This year the ARHP Clinical Focus Course brings together experts in the field to provide an interprofessional approach to the management of systematic lupus erythematosus (SLE) to improve patient outcomes. The daylong course, titled Systemic Lupus Erythematosus: Taming the Wolf—Salient Lessons from Practice and Research, which is offered on Nov. 4, will provide a case-based approach to complex diagnostic and management challenges in the care of these patients.
Benjamin J. Smith, PA-C, DFAAPA, will discuss the basics of SLE: diagnosis, management and disease monitoring. This presentation will review current diagnostic and treatment approaches for patients with SLE. He will highlight the importance of considering SLE early in the diagnostic workup of individuals presenting with connective tissue disease signs and symptoms, and will provide examples of appropriate monitoring mechanisms when caring for persons with SLE.
Mr. Smith is the academic coordinator for the School of Physician Assistant Practice at the Florida State University College of Medicine. He has worked clinically in rheumatology for close to 18 years and is an ARHP past president.
Tracey Wright, MD, assistant professor in the Department of Pediatrics and fellowship program director, Division of Rheumatology at UT Southwestern Medical Center, will present the unique challenges of diagnosis and management in children and adolescents with SLE. Children and adolescents with SLE frequently present with severe disease. However, they are especially vulnerable due to the broad impact of SLE on all aspects of their growth and development. Dr. Wright’s presentation will explore the unique challenges healthcare providers encounter in the management of pediatric SLE and provide participants with a strategy for comprehensive care for these young patients.
Dr. Wright is the primary investigator for the Clinical Core for the Center for Lupus Research funded by the National Institutes of Health (NIH), and her interests relate to pediatric SLE and improving outcomes for children and adolescents with this disease.
Bonnie Bermas, MD, formerly of Brigham & Women’s Hospital (BWH) in Boston, is a rheumatologist in the Rheumatology Division at UT Southwestern. Dr. Bermas’ presentation will illustrate how SLE preferentially affects women, particularly during their peak reproductive years. She will explain how hormonal factors and gender likely impact disease occurrence and presentation and will explore the role of gender and hormones on the incidence and the disease spectrum of SLE.
Dr. Bermas completed rheumatology fellowships at BWH and at the NIH before returning to Brigham and Women’s Hospital as an attending. At BWH, she became interested in the intersection of rheumatologic disease and reproduction inclusive of hormonal impacts and gender.
Edward H. Yelin, PhD, emeritus professor in the Department of Medicine (Division of Rheumatology) and Philip R. Lee Institute for Health Policy Studies at UCSF, will discuss the variability in management and clinical outcomes by socioeconomic status, ethnicity/race, and access to care. Data indicate outcomes and survival in SLE have improved dramatically over the past several decades, indicating that improvements in medical care have made a difference. However, members of racial and ethnic groups and those of lower socioeconomic status have not shared in these gains in quality and quantity of life. This presentation will explore the reasons that these groups remain at a disadvantage, focusing both on what we know about their interactions with health providers and healthcare systems accounts for lingering disparities, as well as what about their lives outside of healthcare contributes to the disparities.
Because stresses associated with food, housing and medical care insecurity and exposure to the threat or actual experience of crime in their neighborhoods play roles in SLE outcomes for the poor, the presentation will discuss what it is reasonable to ask health providers to do to deal with these issues, traditionally not seen as within the provider’s purview.
Dr. Yelin’s work is focused on disparities in access to care and outcomes for people with severe autoimmune diseases, including SLE. His research in this area is funded by the UCSF Multipurpose Clinical Research Center, which emphasizes the causes and consequences of health disparities, and by an Investigator Award in Health Policy from the Robert Wood Johnson Foundation.
Ram Raj Singh, MD, MBBS, professor of medicine and pathology, UCLA Division of Rheumatology, and an ACR fellow, will highlight the issues related to high mortality in people with SLE. Although the mortality rate in the general population declined every year from 1968–2013, there was a rise in SLE-ASMR in the 1970s–90s followed by a decline in recent years. It is disappointing that, relative to the general population mortality, SLE mortality is higher in 2013 than in 1968.
Importantly, significant gender, racial and regional disparities persist in SLE mortality. Dr. Singh plans to discuss various measures of chronic disease mortality, including age-standardized mortality rate, case fatality, standardized mortality ratio, leading cause-of-death ranking and proportional death burden in SLE.
Time permitting, he will discuss the estimated national prevalence of SLE with its racial/ethnic, gender and geographic region variation.
Dr. Singh’s research interests include the pathogenesis of autoimmunity, with a focus on the role of T cells and dendritic cells, mechanisms of sexual dimorphism in autoimmune diseases and secular trends in autoimmune disease mortality with a focus on mechanisms underlying the disparities.
SLE can lead to disruption in multiple areas of life, including work, participation in family and intimate relationships, and other interpersonal relationships. These effects on social interactions, combined with disease manifestations, such as pain, fatigue, cognitive impairment or changes in appearance, have been linked to psychological distress and depression.
Patricia P. Katz, PhD, professor in the Department of Medicine (Division of Rheumatology) and Philip R. Lee Institute for Health Policy Studies at the University of California San Francisco, will explore the social and psychological impact of SLE, and discuss potential coping and intervention strategies. Dr. Katz’s research has focused on the psychosocial impact of rheumatic diseases, particularly the relationship between disability and depression.
Donna Everix, PT, will wrap up the day with a discussion of effective nonpharmacologic management strategies. This session will provide strategies to deal with fatigue and deconditioning, such as sleep hygiene, modes, frequency and intensity of exercise, interval training, use of assistive devices and orthotics as well as novel technology applications to track symptoms and physical activity. Ms. Everix has been a physical therapist for almost 30 years, with experience in inpatient, private practice and home health settings, and specializes in orthopedics, rheumatology and aquatic therapy. She has been involved with the ARHP since 1987 and was awarded the Addie Thomas Service Award in 2015 for her commitment to the field of rheumatology.
For more information on the Clinical Focus Course and the 2017 ACR/ARHP Annual Meeting, click here.
Maura Iversen, BSc, PT, DPT, SD, MPH, is an associate editor of The Rheumatologist. She is also professor and chair of the Department of Physical Therapy, Movement and Rehabilitation Sciences at Northeastern University, a behavioral scientist in the Division of Rheumatology, Immunology, and Allergy at Brigham and Women’s Hospital, and a lecturer at Harvard Medical School, Boston.