UPMC Physician Resources

Archives for Rheumatology

Pitt Rheumatology Division Named Part of NIH Network for Lupus and Rheumatoid Arthritis Study

PITTSBURGH, Sept. 24, 2014 – The National Institutes of Health (NIH) announced today that it has awarded five-year grants to 11 research centers across the United States in a private-public partnership designed to better identify and develop new diagnostics and drugs for rheumatoid arthritis (RA) and lupus. The Division of Rheumatology and Clinical Immunology of the University of Pittsburgh School of Medicine, led by chief Larry W. Moreland, M.D., has been chosen as one of the research sites – the only one between the states of New York and Colorado.

“From our perspective, this is a tremendous collaborative effort involving physicians and researchers across disciplines, including basic scientists, clinical researchers, orthopaedic surgeons, radiologists and numerous clinical rheumatologists,” said Dr. Moreland. The lab of Mandy McGeachy, Ph.D., assistant professor of medicine, will direct the basic science effort for the Pitt team.

Under this NIH Accelerated Medicines Partnership:

  • Pitt’s research team will collect data from a large group of patients already participating in NIH-funded research. The project aims to unravel biological pathways involved in RA by examining surgical tissue samples, performing ultrasound-guided biopsies of inflamed joints, and utilizing specialized tissue processing for immune-cell analytics, as well as conducting other tests. The team also has proposed a clinical study in which patients who haven’t responded to first-line therapy with methotrexate will be randomized to receive a biologic therapy.
  • Members of the 11 network centers – totaling 18 principal investigators – will collaborate as a consortium, starting with a meeting scheduled for the end of October.
  • The incentivized research plan consists of a seed grant from the NIH, which then may award larger sums moving forward dependent upon the progress of the research and further studies to follow.

The NIH news release can be found on its site.

2014 Marshall S. Levy, MD, Memorial Lecture

UPMC and the University of Pittsburgh Division of Rheumatology and Clinical Immunology are pleased to host Iain McInnes, PhD, as the guest lecturer for the 2014 Marshall S. Levy, MD, Memorial Lecture.

Professor McInnes currently serves as the Muirhead Chair of Medicine and Director of Institute of Infection, Immunity and Inflammation at the University of Glasgow.

He has a major interest in the biology of inflammatory synovitis in rheumatoid arthritis, psoriatic arthritis, and septic arthritis. He operates a translational science program in which state of the art cellular and molecular biology techniques are applied to elucidate the mechanisms underlying the perpetuation of synovial inflammation. In parallel they have an extensive clinical trials facility in which they perform studies of novel biologic agents in inflammatory arthritis.

Dr. McInnes has an established leadership role in translational medicine reflected in academic participation in the United Kingdom as the chair of the newly created Arthritis Research UK New Agents Committee, as the vice chair of the Medical Research Council Panel for Training and Fellowships, and the UK Clinical Research Network Specialty Groups Scottish Lead for Inflammation Medicine.

He has also served as chief or principal investigator at the global and national level for numerous phase I, II, and III drug development programs. As such he provides knowledge and experience in the conduct and translation of a variety of investigative modalities in the field of inflammation medicine.

Dr. McInnes’ lecture, Micro Molecules with Macro Effects in Rheumatology, will be presented on Friday, October 10, 2014.

Marshall S. Levy, MD, was a nephrologist at UPMC for nearly 40 years. During this time he served as the president of UPMC St. Margaret Hospital staff. He used his position to advocate for patients’ rights and concerns.

For more information on the lecture contact Hilary Peterson at HJP4@pitt.edu or 412-383-8100.

Unusual Immune Cell Needed to Prevent Oral Thrush, Pitt Researchers Find

PITTSBURGH, Sept. 8 – An unusual kind of immune cell in the tongue appears to play a pivotal role in the prevention of thrush, according to the researchers at the University of Pittsburgh School of Medicine who discovered them. The findings, published online today in the Journal of Experimental Medicine, might shed light on why people infected with HIV or who have other immune system impairments  are more susceptible to the oral yeast infection. 

Oral thrush is caused by an overgrowth of a normally present fungus called Candida albicans, which leads to painful white lesions in the mouth, said senior investigator Sarah L. Gaffen, Ph.D., professor, Division of Rheumatology and Clinical Immunology, Pitt School of Medicine. The infection is treatable, but is a common complication for people with HIV, transplant recipients who take drugs to suppress the immune system, chemotherapy patients and babies with immature immune systems. 

