Rheumatology

1 DIVISION OF RHEUMATOLOGY

The Division of Rheumatology at The George Washington University School of Medicine and Health Sciences provides state-of-the-art rheumatologic care in the heart of Washington, D.C.

Rheumatologic disease is the number one cause of disability in the United States. Our division’s mission is to:

• Care for patients with rheumatic diseases • Conduct research that infuences patient outcomes in

rheumatic diseases • Educate and advocate for rheumatology

DIRECTOR’SMessage

I am proud to report that in 2019, with the dedication of our faculty members and staff, we have made signifcant strides towards all three components of our mission.

In patient care, the addition of two new faculty members has allowed us to expand our capacity for musculoskeletal ultrasound aa well as bone densitometry services for GW Medical Faculty Associates.

With more than 400 patients enrolled in clinical research studies, research continues to be a strength of the division. Our team published 26 manuscripts, and gave multiple research presentations at local, national, and international meetings.

We continue our efforts to educate and advocate for the future of rheumatology. Our ACGME accredited fellowship is highly regarded, and is one of the few fellowships that focuses on training musculoskeletal ultrasound. Our faculty teach locally and nationally as well as serve in directorship roles for national and international rheumatology conferences.

Victoria K. Shanmugam, MRCP, MBBS, FACR, FACP Director, Rheumatology

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HIGHLIGHTINGNew Faculty

ADAM KILIAN, MD

Dr. Adam Kilian completed his undergraduate education in the Honors Program at the University of Michigan. He obtained his medical degree from Michigan State University College of Human Medicine in Grand Rapids, MI, and he completed internship and residency in internal medicine at the University of Utah Hospitals and Clinics in Salt Lake City. Subsequently, he returned to Michigan for rheumatology fellowship at the University of Michigan.

Dr. Kilian is passionate about clinical care, research, and teaching. He has published many peer-reviewed articles, and he has presented at more than ffteen national and international conferences. He has received many regional and national awards for his work, including the Grand Award at the American College of Physicians Annual Research Competition in 2018. Dr. Kilian is an active member of several professional societies, including the Gold Humanism Honor Society, the American College of Physicians, the American College of Rheumatology, and the American Medical Association.

NADINE MBUYI, MD

Dr. Nadine Mbuyi joined GW Rheumatology as an Assistant Professor of Medicine in November 2018. Dr. Mbuyi received her Medical Degree at the Saint George’s University School of Medicine. She completed her residency training in Internal Medicine at the Roger Williams Medical Center, Boston University School of Medicine and fellowship in rheumatology at Brown University, where she received training on the diagnosis and management of a broad range of rheumatic diseases. Dr. Mbuyi has expertise in musculoskeletal ultrasound having completed the rigorous Ultrasound School of North American Rheumatologists (USSONAR) training. She is certifed in musculoskeletal ultrasound by the American College of Rheumatology.

Dr. Mbuyi is building her research program in gout and the management of early arthritis. She has several publications in prominent journals. Dr. Mbuyi is an active member of the American College of Rheumatology. At GW School of Medicine and Health Sciences, Dr. Mbuyi is serving as secretary of the Clara Bliss Hinds Society for Women in Medicine and Science.

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FACULTYAwards

Dr. Patience White received the American College of Physicians D.C. Chapter, John F. Maher Laureate Award from Governor Alice Fuiz, in recognition of her services to Medicine and to the D.C. Community. The Laureate Award is the highest award that the D.C. Chapter can bestow on any of its members.

FACULTYService Dr. Marc Phillpotts has been selected to serve on the GW School of Medicine and Health Sciences Committee for MD Program Admissions. The committee is dedicated to admitting a diverse group of students, who will be prepared to meet the broad and disparate needs of patients and their communities.

THE FACE OFMusculoskeletal Ultrasound

In the hands of trained rheumatologists, musculoskeletal ultrasound is a powerful diagnostic tool. The George Washington University Division of Rheumatology is the only academic division of rheumatology in the Washington, D.C. metropolitan area with several physicians who have been certifed by the American College of Rheumatology in Musculoskeletal Ultrasound (RhMSUS) to perform diagnostic and therapeutic musculoskeletal ultrasound.

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BUILDING A TEAM FORBone Health

The GW Rheumatology Division recently assumed leadership of Bone Densitometry services for the GW Medical Faculty Associates and operates bone density scans fve days per week. Our team of trained rheumatologists also provide expert consultation for osteoporosis management.

STUDENTSuccesses

GW Medical Student Amil Agarwal recently received the Rheumatology Research Foundation Student Achievement Award. This award is presented to encourage medical and graduate students to consider a career in rheumatology, by recognizing promising work. Amil will be presenting a poster at the American College of Rheumatology meeting in Atlanta.

