epidemiology and immunology, and clinical trials in vasculitis.
This interview with Dr. Grayson was conducted by the Vasculitis Foundation, June 2013.
Lawrence Shulman Scholar in Translational Medicine, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
“Too often research in the lab is isolated from what’s happening in the clinic, and it can take a very long time for discoveries to get translated into practical use,” notes Peter Grayson, the newly appointed Lawrence Shulman Scholar in Translational Medicine at the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Grayson is determined to change that. Translational research puts scientific discoveries from lab, clinical and population studies to use in clinical applications that directly improve patient care.
“This kind of research creates synergy and is powerful,” he notes. “My goal is to make an immediate impact towards improving the quality of life for people living with vasculitis and finding cures for these diseases.”
A rheumatologist, Grayson studied history at Brown University before returning to his hometown of Charleston, S.C. to attend the Medical University of South Carolina. He got his degree there in 2004; he did his internship, residency, chief residency and rheumatology fellowship training at Boston University. Grayson joined the faculty there in 2012 as an assistant professor.
“I chose this specialty because the most interesting and rewarding experiences I had as a medical student involved the care of patients with rheumatalogic diseases,” he says. “Rheumatologists deal in uncertainties, and we see some of the most unusual cases in medicine. Oftentimes, we can’t provide a specific diagnosis because one simply does not exist. In those situations many doctors elect not to initiate therapy—a good rheumatologist learns how to conscientiously care for a patient in the face of uncertainty. The most rewarding aspect of the job is helping improve the lives of patients with chronic diseases.”
Grayson is interested in whole-genome gene expression profiling made possible by bioinformatics, the acquisition, analysis and interpretation of large volumes of biological data. The goal of this emerging field of study is to discover novel aspects of disease.
“We’re able to study what’s happening at the molecular level inside specific groups of cells by profiling the expression of 30,000 genes simultaneously within those cells,” he explains. “It will redefine what we know about vasculitis and other diseases over the next few decades.”
Grayson hopes his new position at the NIH will create opportunities for vasculitis patients to participate in the institute’s cutting-edge research.
“The original clinical trials that established the first life-saving therapies for vasculitis were conducted at the NIH in the 1970’s,” Grayson explains. “Unfortunately, there’s been minimal investigative work in vasculitis at the NIH in over a decade. Hopefully, my presence there will revive research interest in these diseases. The NIH has tremendous resources which I intend to use to advance understanding of vasculitis, to improve the lives of patients with vasculitis, and to potentially find cures for these diseases. I hope many patients with vasculitis will be motivated to visit the NIH and participate in our research.”
Tanaz Kermani, MD, MS is an Assistant Professor of Medicine at UCLA Medical Center, Division of Rheumatology, Santa Monica, CA. Dr. Kermani completed her VCRC Fellowship (2010-2011) at the Mayo Clinic, Rochester, with Steven R. Ytterberg, MD as her mentor. At UCLA, Dr. Kermani sees patients with all rheumatologic diagnoses but has a special interest and expertise in vasculitis. She is an active member in the vasculitis community, and has ongoing research collaborations and several publications in large-vessel vasculitis.
This interview with Dr. Kermani was conducted by the Vasculitis Foundation, July 2011.
For as long as she can remember, Tanaz Kermani was drawn to the medical field. “The ability to positively impact people’s lives and my love for biology were the primary factors that influenced my decision to pursue this career”, she says. The Mumbai native moved to the U.S. for undergraduate college and received her medical degree from the New York Medical College in Valhalla, New York.
Kermani, an assistant professor of medicine at the Mayo Clinic, specializes in rheumatology. “During my training, I was struck by the multi-system nature of these illnesses and the damage they could cause,” she says. “Rheumatology has always been regarded as one of the ‘cognitive’ specialties, requiring strong knowledge of general medicine and clinical skills. I quickly realized rheumatology would be the most rewarding and gratifying field of medicine for me and have never regretted this decision.”
After a rheumatology fellowship, Kermani is now doing a Vasculitis Clinical Research Consortium (VCRC) Fellowship at the Mayo Clinic. “My interest in vasculitis began during my fellowship program when I spent a few half-days working with Dr. Kenneth Warrington in our Vascular Center,” she recalls. “When I became aware of the VCRC fellowship, which would enable me to dedicate two years to learning more about vasculitis, I was excited to pursue it.”
Her goals for the fellowship are two-fold: to gain expertise in the care of patients with vasculitis and to develop additional skills in clinical research. “The ability to focus my attention for two years only on vasculitis is invaluable, “she asserts. “Being part of the VCRC has also enabled me to interact with the experts in the field at other medical centers. The clinical and research experiences I have gained thus far are unparalleled and would not have been possible without such a resource.”
As a VCRC fellow, she participates in all ongoing studies. She is currently working with Dr. Steven Ytterberg, Dr. Ulrich Specks, and Dr. Warrington at the Mayo Clinic in the longitudinal studies of patients with different forms of vasculitis, and is involved in an ongoing clinical trial in Takayasu’s arteritis and giant cell arteritis (GCA). The latter disease is her primary research interest.
“Specifically, I am interested in the clinical course of the subset of GCA patients who develop the disease in the aorta and its branches,” she says. “There are many aspects of GCA which make it a fascinating disease to study. First it almost never affects younger individuals. As with many other auto immune diseases, it affects women more than men. Additionally, the highest incidences are reported for Scandinavian countries and in U.S. populations of Northern European ancestry. Many aspects of this disease remain poorly understood such as who develops complications, which patients have difficultly discontinuing their medications, and how best to monitor GCA patients for aortic complications. These and other clinical questions are the focus of our research.”
Kermani knows that finding better treatments depends on support from advocacy groups like the VF. “Vasculitis advocacy groups are important and can assist patients through education and moral support,” she says. “Patients with vasculitis and other rare diseases can feel isolated. Knowing that there are other people with the same condition and having the opportunity to share these experiences can be reassuring. From the physician’s standpoint, advocacy groups may be better able to reach out to our patients. They can inform them of the location and different types of research studies that may be of interest to them. This helps us engage our patients in research. Advocacy groups also provide a voice for their members and can communicate to us what we can do better to support and help our patients. The best way physicians and advocacy groups can work together is through collaboration and mutual respect.”
