Tell us about your clinical practice of Med-Peds rheumatology.
Dr. Nigrovic: In 2005, I started the Center for Adults with Pediatric Rheumatic Illness (CAPRI) at the Brigham and Women’s Hospital (BWH) to provide both transition assistance and long-term care for adults whose rheumatic diseases began as children. Since that time, we have seen over 700 new patients, most transitioning from Boston Children’s Hospital, but also patients coming to Boston for college or adults with diseases that we see more often in childhood, such as Still’s disease and autoinflammatory diseases. CAPRI has attracted great rheumatology fellows, many of whom have stayed at BWH as CAPRI attendings with specialized expertise in these diseases.
Tell us about your research.
Dr. Nigrovic: I direct a basic and translational science laboratory at Boston Children’s Hospital that is focused on arthritis and lupus, but also related genetics and basic immunology, including, for example, neutrophil subtypes and the role of megakaryocytes in immunity. Recently, using both human and mouse systems, we described a population of T resident memory cells in joint tissues that form during inflammation and remain during remission to nucleate recurrent disease. Looking at CAPRI patients, many of whom were followed for over a decade, we showed that patients with arthritis display a corresponding phenotype that we term joint-specific memory (i.e., the tendency of previously inflamed joints to flare again). We believe these observations have important implications for arthritis management strategies.
How has your combined training influenced your clinical practice and research?
Dr. Nigrovic: Stepping back, it seems very clear that most rheumatic diseases are very similar in adults and kids, with some notable exceptions (e.g., early onset oligoarticular arthritis, Kawasaki disease, giant cell arteritis), although, of course, treatments need to be tailored to age and comorbidities, which differ across patients. When I speak about rheumatic diseases, I seek to highlight these similarities and to expose the very tenuous, often trivial historical bases for the sharp division rheumatology draws based on age of onset, something really no other specialty in medicine does. Where we can, we expose these similarities through research in the lab, for example, showing that causal genetic variants are shared across the age spectrum.
What would you say to a medical student or resident considering a career in Med-Peds rheumatology?
Dr. Nigrovic: It is a long road, but I have loved it. The extra two years are a small fraction of one’s professional life and were absolutely worth it for me. Adult rheumatology has great depth of clinical wisdom and research. Pediatric rheumatology is a wonderful, small community that works well together, including on biologically informative diseases, such as Still’s disease, and the autoinflammatory conditions, as well as inborn errors of immunity, that are more common in children.