Undergraduate student Kanchan Misra won the Research Day School of Public Health First Prize in the Undergraduate Research Category for a poster presenting work from the GW Lupus study investigating the impact of educational levels on lupus disease activity.

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Rheumatology GWRheumatology

++

+ + 2019

+

+

+ Our work added up to make

Count!

26Rheumatology Interest

Group Members +

+

29Research

Presentations 417Patients currently

enrolled in Rheumatology Research Studies

342 Teaching

Hours

26 Manuscripts

Published

27 Lectures

Given654 Volunteer

Hours

56 Trainees Educated 352

Tweets

6 Prizes

and Awards

84 Hours of

Ultrasound Teaching

+

#GWRheum

#GWRheum

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RHEUMATOLOGY FELLOWSHIPGrows

In 2019 the GW Rheumatology fellowship has expanded to three fellows. The fellowship is an ACGME-accredited training program that prepares physicians to become board certifed in Rheumatology.

Senior fellow Dr. Ishita Aggarwal has successfully published multiple research manuscripts during her fellowship. She is currently receiving dedicated training in musculoskeletal ultrasound. Junior fellows Drs. Maha Almackenzie and Mamata Chand are learning rheumatology through tutorials and at the bedside. They each have dedicated continuity clinics and are working on research and quality improvement projects.

LEADING THE WAY INQualityAs Chair of the Clinical Competency Committee and part of the GW Rheumatology fellowship leadership team, Dr. Saira Bilal is mentoring fellows in quality improvement projects. Through these projects, our team is working with patients and multiple members of the healthcare team to streamline several aspects of the care we deliver. We are focused on improving important clinical outcomes for our patients.

MYOSITIS CENTER TAKES ITS RESEARCH International

The GW Myositis Team had a very successful year with three presentations at international meetings. The team presented data on the use of ultrasound in the diagnosis of juvenile myositis, as well as data from a study on anti-MDA5 antibody associated juvenile dermatomyositis at the 3rd Global Conference on Myositis in Berlin, Germany. They also presented data on anti-MDA5 autoantibody associated juvenile dermatomyositis at the 63rd Annual Scientifc Meeting of the Japan College of Rheumatology in Kyoto, Japan.

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STUART S. KASSAN, MD ’72Endowed Lecture

GW Rheumatology hosted Dr. John Stone, an internationally renowned rheumatologist for the 2nd Stuart S. Kassan Endowed Lecture in Rheumatology. Dr. Stone spoke about IgG4 related disease, describing the evolution from a previously unknown phenomenon to diagnostic criteria and novel therapies.

CUTTING EDGE Research

Systemic Lupus Erythematosus is a chronic autoimmune disease in which the immune system becomes active against parts of our own cells. The causes of lupus are not well understood, and there is great need to improve outcomes for patients with Lupus. The goal of the GW Lupus study is to investigate predictors of Lupus activity and clinical outcomes.

Scleroderma is an immune disease characterized by infammation, vasculopathy, and fbrosis. The STOP Scleroderma study is designed to investigate various biomarkers that predict disease progression in scleroderma, and to try to understand factors that predict prognosis for patients with early disease.

Through the Wound Etiology and Healing Study we have developed a longitudinal cohort of patients with Hidradenitis Suppurativa (HS). Work conducted through this study has allowed us to investigate the interplay of the microbiome with HS disease activity and to study keratinocyte function and antimicrobial peptide production. Defective innate immune responses may drive the development of HS, and our team is working with collaborators to better understand the drivers of this disease and potential new therapies.

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ADVOCATINGfor Arthritis

Dr. Adam Kilian recently joined the American College of Rheumatology Advocates for Arthritis program and spent two days on Capitol Hill advocating for increasing the rheumatology workforce and for improving access to rheumatologic medications for our patients.

PULLING TOGETHERfor Rheumatology As our division has grown, we have been working hard to strengthen our support team and improve the fow for our patients. Our team of dedicated staff guide our patients through the clinic and assist with scheduling follow up appointments.

CHANGING Lives

Our team of physicians and post-doctoral research scientists collaborate on synergistic projects that advance discovery in autoimmune disease and promote education in rheumatology. Much of the support for these projects comes from generous donations to the Rheumatology Research Fund, Alumni Endowments, and faculty donations to the Rheumatology Medical Education Fund.

Research funding is so important. Because of cutting-edge research, my doctors have been able to develop an amazing treatment plan.

– Ceci and Dennis Wraase, MS’75

The Rheumatology Medical Education Fund celebrates and promotes Rheumatology education at GW. I am proud to support it!

– Adam Kilian, MD

As a Rheumatologist and a graduate of the George Washington University School of Medicine and Health Sciences, I could not think of a better way to promote and enhance this important discipline than by funding the endowed lecture series in rheumatology at GW. The Division is outstanding, and I am thrilled to support their work.