Atul Khasnis, MD, MS is a Rheumatologist specializing in vasculitis at Piedmont Clinic in Georgia. He completed his VCRC Fellowship (2009-2011) at the Cleveland Clinic, with Carol A. Langford, MD, MHS as his mentor, and post-fellowship was an Assistant Professor at Case Western Reserve University and Rheumatology Faculty at the Cleveland Clinic for three years. Dr. Khasnis is a member of the Vasculitis Foundation Scientific and Advisory Committee and the American College of Rheumatology.
This interview with Dr. Khasnis was conducted by the Vasculitis Foundation, November 2011.
Growing up in Mumbai, India, Atul Khasnis knew he wanted to pursue a career in biology. When he wasn’t playing in cricket matches and table tennis games, he eventually decided to focus on human biology and become a medical doctor.
“I found biology very fascinating in terms of its complexity and my ability to relate to its concepts,” he recalls.
Course of Study
After graduating with an MBBS and MD in internal medicine from the University of Mumbai, Khasnis completed an internal medicine residency at Michigan State University, followed by a two-year fellowship in rheumatology and a two-year fellowship in vasculitis offered by the Vasculitis Clinical Research Consortium at the Cleveland Clinic.
“I wanted to pursue a specialty that included diseases affecting multiple organ systems, was closely linked to internal medicine and required a comprehensive approach to diagnosis and treatment -- a combination of presenting symptoms, physical exam findings and laboratory or imaging tests,” he says.
Focus on Immunology
Vasculitis fit the bill. Khasnis’ research focuses on immunosuppressive medications that are effective, but can be pretty toxic to patients. This creates a need for studies that can contribute to evidence-based guidelines for monitoring to maximize medication safety. His thesis project (for a Master’s in clinical research) was one step in that direction.
“It involved comparing the cost effectiveness of weekly versus monthly WBC count measurements in preventing low WBC counts and consequent complications such as severe infection in patients with granulomatosis with polyangiitis (Wegener’s) on Cytoxan,” he explains. “Cyclophosphamide (Cytoxan) -- is an immunosuppressive medication commonly used to treat patients with severe vasculitis,” he says. “One of the major toxicities of this medication is its suppressive effect on the bone marrow especially with prolonged or repeated use, which can lead to decrease in white blood cell (WBC) counts. Since WBCs are key cells in fighting infection, a critically low WBC counts increases risk of serious infection.”
Khasnis says the biggest challenge he faces is how differently these diseases present in each patient. “Diagnosing these diseases is therefore challenging when early in the course. Also, there are no laboratory tests that absolutely establish a diagnosis, making it necessary to evaluate the full patient.”
But meeting that challenge makes for a fulfilling career. “Most vasculitic diseases are treatable, not curable,” he continues. “Patients are significantly distressed by the impact of these illnesses on their quality of life. Helping them understand their illness and treating them with a goal to try and restore an acceptable quality of life and function is the most rewarding part.”
Patients and Research
Also rewarding: Working with the VF, which Khasnis says is critical for patients and researchers. “The Vasculitis Foundation forms a core medium for education of patients with these rare diseases,” he notes. “It provides them with up-to-date information about ongoing research and newer therapies. It therefore allows them to get involved in research. Patients with a diagnosis of a rare vasculitic disease yearn to share their journey with their illness and learn from the experiences of others who have experienced a similar illness. The Vasculitis Foundation provides them with an invaluable opportunity to do this which patients are extremely grateful for.”
Looking forward, Khasnis expects the next big development in research will be a translational immunology network to understand the underpinnings of these diseases. “We really need detailed characterization of the immune system in the different vasculitic diseases, during different phases of the illness -- active disease versus remission -- and alterations in the immune system as a consequence of therapies.”
Curry Koening, MD, MS is an Assistant Professor of Medicine at the University of Utah and Salt Lake City Veterans Affairs Medical Center. He completed his VCRC Fellowship (2005-2007) at the Cleveland Clinic, with Carol A. Langford, MD, MHS as his mentor. Dr. Koening is Director of the Vasculitis Clinic at the University of Utah and Salt Lake City Veterans Affairs Medical Center, which is a VCRC Clinical Site, and member of the VCRC Steering Committee.
This interview with Dr. Koening was conducted by the Vasculitis Foundation, February 2006.
I first realized that I wanted to be doctor when I was in high school. I grew up in a small town in West Texas. Farming and ranching were how most families made a living in this part of the country. Oil also played a huge part in the local economies. However, lack of primary medical care was a major issue in many of these small towns. Not many doctors were moving to these rural areas to start a practice, leaving many with limited access to medical care. I began medical school with the intent of moving back to rural Texas and starting a general medical practice.
After college I went to medical school at Texas A&M System Health Science Center College of Medicine. I was first introduced to rheumatology during my third year clerkship. I decided to pursue it as a profession after spending some time on the rotation during my internal medicine residency at the University of Utah. Rheumatology was not unlike primary care. It too needed new, young doctors to help underserved areas, especially where wait times to see a rheumatologist may have been as long as six months. I completed my rheumatology fellowship at the University of Utah in June of 2005 and moved to Cleveland shortly thereafter to learn more about vasculitis at the Center for Vasculitis Care and Research at the Cleveland Clinic Foundation. Because few doctors have trained specifically in vasculitis, patients with these diseases are underserved. Research in this field is also lacking and clinical trials for new therapeutics have lagged behind.
I am fortunate to be receiving support for my vasculitis training from funds provided by the National Institutes of Health through the Vasculitis Clinical Research Consortium (VCRC). It is the mission of the VCRC to train physicians to serve patients with vasculitis and through research provide better therapies, diagnostic tools and identify the causes of these diseases. I am fortunate to be a part of this organization and I look forward to playing a greater role in the care of patients with vasculitis and leading research studies in the future.
The Vasculitis Clinical Research Consortium (VCRC) has four main clinical centers: Boston University School of Medicine, Cleveland Clinic Foundation, Johns Hopkins School of Medicine and Mayo Clinic College of Medicine. The goal of the VCRC is to conduct clinical research in hopes of developing new treatments for patients afflicted with vasculitis. It has been the goal of the VCRC to train new clinicians to care for patients with vasculitis, conduct clinical trials for new drugs in the treatment of vasculitis, and work with vasculitis patient support groups. My goal as a trainee through the VCRC is to maintain this tradition. My training will consist of two years of research, patient care and academic work. This includes not only learning how to better care for patients with vasculitis, but also graduate work in how to perform basic clinical research that will serve to ultimately improve our patient’s daily lives.