“In previous work, we found the cytokine interleukin-17 (IL-17), a protein involved in immune regulation, must be present to prevent the development of thrush,” Dr. Gaffen said. “But until now, we didn’t know where the IL-17 was coming from.” 

Typically, IL-17 is produced by immune T-cells that learn to recognize and remove a foreign organism after an initial exposure, known as adaptive immunity. But unlike humans, mice do not normally acquire Candida during birth and are considered immunologically naïve to it. When the researchers exposed the lab animals to Candida, their IL-17 levels rose within 24 hours despite the lack of a T-cell response. This suggested the immune activity was innate, rather than acquired. 

To find the cell responsible for IL-17 secretion, lead investigator Heather R. Conti, Ph.D., devised a way of applying a scientific technique called flow cytometry to sort for the first time cells gathered from the oral tissues. In the tongue, she identified unusual ones known as natural TH17 cells that looked very much like T-cells but didn’t behave like them. Subsequent tests showed that the novel cells did, indeed, make IL-17 when exposed to Candida. 

“These cells are part of a natural host defense system that is present at birth and does not require a first exposure to be activated,” Dr. Gaffen explained. “This study demonstrates for the first time that natural TH17 cells protect against infection.” 

The researchers speculate that the similarities natural TH17 cells share with T-cells make them vulnerable to HIV, chemotherapy and other agents as well, which could explain why certain people are more susceptible to oral thrush. Also, new drugs that block IL-17 soon will be on the market for treatment of rheumatologic conditions, so it’s possible that thrush could be a side effect. 

The team plans to examine the factors that influence thrush development within the high-risk groups.

 Co-authors of the paper include other researchers from the University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of UPMC, the University of Pennsylvania, Genentech Inc., and the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH). 

The project was funded by NIH grants DE022550, AI107825, DE023815, AI095466, AI097333, AI106697, AI1110822, DE023293, AI098243 and T32-DK063922; Children’s Hospital of Pittsburgh of UPMC; the Pediatric Infectious Disease Society; the Edmond J. Safra Foundation/Cancer Research Institute; and the NIAID.

UPMC Named to U.S. News & World Report Honor Roll of ‘Best Hospitals’ for 15th Time

UPMC Ranks #1 in Pennsylvania, #1 in Pittsburgh for Clinical Excellence

PITTSBURGH, July 15, 2014 UPMC has once again received national recognition for its clinical expertise, earning 12th position on the annual U.S. News & World Report Honor Roll of America’s “Best Hospitals.” UPMC is the highest-ranked medical center in both Pennsylvania and in Pittsburgh.

“While we’re very proud that UPMC was recognized for the 15th year, it is our patients who are the ultimate winners. Our exceptionally skilled and devoted health care professionals do what they do best every day — provide the finest health care in the state and in the region,” said Leslie C. Davis, president, UPMC Hospital and Community Services Division.

“We are honored to receive this national distinction, which recognizes UPMC’s unique combination of high-quality medical care, a top health insurance plan, and close affiliation with the University of Pittsburgh, one of the best medical schools in the country,” added Steven Shapiro, M.D., executive vice president and chief medical and scientific officer at UPMC. “Furthermore, it emphasizes UPMC’s commitment to our patients and showcases how we are leading the way in the development of new technologies and methods of care.”

Nationally, UPMC is ranked for excellence in 15 of 16 specialty areas, and is among the top 10 hospitals in six specialties: ear, nose and throat; gastroenterology; gynecology; psychiatry; pulmonology; and rheumatology.

U.S. News analyzed 4,743 medical centers in the nation, but only those that achieved high scores in six or more specialties were included in the distinguished Honor Roll group. Scores were based on a variety of factors including hospital volume, patient safety, outcomes and reputation for delivering high-quality care.

Last month, U.S. News named its 2014 Honor Roll of America’s Best Children’s Hospitals, recognizing Children’s Hospital of Pittsburgh of UPMC as 9th in the country.

Premature Aging of Immune Cells Present in Joints of Kids with Chronic Arthritis, Pitt/Children’s Hospital Team Says

PITTSBURGH, July 29, 2013 – The joints of children with the most common form of chronic inflammatory arthritis contain immune cells that resemble those of 90-year-olds, according to a new study led by researchers at Children’s Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine. The findings, published in the August issue of Arthritis and Rheumatism, suggest that innovative treatment approaches could aim to prevent premature aging of immune cells.
 
Juvenile idiopathic arthritis, or JIA, is the most prevalent rheumatic condition in the world and affects one of every 1,000 children in the U.S., said senior researcher Abbe de Vallejo, Ph.D., associate professor of pediatrics and immunology, Pitt School of Medicine. It usually starts with a swollen ankle, knee or wrist that parents often assume is due to a minor injury sustained while playing.
 
