As Division Head, I am pleased to provide an overview of the activities of the Division of Rheumatology in its three major domains of education, clinical care and research. In addition, I will highlight some of the additional administrative and programmatic advances that we have recently made.
Perhaps most notable of recent news is that Dr. Sterling West, our outstanding clinician-educator who recently stepped down as the divisional fellowship director, received the singular 2016 American College of Rheumatology Outstanding Rheumatology Program Director Award. This award is in recognition of Sterling’s leadership not only of our own fellowship program but also his broad impact across the educational field. Following in Dr. West’s footsteps is Dr. Jason Kolfenbach, who is performing a stellar job as our recently appointed Rheumatology Fellowship Training Program Director. Importantly, Dr. Kolfenbach is developing new approaches to expanding the number of clinical and research fellows that the division can train, as well as updating and refining the components of the training program.
Additional advances in our educational activities have included the development under the leadership of Dr. Kevin Deane, Associate Division Head for Education, of an inpatient resident consult service rotation to accommodate individuals interested in learning more about the care of complex patients with life threatening problems. Another highlight has been the recent naming of Dr. Lisa Davis as an Internal Medicine Program Associate Director, a relationship that should strengthen our ties with residents and students interested in Rheumatology. These new activities build upon a long history of excellence in education led by Dr. Robert Janson and Dr. Joel Hirsh, which have focused on resident outpatient clinic rotations as well as teaching in the medical student Pathophysiology Course and overseeing medical student clinical rotations that are typically supported by a preceptor grant from the American College of Rheumatology (ACR) Rheumatology Research Foundation (RRF). Further impact through his efforts within the School of Medicine has been made by Dr. Dennis Boyle, Assistant Dean for Community Based Medical Education. Dr. Boyle leads School of Medicine efforts to engage community physicians in medical education.
With regard to Rheumatology Fellows, the Division continues to recruit an outstanding cadre of clinical and research fellows. Recently, we have recruited two MD/PhD fellows in the PSTP Program who bring outstanding research skills. A final notable highlight is the ability of the Division to support medical student research through its NIAMS T32 Training Grant.
With regard to clinical programs, these are overseen by Dr. Duane Pearson, who is Associate Division Head for Clinical Affairs and Director of the University of Colorado Hospital Rheumatology Clinic. Dr. Pearson has been leading expansion/re-organization on multiple fronts, including eConsults, expansion of patient access, ECHO telemedicine, outpatient clinic management reorganization, updating of clinic templates, and working to develop new clinical care pathways within the ever-expanding University of Colorado Health system network. A relatively new addition is also Dr. Elena Weinstein, who has joined the Division as a clinician-educator with a primary location in Lone Tree, a Denver south suburban site. Dr. Weinstein represents the first of many anticipated additions to the clinician-educator faculty with primary clinical practices in the Denver metro region. Addition clinical activities include the expansion of a Lupus Clinic, led by Dr. Susan Boackle, and the test piloting of a TEAM Clinic to identify early disease for integration into clinical research and clinical trials efforts. In another new initiative, Dr. Aryeh Fischer has been recruited to build collaboration/integration with the Center for Lung and Breathing. The Division also continues to support a weekly Scleroderma Clinic (Drs. Fischer and Kolfenbach) and its large number of complex patients with multi-systems disease. Linda Rodamaker continues to serve as the nurse practitioner for our practice, playing an essential role in the integrated patient management system. Finally, as all are aware, University of Colorado Health is undergoing a very substantial expansion to include clinic and hospital sites up and down the front range. The Division is committed to meeting the expanded clinical needs and also integrating patients as they are interested into the many ongoing research programs of the Division.
With regard to research activities, these efforts are organized in the Division through the activities of Dr. Liron Caplan, Associate Division Head for Research. Notable recent successes include Dr. Deane, who is leading a first-in-kind rheumatoid arthritis (RA) clinical prevention trial designated StopRA. Efforts also under the SERA (Studies of the Etiology of Rheumatoid Arthritis) umbrella that are focused on deciphering the mechanisms that underlie the preclinical development of RA. In that research area, Dr. Kristen Demoruelle is making great progress by focusing on the role of mucosal inflammation in the lung in preclinical disease. She has received an NIH K23, two U01 Prevention Center pilot grants and other grants, has several recent high profile publications, and was recently named a Department of Medicine Rising Star. Another highly successful young research-intensive faculty member is Dr. Kristi Kuhn, who has likewise received an NIH K08 as well as multiple grants to support her work focused on understanding the link between the microbiome and systemic autoimmune disease. Dr. Kuhn continues to receive funding to manage the CU Gnotobiotic Facility, which supports the efforts of many faculty members. In addition, Dr. Kuhn was named to the ACR Committee on Research.
Several investigators in the Division (Dr. Michael Holers, Dr. Lindsay Kelmenson, as well as Drs. Deane and Demoruelle and the longstanding collaborator from the Colorado School of Public Health Dr. Jill Norris) are working under a larger SERA (Studies of the Etiology of Rheumatoid Arthritis) umbrella. SERA is a longstanding study focused on understanding the mechanisms by which rheumatoid arthritis begins in the preclinical period, with the goal of understanding pathogenesis and developing novel prevention strategies that can be applied in this very early period.