My current research interest is in disease monitoring. Little is known regarding how best to follow patients with vasculitis who are considered to be in “remission”. For most patients who are on immunosuppressant drugs, regular blood and urine monitoring are a requirement. How to follow patients who are in a low disease state or even disease remission and not on immunosuppressant drugs is much less clear. Do these patients need regular blood monitoring to detect an early disease relapse? Do these patients need regular CAT scans or chest x-rays to detect an asymptomatic lung relapse of their disease? If so, then how often do they need to be seen and is it cost effective to do regular lab monitoring? These are questions that still remain and that future research will address.
My first encounters with GPA and other forms of vasculitis were during my residency. As you might guess, these experiences were infrequent. Nonetheless, I had the opportunity to care for a few patients with GPA, Takayasu's arteritis, eosinophilic granulomatosis with polyangiitis (Churg-Strauss), and other forms of vasculitis when they were hospitalized. I learned in my fellowship that patients with vasculitis often have life-threatening complications, but with prompt and proper therapy they can do very well.
The number of vasculitis patients that we see at the Cleveland Clinic varies from week to week. About 50 patients with vasculitis will be seen on average per week. GPA patients make up a large number of those seen and is one of the most common vasculitides that we take care of at the Center for Vasculitis Care and Research. Other vasculitides that we see commonly include Takayasu’s arteritis, giant cell arteritis, polymyalgia rheumatica, polyarteritis nodosa, eosinophilic granulomatosis with polyangiitis (Churg-Strauss) and Behçet’s. The Center for Vasculitis Care and Research has one of the largest populations of GPA patients worldwide. Not only has the Center committed itself to the care of patients with vasculitis but also to increasing our knowledge about these diseases through clinical trials and basic research.
As a fellow in vasculitis my job entails many things:
The importance of communication has been the most helpful thing that I have learned during my training. I have found that taking the time to discuss any concerns that patients have and helping them develop a plan to deal with their disease has greatly enhanced my relationship with my patients. In this day and age of an electronic medical record and e-mail there is no reason that patients should ever feel “left out of the loop.”
I think there are some things that we as physicians and patients can do to make things easier for both. First, I think it is very important for patients to have a vested interest in their disease. In this way, patients will be more apt to report changes that they may recognize as a disease flare. Patients will also be prompted to ask questions that are important to their own care. Patients should be optimistic about the progress that is being made that has led to better care for patients with vasculitis. Progress in the field of vasculitis research cannot happen without the help of patients. I think it is important for patients to keep an open mind when it comes to participating in clinical trials. The more people that are willing to participate in trials, the better our understanding of these rare diseases will be. Patients should also be involved in their local Vasculitis support groups. It is through these groups where patients can learn about new therapies and how they can support future research in this area.
I think the best advice for any vasculitis patient is to recognize that recent medical advances have made not only long term survival but long term disease remission a reality. Even though disease remission is a reality for almost all patients, a cure is still many years away. Patients should continue to have frequent follow-up visits with their care providers, ask pertinent questions and be involved with their local and national Vasculitis organizations. This also includes patients who have been in disease remission for an extended period of time. These patients also have a high risk of relapse from their disease. Vigilance can prevent complications. Early detection of relapses can lead to early treatment, shorter exposure to immunosuppressant drugs, less morbidity and hopefully a faster return to normal daily living.
I have several goals that I would like to accomplish before my time is complete at the Cleveland Clinic . My ultimate goal is to learn how to design and implement clinical trials for the treatment of patients with Vasculitis. I would also like to be a part in developing new imaging and laboratory modalities that will help how we follow patients in the future. Through my course work at Case Western Reserve University and clinical time at the Cleveland Clinic, I hope also to forge collaborations worldwide with clinicians and researchers who are dedicated to better understanding Vasculitis and the patients we care for. Finally, as any young physician I want to provide the most advanced therapies for my patients in a compassionate clinical setting for which patients can feel a part of.
My plans at this time are to take an academic appointment at the University of Utah in Salt Lake City. Here, in conjunction with the Department of Medicine and Division of Rheumatology, we plan to create a vasculitis center. This will be the first Center in the Western United States. Our goal is to be a tertiary referral center for patients from all over the United States and the World who are afflicted with either GPA or other rare vasculitides. We will also offer clinical trials of new therapeutics to treat patients with vasculitis that would not otherwise be able to participate. We also hope to build a strong relationship with local and national Vasculitis support groups such as the Vasculitis Foundation and maintain a strong collaborative network with the Centers for Vasculitis Care and Research and other Vasculitis centers around the world.
Alfred Mahr MD, MPH, PhD, is a Physician (Faculty), and Head of the Internal Medicine Department, at Hospital Saint-Louis, Paris, France. Dr. Mahr completed his VCRC Fellowship (2005-2007) at Boston University Medical Center, with Peter A. Merkel, MD, MPH as his mentor. Dr. Mahr is an active member of the European Vasculitis Society (EUVAS), and continues to collaborate with the VCRC.
This interview with Dr. Mahr was conducted by the Vasculitis Foundation, December 2006.
Dr. Alfred Mahr was born in Germany and at the age of four he moved to France for the next five years. His whole family fell in love with France and though they returned to Germany when he was nine, they visited often for vacations. France would become Dr. Mahr’s second home.
Dr. Mahr knew in high school that he wanted to attend medical school. His father was an engineer and his mother a physical therapist but his grandmother, great-grandfather and great-great-grandfather were also doctors. Dr. Mahr knew that he wanted to work with people and medicine was a perfect balance between an intellectual challenge and humanitarian work. That mixture drove him to become a doctor and is what continues to motivate him today.
Once Dr. Mahr finished high school in Germany, he moved to Montpellier in the south of France to attend medical school, the oldest in the country, and complete his residency in internal medicine. He then moved to Paris to specialize and complete his fellowship. Dr. Mahr’s wife, Laurence, is also a physician and they have a five-month-old baby named Simon.