– Stuart S. Kassan, MD’72

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SCIENTIFICPublications 1. Prevalence of antinuclear antibodies in hidradenitis suppurativa. Mulani S, McNish

S, Jones D, Shanmugam VK. Int J Rheum Dis. 2018 May;21(5):1018-1022. doi: 10.1111/1756-185X.13312.

2. Recommendations for Value-Based Payment for  Pediatric and Adult Health Care Systems: A Leadership Round Table Report. McManus P, White PH, Schmidt A.  Washington DC. Got Transition, 2018 Sept.

3. Transition planning among youth with and without special health care needs in the Unit-ed States.Lebrun-Harris L,McManus M, Ilango SM,Cyr M,McLellan SB,Mann MY, White PH.  Pediatrics. 2018 Oct;142(4):1-11. doi: https://doi.org/10.1542/peds.2018-0194.

4. A Comparison of Health Care Transition Implementation in State Title V Care Coor-dination Programs Between 2017 and 2018. Ilango S, Beck D, McManus M, White P.  DC: Got Transition, 2018 Oct.

5. Supporting the health care transition from adolescence to adulthood in the med-ical home. White PH, Cooley WC, Transitions Clinical Authoring Group, American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians. Pediatrics. 2018 Nov; 142:85-104. doi: 10.1542/peds.2018-2587

6. Features distinguishing clinically amyopathic juvenile dermatomyositis from juve-nile dermatomyositis. Mamyrova G, Kishi T, Targoff IN, Ehrlich A, Curiel RV, Rider LG; Rheumatology (Oxford). 2018 Nov 1;57(11):1956-1963. doi: 10.1093/rheuma-tology/key190.

7. Pneumocystis jirovecii pneumonia (PJP) prophylaxis patterns among patients with rheumatic diseases receiving high-risk immunosuppressant drugs. Schmajuk G, Jaf-ri K, Evans M, Shiboski S, Gianfrancesco M, Izadi Z, Patterson SL, Aggarwal I, Sarkar U, Dudley RA, Yazdany J. Semin Arthritis Rheum. 2018 Nov; 3. [Epub ahead of print]

8. Improving Health Care Transition and Longitudinal Care for Adolescents and Young Adults with Hydrocephalus: Report from the Hydrocephalus Association Transition Summit. Williams M, van der Willigen, T, White P, Wood D, Cartwright C, Hamilton M. Journal of Neurosurgery, 2018 Nov 23. https://thejns.org/doi/ abs/10.3171/2018.6.JNS188.

9. Anticoagulation in patients with concomitant lupus nephritis and thrombotic micro-angiopathy: a multicentre cohort study. Sciascia S, Yazdany J, Dall’Era M, Fenoglio R, Radin M, Aggarwal I, Cuadrado MJ, Schreiber K, Barreca A, Papotti M, Roccatello D. Ann Rheum Dis. 2018 Dec 14. [Epub ahead of print]

10. Gaps in Ambulatory Patient Safety for Immunosuppressive Specialty Medications. Patterson S, Schmajuk G, Evans M, Aggarwal I, Izadi Z, Gianfresco M, Yazdany J. Jt Comm J Qual Patient Saf. 2019 Jan 24. [Epub ahead of print]

11. Workforce Trends in Rheumatology. Kilian A, Upton LA, Battafarano DF, Monrad SU. Rheum Dis Clin North Am. 2019 Feb;45(1):13-26. doi: 10.1016/j.rdc.2018.09.002.

12. Impact of a Student-Led Rheumatology Interest Group on Medical Student In-terest in Rheumatology. Krupnikova S, Brady T, Sheppard M, LaCombe, N, Jones D, Shanmugam V. Int J Rheumatol. 2019 Feb 24;2019:4892707. doi: 10.1155/2019/4892707. eCollection 2019.

13. Transcriptome patterns in hidradenitis suppurativa: support for the role of antimi-crobial peptides and interferon pathways in disease pathogenesis. Shanmugam VK, Jones D, McNish S, Bendall ML, Crandall KA. Clin Exp Dermatol. 2019 Mar 3. doi: 10.1111/ced.13959.

14. Co-occurrence of Anaerobes in Human Chronic Wounds. Choi Y, Banerjee A, McNish S, Couch KS, Torralba MG, Lucas S, Tovchigrechko A, Madupu R, Yooseph

S, Nelson KE, Shanmugam VK, Chan AP. Microb Ecol. 2019 Apr;77(3):808-820. doi: 10.1007/s00248-018-1231-z.