Additionally, within the Division research undertaken by Dr. Boackle is focused on understanding the mechanisms whereby immune tolerance is broken in patients who suffer from systemic lupus erythematosus (SLE). She is working to understand how genetic studies that link certain areas of the genome to SLE risk operate to promote the development of this serious disease. Dr. Caplan is continuing his MERIT-funded work to improve medication adherence and outcomes in cardiovascular and rheumatic diseases, and separately, to advance our understanding of spondyloarthritis through the University of Colorado Program to Advance Spondyloarthritis Treatment. Dr. Caplan is also a mentor for a Rheumatology fellow, Dr. Patrick Wood, who has received a Department of Medicine Clinician Educator Fellowship Award. A more recent recruit is Dr. Aryeh Fischer, a clinical and research expert in autoimmune lung diseases, one that both overlap with rheumatoid diseases or only affect the lung. Dr. Fischer is heading up several industry clinical trials that are focused on identifying novel drugs as well as optimizing therapy for these complex patients. Dr. Fischer also served as a Co-Organizer of the 2016 Clinical Research Conference that occurs immediately prior to ACR Annual Meeting. Additionally, Dr. Hirsh is continuing his studies to understand and mitigate cultural differences that interfere with optimal care of rheumatic disease patients. On another front, Dr. Christopher Striebich has been greatly expanding his clinical trials program to take advantage of expanding opportunities in this area in both industry as well as NIH. Additionally, Dr. Nirmal Banda and Dr. Liuda Kulik are PhD scientists who are making great research strides in understanding the pathogenesis of inflammatory arthritis and mechanisms of tissue injury, respectively.
From an institution standpoint, the Division is well positioned to utilize new tools and data in the area of the Personalized Medicine, including Health Data Compass, a central data acquisition method whereby patients contribute to research through provision of blood samples for biomarker studies and linkage to their clinical findings.
Finally, as Division Head I have been fortunate to continue excellent grant support for basic and translational research programs, including a NIAMS R01, an NIAID U01 Prevention Center and U19 Autoimmunity Center of Excellence, and work with the NIAMS Accelerating Medicines Partnership (AMP) program. I also continue as a member of the NIAMS Council and Chair of American College of Rheumatology Division Director Special Committee.
With regard to new programmatic efforts, Dr. Ashley Frazer-Abel was recently recruited to the division in order to develop Exsera BioLabs, a laboratory that now incorporates autoantibody testing from the Rheumatology Clinical Laboratory (formerly, the ANA Lab) as well as encompasses a large number of complement clinical assays and other novel biomarkers. She has an outstanding start on this effort, with ongoing activities with the biotech/pharma industry, clinical care and new collaborative research efforts.
Underpinning all of these efforts are the administrative staff, led in an outstanding fashion by our Division of Rheumatology Administrator Ms. Carissa Figal. In particular, she has revolutionized business processes to allow the Division to maximize its productivity and impact, especially focusing on Exsera BioLabs, described above. The Divisional clinical trials efforts are expanding substantially under her administrative management. She also oversees the activities of Ms. Sheryl Hartmann, Grants Manager and Ms. Shirley Hanson, Rheumatology Training Program Administrator. In aggregate, our outstanding administrative group has greatly facilitated the activities of the Rheumatology clinical and research track fellows in training as well as supports the many activities of our large, professional and highly effective research, clinical and educational staff.
The Denver Veterans Affairs Medical Center has undergone considerable expansion of clinical, educational, and research activities. University-affiliated staff include Drs. Liron Caplan, (Rheumatology Section Head), Robert Janson, Susan Boackle, and Kevin Deane. Susan Mann, NP, provides substantial support for clinical activities. A new main VA health care and research facility is opening on the Anschutz campus adjacent to the University which will house all clinical services and a VA national registry for spondyloarthritis. In addition, the VA benefits from the volunteer services of over twenty local private practice rheumatologists and offers veterans a regional spondyloarthritis clinic and an innovative tele-medicine clinic.
Denver Health (DH) continues to play a role in the clinical, education, and research missions of the division. In addition to the long-time efforts of Drs. Joel Hirsh (Division Chief), Dennis Boyle, and Lisa Davis, DH has expanded its faculty in the past several years to include Drs. Itziar Quinzanos, Jennifer Stichman and JoAnn Zell. The DH Rheumatology clinic has been recognized at Denver Health for its role expanding external referrals, its low wait time and for having the highest customer satisfaction ratings of any specialty clinic at DH. The DH faculty are actively engaged in funded research projects looking to improve the processes and outcomes of care for patients with limited health literacy.
In conclusion, I hope that you enjoy your “tour” through the Division of Rheumatology site. Please contact us with any questions or suggestions at: 303-724-7605 or via e-mail at email@example.com
V. Michael Holers, MD
Scoville Professor and Head, Division of Rheumatology
University of Colorado School of Medicine