While doing rounds in various specialties, he met his first vasculitis patient in 1995 when he was a fellow in internal medicine. The patient initially presented with fevers and muscle aches. It took quite a while to unravel the nature of the patient’s disease before he could be diagnosed with Polyarteritis nodosa. Soon thereafter, he saw an elderly lady with Microscopic polyangiitis involving the kidney. At that time, Dr. Mahr became intrigued by vasculitis. He felt that, because they were rare and presenting so differently from patient to patient, vasculitides were more difficult to understand and recognize than many other diseases he has taken care of since then.
In 1997 he decided to complete rounds with Dr. Loïc Guillevin who is the head of the Department of Internal Medicine at Hôpital Cochin in Paris and a prominent expert in the field of vasculitis in Europe. Folks come from many countries to seek his help. During his rounds with Dr. Guillevin, Dr. Mahr came to see many patients with different forms of vasculitis. At that time, he decided to devote his medical thesis to granulomatosis with polyangiitis (Wegener’s). After completion of his fellowship in 1998 he accepted an offer to return to Dr. Guillevin’s department as a faculty member, a position that he has not left until now. Since 1998, he has continuously worked in the field of vasculitis and has learned to take care of various types of vasculitis including granulomatosis with polyangiitis (Wegener’s), Microscopic polyangiitis, Polyarteritis nodosa, Behçet’s disease, eosinophilic granulomatosis with polyangiitis (Churg-Strauss), giant-cell arteritis, Takayasu’s arteritis, and others.
During this time, Dr. Mahr also completed a Master’s in Public Health and began to foster his personal research by combining his interest in vasculitis with epidemiology. Epidemiology can be defined as a field of study that searches to understand the triggers and causes of diseases. Dr. Mahr has accomplished different studies conducted on the prevalence of vasculitis in the Parisian region, which include an investigation of factors that predict the severity of vasculitis and a study of links between use of particular anti-asthma drugs and eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Dr. Mahr is also working on his Ph.D. thesis in Public Health, which he plans to submit in 2007 on the theme of vasculitis.
While attending various meetings, Dr. Mahr met Dr. Peter Merkel who, in time, invited him to come to Boston and work on vasculitis research by enrolling in a fellowship program with the Vasculitis Clinical Research Consortium (VCRC). Boston proved to be an excellent location for Dr. Mahr because the Vasculitis Center in Boston has both the skills in vasculitis and the tradition of doing epidemiological studies. The position couldn’t be more perfect for the studies that he is currently working on. He took a sabbatical from his position in Paris for two years and came to Boston in November 2005.
Dr. Mahr’s primary goal as he works in Boston is to become more skilled in research . He is grateful he has the opportunity to study here and is learning a lot in the United States from a scientific and a personal standpoint. He is taking advanced classes in statistics, genetics, and research methods. Dr. Mahr is also conducting new studies of granulomatosis with polyangiitis (Wegener’s), eosinophilic granulomatosis with polyangiitis (Churg-Strauss), giant cell arteritis, and other topics. When his training in Boston is completed in November 2007, Dr. Mahr plans to return to Paris where he will continue to work with Dr. Guillevin. However, he hopes to continue collaborating with physicians from the United States as well as from other parts of the world. For rare diseases such as vasculitis, it is crucial that physicians and researchers from different countries combine their efforts to keep moving forward in the understanding and treatment of these illnesses.
Dr. Mahr enjoys taking care of his patients . He feels privileged in his role as their doctor and of being able to assist them while they are going through a difficult patch. He feels that a good relationship between a patient and his doctor should be built on one of complete trust and confidence. Dr. Mahr encourages his patients to tell or ask him everything they have on their mind. His motto is “There is nothing to hide” and “There are no stupid questions”!
Christian Pagnoux MD, MPH, PhD, is an Associate Professor of Medicine, at Mount Sinai Hospital, Toronto. Dr. Pagnoux completed his VCRC Fellowship (2010-2012) at Mount Sinai Hospital, Toronto, with Simon Carette, MD MPhil, FRCPC (link to the Mount Sinai site page) as his mentor. Dr. Pagnoux is member of the VCRC Steering Committee, a Co-Investigator, and has led on a numerous VCRC biomarker, genetic, and clinical research projects.
This interview with Dr. Pagnoux was conducted by the Vasculitis Foundation, March 2013.
Dr. Pagnoux, what are your expectations or goals as a member of the VCRC? Why is this opportunity important to you?
I wanted to have a different look on the way to manage patients with vasculitis and conduct clinical research than that I gained during the past eight years working in France with Professor Guillevin and the French Vasculitis Study Group. The VCRC has built an impressive network and patient registry and conducted major and cornerstone trials in vasculitis.
Thus, I hope to learn a lot from this two-year fellowship on how to manage a network and make it a long-term success. Working besides world renown experts from across the Atlantic is a major opportunity and I am happy they granted me to do this, the VCRC but also the Toronto Western Hospital/Toronto General Hospital Foundation and Dr. Simon Carette, my mentor here.
Share some of the current studies or clinic trials in which you’re involved.
In France, I am involved in some of the FVG prospective trials, including the patient cohort database, created in 1983 by Professor Guillevin and that I reformatted it in 2002 and have updated thereafter, the CHUSPAN 2 trials, which aimed to compare azathioprine and corticosteroids versus placebo and corticosteroids in patients with eosinophilic granulomatosis with polyangiitis (Churg-Strauss), polyarteritis nodosa (PAN), or Microscopic polyangiitis (MPA) without poor prognosis FFS factor (55 patients enrolled); the MAINRITSAN trial, which is to compare regular infusions of rituximab versus azathioprine for maintenance in ANCA-ASV; and the creation of a registry for primary Central nervous system vasculitis (CNS).
During my stay in Canada, I will try to conduct several studies (comparison of patient database using different methods to adjust for their potential baseline differences to study treatment effect and outcome; management of corticosteroids during therapeutic trial and their potential impact on treatment effect evaluation), initiate some clinical studies across Canada (Canadian Vasculitis Research Network) and will be part of the PEXIVAS at Toronto. I am currently in charge of the approval procedure for the center to open.
How has your previous experience / education prepared you for what you’re now doing with the VCRC?
I gained experience by working with Professor Guillevin on how to make a research network to work and conduct major studies, always keeping in mind that studies have to yield practical conclusions to improve patient management and outcomes.
Why did you choose rheumatology as your specialty? Has anyone in your friend/family circle ever had an autoimmune/vasculitis disease? Other than rheumatology, what are some of your other clinical/medical areas of interest?