15. Quality of Care for the Screening, Diagnosis, and Management of Lupus Nephritis Across Multiple Healthcare Settings. Aggarwal I, Li J, Trupin L, Gaynon L, Katz PP, Lanata C, Criswell L, Murphy LB, Dall’Era M, Yazdany J. Arthritis Car Res. 2019 May 6.

16. Long-term outcomes in Juvenile Myositis patients. Tsaltskan V, Aldous A, Seraf S, Yakovleva A, Sami H, Mamyrova G, Targoff IN, Schiffenbauer A, Miller FW, Simmens SJ, Curiel R, Jones OY, Rider LG. Semin Arthritis Rheum. 2019 Jun 28. pii: S0049-0172(19)30136-2. doi: 10.1016/j.semarthrit.2019.06.014.

17. Care of the Older Adult with Knee Pain. Battistone MJ, Barker AM, Milne CK, Kilian A, Johnson SA, Eleazer GP. J Gerontol Geriatr Med. 2019 July; 5(2): 032.

18. Prescription Opiod Use among Acute Gout Patients Discharged from the Emergen-cy Department. Dalal D, Mbuyi N, Shah I, Reinert S, Hilliard R, Reginato A. Arthritis Care & Research. 2019 July 2.

19. Evaluation of a health care transition improvement process in seven large health care  systems. Jones MR, Tisa Johnson Hooper T, Cuomo C, Crouch G, Hickam T, Lestishock L, Mennito S, White PH. Journal of Pediatric Nursing, 2019 Jul-Aug; 47: 44–50. doi: 10.1016/j.pedn.2019.04.007

20. Retinal vasculitis with Chronic Recurrent Multifocal Osteomyelitis: a case report and review of the literature. Shanmugam V, Phillpotts M, Brady T, Dalal M, Haji-Mome-nian S, Akin E, Nataranjan K, McNish S, Karcher D. BMC Rheumatol. 2019 Aug 1;3:29. doi: 10.1186/s41927-019-0076-5. eCollection 2019.

21. Severe cutaneous necrosis associated with type I cryoglobulinemia. Murphy A, Kil-ian A, Lowe L, Marder W. JAAD Case Rep. 2019 Aug 5;5(8):736-738. doi: 10.1016/j. jdcr.2019.06.020. eCollection 2019 Aug

22. Hidradenitis Suppurativa—Diagnosis and Management. Hood C, Shanmugam VK. The Journal for Nurse Practitioners, 2019 Sep 13. ISSN 1555-4155, https://doi. org/10.1016/j.nurpra.2019.07.004.

23. Mass Spectrometry Imaging of Triglycerides in Biological Tissues by Laser Desorp-tion Ionization from Silicon Nanopost Arrays. Fincher J, Korte A, Dyer J, Yadavilli S, Morris N, Jones D, Shanmugam V, Pirlo R, Vertes A. J Mass Spectrom. 2019 Sep 16. doi: 10.1002/jms.4443. [Epub ahead of print]

24. Segmental Arterial Mediolysis:  A vasculitis mimic. Bilal S, Alkhatib A, Solow E, Kalva S. Journal of Clinical Interventional Radiology. 2019 Oct 10.

25. A middle-aged woman with necrotic breast lesions. Mbuyi, N, Joanne C. Arthritis Care & Research. 2019 Oct 25. https://doi.org/10.1002/acr.24099.

26. Collaborative National Quality and Effcacy Registry (CONQUER) for Scleroderma: outcomes from a multicenter US-based systemic sclerosis registry. Shanmugam V, French T, Steen V, Hummers L, Shah A, Bernstein E, Khanna D, Gordon J, Castelino F, Chung L, Hant F, Startup E, VanBuren J, Evnin L, Assassi S. Clinical Rheumatology. doi: 10.1007/s10067-019-04792-y.

BOOK CHAPTERS 1. Distinguishing Disease Activity and Damage in Myositis. Curiel RV, Rider LG. In Man-

aging Myositis: A Practical Guide ISBN 978-3-030-15819-4. 2. Fibromyalgia, Ferri’s Clinical Advisor. Mbuyi, Nadine. Elsevier, 2020, ISBN13

9780323672542

SUPPORTING THEFuture Philanthropic donations to the Rheumatology Research Fund support investigations into autoimmune disease, educational research and faculty development. Many of these donations come from grateful patients, whose lives have been changed by our work. We want to thank all of our supporters including alumni, faculty and grateful patients as we continue to focus on conducting cutting edge research, and improving care for patients with rheumatic disease.

Thank you for your support of the GW Division of Rheumatology.

Donations to support the GW Division of Rheumatology may be made online at:

go.gwu.edu/Give2Rheumatology

Division of Rheumatology

The GW School of Medicine and Health Scineces smhs.gwu.edu/medicine/divisions/rheumatology