The system in France is a little bit different. I am specialized in internal medicine, not rheumatology. In France, you have six years of medical school, then you have to go through a national examination and depending on your rank, you can chose a specialty or become a general practitioner.
If you can choose a specialty, then you can opt for example for rheumatology (four additional years of PGY) or internal medicine (five additional years of PGY, with rotations in rheumatology department if you want). I chose internal medicine, because it has a more global way of managing patients, but had three rotations of six months each in rheumatology department during my PGY.
None of my friends or family had autoimmune disease. My father died of cancer. I like rare diseases, internal medicine and, far from it, orthopedic surgery. That is the specialty that I would have chosen, if I had not been so interested in internal medicine and its global way to take care of patients. Extreme specialization can be good, but I like to know how to treat mild hypertension, diabetes, common infections, and not to always consult a specialist for every issue that is not rheumatology.
Have you studied or concentrated on any particular vasculitis disease? If so, why are you drawn to this specific vasculitis?
Yes, I concentrated on eosinophilic granulomatosis with polyangiitis (Churg-Strauss), granulomatosis with polyangiitis, microscopic polyangiitis, and polyarteritis nodosa, so far, mainly because these were the diseases on which Prof Guillevin has conducted the majority of his trials during the past year. In addition, they are very diverse and can involve so many organs. From an internist point of view, that is fascinating and asks you to be able to handle with all these different organ manifestations at the same time. It is the same for other systemic diseases, like lupus or systemic scleroderma. People you meet during your training make you chose some of them (and I met Prof Guillevin who is a great and passionate physician able to transmit his passion).
You were educated and trained in France. Share some of the differences in how rheumatology is taught to medical students in France and U.S. What are some of the differences in how vasculitis research is done in France and U.S.?
In France, the network was created in 1982 and every center willing to be part of it can be. There is a registry and several studies have been done and their results published through this huge and massive collaboration. In the US, the network is focused on high referral centers, approximately 10, but patients with vasculitis seem to be more regularly and systematically referred to these centers, rather than being managed entirely in their local hospital or by the geographically closest rheumatologist. So, less center but a more sharp entry process. Two different ways and approaches of creating and managing a research network. Very interesting. I don’t know yet which one works the best… you may need both of them, or something between?
Share some of the advancements or improvements in diagnosing and treating vasculitis since you first began your work in rheumatology. New drug therapies, or diagnostic tests, etc.
I started my work in vasculitis in 2002 and I was therefore able to read and follow all these important publication that better devised the standard of care of patients with PAN or AASV, i.e. the EUVAS trials (CYCAZAREM, CYCLOPS, NORAM, MEPEX), the French trials (WEGENT, CHUSPAN, IGANCA) and the VCRC trials (WGET, and more recently the RAVE trial on rituximab).
Treatment can achieve remission in more than 90% of the patients now. Unfortunately, it remains a long-term treatment and there is still an important risk of relapse. Thus, there is still some work to do, treatment strategies to optimize and treatment to identify to further improve the patient outcome and try to get them cured, rather than to obtain “only” sustained remission.
You studied under the noted physician, Professor Guillevin. Share some of your observations, experiences while working with him. How has he impacted your career in rheumatology?
I gained experience by working with Professor Guillevin on how to make a research network to work and conduct major studies, always keeping in mind that studies have to yield practical conclusions to improve patient management and outcomes. Professor Guillevin is a great and passionate physician, able and willing to transmit his passion to others.
One of the goals is to get more vasculitis disease patients into clinical studies. What would you tell a patient who asks you, “Why should I get involved in a clinical study? What good will it do for me, or for other patients, or for vasculitis research.”
Vasculitides are very rare diseases and if we want to know their precise outcomes, know how to adjust therapy based on each individual patient characteristic, or identify new effective drugs, we need to conduct studies involving a lot of patients. There are many studies in which every patient can be included, the simplest one being the observational cohort studies. In the cohort studies, patients would not receive any “experimental treatment” or be “lab animals”, but we will collect, anonymously, their clinical data, and sometimes blood samples, so we can ultimately try to identify disease markers or clinical parameters of prognosis.
In addition, since we still are trying to adjust and improve therapy, several therapeutic trials are ongoing with the aim to improve outcome. And at present, we cannot, like in the past when diseases were often fatal, experiment with new drugs, from one day to another. All drugs are strategies we use now are to improve outcome. They usually have been used for other diseases before being studied in vasculitis. Thus we are almost confidently aware of the pros and cons of their use in vasculitis. The question is whether they can further improve patient outcomes and reach the absolute goal of durable disease cure.
Why are vasculitis patient advocacy groups important to the overall research into the disease? What role do they play in helping find treatments? What are differences and similarities between patient advocacy groups in France and the U.S.? How can a patient advocacy group be helpful to doctors like you? How can patient advocacy groups work in a good way with the medical community?
I was very happy to be part of the creation of the patient support group in France. They made a lot of progress in France to help patients and to raise awareness of the disease. Information and itinerant meetings across France have been done, to inform patients, their families and their GPs on what was vasculitis, at what point was the research in the world on these rare disease and what could be expected for the future. It is usually a great pleasure to meet patients and their families and listen to their expectations. This gives us energy for the work we are trying to do and I am so happy to see one/some of my patients during these meetings, doing so well that they can attend, bring their families, enjoy meeting other patients, and just not feel alone with their rare disease.
Studies can also be done through the patient support group, as well as dissemination of information on ongoing trials and referral centers. Sometimes, this is very useful… for the patients to be reviewed by specialists in the field.
Alicia Rodríguez-Pla MD, PhD, MPH is a Clinical Fellow in Rheumatology at Boston University Medical Center. Dr. Rodríguez-Pla completed her VCRC Fellowship (2007-2009) at Johns Hopkins University, with Phil Seo, MD, MHS as her mentor. Dr. Rodríguez-Pla is conducting clinical research with Dr. Paul Monach, MD, PhD, and collaborating with the VCRC on biomarker research projects.
This interview with Dr. Rodríguez-Pla was conducted by the Vasculitis Foundation, March 2007.
I grew up in the southeast of Spain, between Caudete, a small town in which I was born, and Alicante, a nearby Mediterranean tourist city. I am married and have a four-month-old baby son called Mark. My husband, José, is also a doctor who specializes in Preventive Medicine and Public Health.
I spend as much of my free time as possible with my husband and playing with my son. I like travelling and meeting people from different cultures. I love reading all kinds of books, especially novels, walking, swimming, going to the theater and getting together with friends. Although it may sound weird, studying and learning are my main hobbies.
I realized I wanted to become a doctor in high school. During those years I started to develop a great interest in health related issues, primarily for helping people and for research, which I consider the basic tool for medical advances. And last but not least, decreasing the negative impact of diseases in people.
I received a scholarship which allowed me to attend medical school in a very prestigious private university called Universidad de Navarra, in Pamplona, a city in the north of Spain. After medical school I moved to Barcelona and enrolled in a fellowship program in rheumatology. Once completed, I worked on my Ph.D. thesis, where I studied several pathogenic and epidemiologic aspects of giant cell arteritis. It was shortly after defending my thesis in 2003 that I moved to the United States.
Very early in my career I became fascinated by vasculitis disorders. My first clinical rotation was in the Department of Cardiovascular Surgery in 1991, during my fourth year in medical school. I remember the first patient I visited in the hospital was a woman affected by Takayasu’s arteritis who had also developed retroperitoneal fibrosis. Never before had I heard that blood vessels could become inflamed. The faculty in charge asked me to review the literature to find out if a similar association between Takayasu’s arteritis and retroperitoneal fibrosis had previously been reported. I found only one case published in a Japanese journal, which was impossible for me to get at the time. The faculty then asked me to write a short review about Takayasu’s arteritis as an exercise. I remember how my interest and curiosity progressively increased while reviewing the literature and learning about this vasculitis. I typed a thirteen-page manuscript, which I still keep, on a classical typewriter. It was because of the interest that this patient woke up in me that I decided to become a rheumatologist.
I did not come across any other patients with vasculitis until January 1995, when I saw a second patient with Takayasu’s arteritis during my first month as a fellow in rheumatology. This was striking, taking into consideration that this type of vasculitis is quite rare in Spain. During the following months I saw patients with other vasculitic syndromes, including granulomatosis with polyangiitis (Wegener’s), eosinophilic granulomatosis with polyangiitis (Churg-Strauss), polyarteritis nodosa, and giant cell arteritis among others. I was amazed that a patient with giant cell arteritis, who had been completely blind for two days, recovered her vision right after starting prednisone treatment. Fortunately, she had been diagnosed and treated early.
As a curiosity, my father was the third patient I saw with giant cell arteritis and I participated actively in his diagnosis. In May 1996, at the age of 53, he started complaining of intense headaches, fatigue, and pain and weakness in the girdles. He was initially diagnosed with depression, and treated for several months with antidepressant medication. He did not improve, and I suggested to his doctor the possibility of giant cell arteritis. Initially, he did not believe me because my father was too young to have this vasculitis, and I was too young to suggest anything. After almost six months, he finally decided to draw some blood, and the diagnosis then became quite obvious.
I would like to point out that my interest comprises all kinds of vasculitic syndromes and all vasculitis patients. I chose giant cell arteritis for my Ph.D. thesis simply because it is the most frequent type of vasculitis worldwide including Spain. I am convinced that the pathogenic mechanisms underlying the vascular and organ damage have certain similarities among the different vasculitic disorders, and that advances in knowledge of one of them could be quite easily extrapolated to others.
My Ph.D. thesis included a project to study the potential role of different infectious agents in giant cell arteritis. At the American College of Rheumatology Annual Scientific Meeting in San Francisco in 2001, I saw that the group of physicians, including Dr. Stone from the Johns Hopkins Vasculitis Center were also interested in this field. Shortly after the meeting, I contacted Dr. Stone to ask about the possibility of joining his team to continue working on this research. Dr. Stone offered me a two-year fellowship at Johns Hopkins. Towards the end of these two years, my research interest had shifted and focused on understanding the molecular mechanisms underlying the vascular damage in the arterial wall in giant cell arteritis. It was at this point when the VCRC fellowship program was starting, and Dr. Stone mentored me to get into it.
My research is currently focused on better understanding the role of matrix metalloproteinases in giant cell arteritis. Matrix metalloproteinases are a group of enzymes capable of degrading varying components of the extracellular matrix in both normal and diseased tissue. They have been found to be associated with several vasculitic disorders. In concrete, I am working on two different laboratory projects. The first consists on characterizing the specific matrix metalloproteinases involved in vascular damage in giant cell arteritis. The second is a genetic study to determine if certain polymorphisms, that is, mutations, of metalloproteinase-9, a enzyme known to be involved in giant cell arteritis, are associated with this vasculitis.
One of the main things I have learned from my patients is to listen to them. Listening carefully to patients’ symptoms helps us to suspect a serious condition or relapse. Therefore we may act quickly avoiding delays in treatment and, subsequently, preventing or diminishing complications.
I think that to be a better patient is essential to follow the physician’s indications. Of course, this should not be done “blindly” but rather in a “educated” manner. By this I mean that if a patient finds, for example, that a treatment is not working, call the doctor to discuss it with him/her. Another aspect would be by understanding that research is very important for advancing knowledge of the disease, and for developing new therapeutic options. An important challenge for doing investigation on vasculitis is the rarity of these disorders, which makes it difficult to get clinical samples for research purposes. By agreeing to participate in research projects whenever possible, patients can help to get better outcomes for themselves and others. Because most of the patients with vasculitis have chronic conditions, which require long-term follow-up, it is extremely important for them to engage in a good doctor-patient relationship. It is basic for them to find a physician they truly trust, and with whom they can communicate in a direct, open and honest way. They should take good care of themselves, attend regular follow-ups, and learn as much as they can about their diseases. The latter will help them to recognize promptly when they could be suffering from a relapse, which will lead them to look for the best medical care in every situation.
My main job duty is to do research in the laboratory setting. I am also a student in the part-time Master of Public Health program at the Johns Hopkins Bloomberg School of Public Health. So far, I have taken a series of courses in statistics and epidemiology, along with other required courses. I am currently taking a third series of courses on Genetic Epidemiology. I plan to graduate next May.
In addition, I have also been allowed to observe patients in The Johns Hopkins Vasculitis Center. During my stay at Johns Hopkins I have seen more patients affected by granulomatosis with polyangiitis (Wegener’s), eosinophilic granulomatosis with polyangiitis (Churg-Strauss), polyarteritis nodosa, and Takayasu’s arteritis than ever before. Unfortunately, for the last few months my lab work and classes in Public Health have made it impossible for me to attend the clinic.
I am very grateful to the VCRC for the opportunity it has provided me through this fellowship. My weekly visits to The Johns Hopkins Vasculitis Center clinic have offered me a unique opportunity to see a great variety of vasculitis patients, and some of them while going through challenging medical situations. This has greatly enhanced my clinical skills to manage patients with vasculitis. This fellowship has also helped me to increase my laboratory skills, and it has provided me with the opportunity of enrolling in an academic program in the form of a Master of Public Health in the worldwide prestigious Johns Hopkins Bloomberg School of Public Health. In addition, from the personal point of view, this experience has been also very fulfilling.
During my time at Johns Hopkins I would like to increase both my skills as a translational researcher and as a clinician. I think that the tridimensional approach of the training program I have been involved in during my stay here will help me to accomplish this goal. My bench work and the courses of the Master of Public Health program are providing me with essential tools to design and perform translational and epidemiologic investigations. In addition, the time I have spent in clinic has helped me to be a better and more skilled physician for my patients. By combining this training program, the detailed “picture” offered by the laboratory bench research, the patients observation in the clinical setting and the big “picture” provided by the epidemiology and public health perspective, I believe I can integrate a broad range of knowledge, that will overall and help me to be a better scientist.
Once I leave Johns Hopkins, I would like to continue working on vasculitis, and probably on other autoimmune and inflammatory disorders in Spain. I hope the skills I have acquired during my stay here will help me to earn a faculty position in Spain in where I can combine both, patient care and research. I would also like to participate in international projects in the future, which include collaboration among different countries.
Francisco Silva MD, MPH, PhD, is an Assistant Professor, Pontificia Universidad Catolica de Chile, Chile. Dr. Silva completed his VCRC Fellowship (2006-2008) at the Mayo Clinic, Rochester, with Ulrich Specks, MD as his mentor. Dr. Silva is the Director and Founder of Vasculitis Unit, at Pontificia Universidad Catolica, Chile.
This interview with Dr. Silva was conducted by the Vasculitis Foundation in 2007.
I grew up in Santiago, Chile where I completed both my undergraduate and medical degrees at the Catholic University of Chile. I am married to Alejandra Araya who is a nurse and is completing her Ph.D. in Nursing Science at the University of Illinois in Chicago. I enjoy reading Astronomy and observing the night sky. I have especially enjoyed seeing the constellations from the northern hemisphere.
I became interested in becoming a physician in high school where I had the opportunity to participate in a scientific group organized by the Biology teacher. It was a fantastic period in which I discovered the wonderful world of the microscope, fossils and experiments. Since that time my interests in biology and the human body led me to medicine as the vocation that fulfills both.
Patients with vasculitis have fascinated me because of the complex nature of their disease manifestation. They are the type of patients you never forget. To improve their treatment and care, we need to answer many open questions about etiology, pathophysiology and their relationship to other autoimmune diseases.
My interest in vasculitis was sparked by one most memorable patient I took care of during my early days of training . She was a delightful woman in a public hospital in Chile who presented with skin ulcers on her legs. This woman had histologically confirmed microscopic polyangiitis and a positive P-ANCA. What initially seemed to be a minor ulcer progressed rapidly to compromise the entire foot, and new ulcers appeared on her upper extremities. She also developed renal insufficiency. I was impressed that a disease that initially presented itself as mild could progress so rapidly to extensive multi-system involvement. After months of therapy she recovered physically and emotionally, more so than I ever expected. I was extremely impressed by her level of resilience.
My patients teach me about their lives and their disease – this is important, as it is a useful guide for the research I am involved in. I try to teach vasculitis patients that they need to face their disease head-on and need to adhere to therapy. They need to listen to what their bodies tell them so that they can work to keep their disease under control.
I am most grateful to the VCRC for providing me with the opportunity to improve my translational and clinical research skills through the fellowship at Mayo Clinic. I am pursuing a Masters Degree in Clinical Research, and I am involved in several translational research studies. These focus on the utility of PR3-ANCA subsets as biomarkers for disease activity, organ manifestations and prognosis in granulomatosis with polyangiitis (Wegener’s), and on the long term outcome of different therapies in the ANCA-associated vasculitides.
During my time at the Mayo Clinic I would like to acquire the knowledge and skills needed to become an independent translational clinician investigator. I think the Mayo Clinic is an ideal place to achieve this goal. When I have completed my work here I want to return to my country, to become an expert in the care of vasculitis patients and to develop translational research projects in vasculitis.
Gunnar Tómasson, MD, PhD is Staff (Physician), at the University of Iceland, Reykjavik, Iceland. Dr. Tómasson completed his VCRC Fellowship (2008-2011) at Boston University Medical Center, with Peter A. Merkel, MD, MPH as his mentor. Dr. Tómasson’s research is fully focused on vasculitis, with the majority of his research projects being conducted within the VCRC, including as a Project Leader on Patient-Reported Outcomes research.
Medha Soowamber, MD, began her VCRC Fellowship (July 2015-June 2016) at the Mount Sinai Hospital, Toronto, with Simon Carette, MD, MPhil, FRCPC as her mentor.
This interview with Dr. Soowamber was conducted by the Vasculitis Foundation in July 2015.
“My first peek into the field of rheumatology was when, as a fourth-year medical student, I did a rheumatology rotation. What initially struck me was the wide variety of diseases that this field entails,” recalls Medha Soowamber, the recipient of the 2015 Vasculitis Research Clinical Consortium - Vasculitis Foundation (VCRC-VF) clinical fellowship.
“My interest was further driven by its diagnostic and therapeutic challenges as well as its multisystem approach. Someone told me that rheumatologists are the ‘Sherlock Holmes of medicine.’ This statement is indeed true!”
Dr. Soowamber completed medical school and internal medicine training at McGill University in Montréal, and two years of rheumatology training at the University of Toronto.
“During my rheumatology training, I was given the opportunity to do several oral presentations to physicians, medical students, and even patients,” she recalls. “I received positive feedback from these talks, especially the ones given to patients. They were impressed by the simplicity and clarity of my presentations.”
The Mauritius-born Soowamber will complete her VCRC-VF fellowship at Toronto’s Mount Sinai Hospital, under the guidance of mentor physicians Simon Carette and Christian Pagnoux.
“This one-year clinical fellowship will allow me to develop the knowledge, expertise and experience required in diagnosing as well as managing patients with vasculitis,” Soowamber explains. In fact, she finds that one of the most rewarding aspects is the long-term doctor-patient relationship that invariably develops. “What keeps me motivated is the awareness that I can potentially make a positive impact on someone’s life.”
The fellowship also will give Soowamber the opportunity to better understand the current research in vasculitis. “As I deepen my knowledge and gain experience in vasculitis, I would like to incorporate the teaching of this rare disease to both professionals and patients as part of my future career,” she says.
Soowamber is excited by the opportunity the fellowship provides.
“There are still many unanswered questions in vasculitis; it is a growing field with extensive clinical research being undertaken to improve the care and quality of life of patients,” she notes. “With the knowledge gained from the fellowship, I’ll be able to devote my career to greater research in vasculitis and the development of educational and awareness programs for patients and health care providers.”
Jennifer Rodrigues, MD, MSc, FRCPC, completed medical school at the University of Calgary in 2011, her Internal Medicine training at McGill University in 2014, and a Nephrology fellowship at the University of Toronto in 2015. She will be a VCRC-VF Fellow from 2016-2018 and will complete this fellowship under the direction of Dr. Michael Walsh, Associate Professor of Medicine and Clinical Epidemiology & Biostatistics at McMaster University, Hamilton, Ontario
This interview with Dr. Rodrigues was conducted by the Vasculitis Foundation, October 2016.
In the following interview with the Vasculitis Foundation, Dr. Rodrigues talked about why her particular focus on nephrology is such a critical area of research. She also shared why the VCRC-VF Fellowship is not only a professional opportunity for her, but believes it could yield valuable research insights that will help vasculitis patients in the future.
Briefly describe the focus of your work.
I am a Nephrologist interested in glomerulonephritis, diseases that affect the filters of the kidneys, the second most common cause of kidney failure requiring dialysis. The kidneys are frequently affected by vasculitis and while there are treatments, including immunosuppressive and anti-inflammatory steroid medications, to initially control the disease and prevent flare-ups, we don’t know how long patients should remain on these medications.
The duration of treatment has to be balanced with the risk of infection, bone fracture, and the impact on a patient’s quality of life. I will study whether long-term treatment with very low doses of medications prevents flare ups of vasculitis without significant side-effects. Opinions about whether low-dose medications, particularly prednisone, work in vasculitis vary dramatically around the world so the information from this study will change how vasculitis is treated no matter what it shows!
Why is this important to people with vasculitis?
Most patients with vasculitis will receive prednisone through the course of their treatment. At high doses, prednisone can control the damage vasculitis causes but, it also increases the risk of infections, bone fractures, and may play a role in cardiovascular disease and has very obvious effects on patient’s quality of life. While most of these side-effects disappear at low doses for most patients, it is not clear whether they continue to reduce the risk of vasculitis flare-ups. Avoiding long-term use may reduce the risk of harmful side effects but it may also increase the risk of disease flare-ups and the damage to organs like the kidney.
How did you decide on your specialty?
My interest in Nephrology began as a teaching assistant in physiology and was solidified during the early clinical rotations of Internal Medicine training where one of my first patients had kidney failure requiring dialysis. It is a diverse specialty combining various areas including electrolytes, dialysis, kidney transplant, glomerulonephritis, and immunology in daily practice. We look after a wide variety of patients, from the sickest patients in the intensive care unit to those in clinic who are living with kidney disease. Every day we are presented with new challenges and the opportunity for an important impact on patients’ lives.
What do you find most challenging about it?
I think the biggest challenge in Nephrology is the need for more studies to better understand the complex diseases that affect the kidneys such as vasculitis, in order to determine the best treatments for our patients.
As a nephrologist, you are focused specifically on studying the impact of vasculitis on the kidneys. Tell us more about the research you will be doing into this area.
With the support of the Vasculitis Foundation I intend to conduct a pilot clinical trial examining whether long-term low dose prednisone is effective at preventing relapse of ANCA-associated vasculitis and its impact on kidney function with a particular focus on the side effects of prednisone and its impact on patients’ quality of life.
I will study whether long-term treatment with very low doses of medications prevents flare ups of vasculitis without significant side-effects. Opinions about whether low-dose medications, particularly prednisone, work in vasculitis vary dramatically around the world so the information from this study will change how vasculitis is treated no matter what it shows!
Talk about how your research could potentially impact the way that patients are treated with Prednisone in terms of risks vs. benefits to the patient.
Avoiding long-term use of prednisone may reduce the risk of harmful side effects but it may also increase the risk of disease flare-ups and the damage to organs like the kidney. My study will clarify the risks and benefits of low-dose prednisone which will ultimately change the way many patients around the world are treated. Importantly, this study will also help us understand the potential effects of low-dose prednisone in other inflammatory and kidney diseases.
You have said that Glomerulonephritis (GN) is the next big development in our area of study. Please explain Glomerulonephritis and why it needs greater research.
Glomerulonephritis (GN) is a complex and rare disease that is the second most common cause of kidney failure. Specialized clinics as well as an increase in the amount of clinical research in this area will translate into improved outcomes. There are many types of GN in addition to vasculitis, and these patients frequently receive long-term immunosuppressive medications to control their disease.
Determining how long these patients should remain on immunosuppression once their disease is in remission in order to balance medication side effects and impact on patient’s quality of life with the risk of disease relapse is an important research question.
Personally, what does this VF Fellowship mean to you? How do the VF Fellowships advance our understanding of vasculitis? This fellowship will provide me with the opportunity to improve the care provided to patients with vasculitis. I am fortunate to have many excellent mentors within the field of vasculitis and glomerulonephritis and to be among the many previous successful recipients of this fellowship.
The Vasculitis Foundation has been critical to representing patient interests, raising awareness about these diseases, and helping to set research goals.
What is the most rewarding about your work?
It is a privilege to look after patients with kidney disease as we are often able to treat them when they are very ill in the hospital and then follow them over time in the clinic after they improve. We also look after a wide variety of patients of all ages and with a variety of conditions. We see patients with very aggressive types of vasculitis that can cause kidney failure and to be able to offer effective therapy is very rewarding.