“Untreated JIA has devastating consequences,” Dr. de Vallejo said. “It can slow growth and, in extreme cases, the child can be physically disfigured. It’s a degenerative disease that eats up the joints.”
 
Doctors have long thought of JIA as an autoimmune disease, meaning the body attacks itself. But previous studies by Dr. de Vallejo of young adults with rheumatoid arthritis indicated that a certain population of cells present in the joint synovial fluid and blood displayed telltale signs of abnormal cell division and premature aging. His current team at Children’s wanted to see if that was true in pediatric arthritis.
 
They examined immune cells called T-cells in the synovial fluid and blood from 98 children ages 1 to 17 and known to have JIA, as well as 46 blood samples from children who didn’t have the disease. T-cells are the army of immune cells that eradicate infection, tumors and other dangerous agents to which people may be exposed.
 
The research team found about one-third of the T-cells of children with JIA had shortened telomeres and had reduced, or in some cases lost, the capacity to proliferate. Telomeres are the ends of chromosomes that don’t code for proteins and, because they are not fully copied by enzyme mechanisms, are trimmed slightly during each DNA replication cycle. It is thought that aging occurs when the telomeres become too short for DNA replication and cell division to proceed normally.
 
“The T-cells of the children with JIA had very short telomeres, about the length we see in a 90-year-old or a young adult with rheumatoid arthritis. Those same T-cells express unusually high levels of several classic protein markers of cell aging and exhaustion,” Dr. de Vallejo said. “These kids haven’t lived long enough to have cells that look that old. This is the first indication that premature aging in occurring in this childhood condition.”
 
In addition, the T-cells had become dysregulated, and their immune activity could be stimulated through atypical cell surface receptors. Much more must be learned about the unusual cells and about genetic mechanisms that might contribute to the development of JIA, Dr. de Vallejo said, but these findings could point the way to new therapies.
 
“JIA is typically treated with broad-spectrum drugs such as steroids and biologics that essentially paralyze the entire immune system, but only a third of the cells are affected and their abnormality seems to be premature aging, rather than autoimmune activity,” he noted. “This study suggests cell-targeted treatments could be developed to prevent this premature immune aging.”
 
Co-authors of the paper include other researchers from Children’s Hospital of Pittsburgh of UPMC; Pitt School of Medicine; and the Mayo Clinic. The project was funded by the Nancy E. Taylor Foundation for Chronic Diseases, the Arthritis Foundation, and National Institutes of Health grant AR052282.

UPMC Again Earns Top-10 Spot on U.S. News & World Report Honor Roll of America’s Best Hospitals

PITTSBURGH, July 16, 2013UPMC clinches the 10th place in U.S. News & World Report’s annual Honor Roll of America’s Best Hospitals for the second year in a row – again making it the highest-ranked medical center in Pennsylvania.
 
“This prestigious recognition speaks to the skill and commitment of UPMC physicians, nurses and staff as they continue to provide exceptional care to our community. UPMC is dedicated to making a difference in the lives of our patients, and we are honored when our excellence in health care is recognized,” said Elizabeth Concordia, executive vice president of UPMC and president of the Hospital and Community Services Division. “We are proud that patients continue to choose us to deliver world-class care right here in western Pennsylvania.”
 
Nationally, UPMC is ranked for excellence in 15 of the 16 specialty areas, and is among the top 10 hospitals in eight specialties: Ear, Nose & Throat; Gastroenterology; Geriatrics; Gynecology; Neurology and Neurosurgery; Psychiatry; Pulmonology and Rheumatology.
 
Last month, U.S. News named its 2013 Honor Roll of America’s Best Children’s Hospitals, on which Children’s Hospital of Pittsburgh of UPMC ranked 10th. This year marks UPMC’s 14th appearance on the Honor Roll.
 
“UPMC’s national ranking highlights our unique combination of superb medical care, a leading health insurance plan and close ties to one of the nation’s best medical schools at the University of Pittsburgh,” added Steven Shapiro, M.D., executive vice president and chief medical and scientific officer, UPMC.  “We are proud to be a leader on the U.S. News Honor Roll — but, most importantly, to be leading the way in developing new and better ways of taking care of patients.”

UPMC is Only Health System Named ‘Most Wired’ for 13 Consecutive Years

PITTSBURGH, July 11, 2011 – For the 13th consecutive year, UPMC has been named one of the 100 “Most Wired” health systems in the country, the only organization to earn that distinction, according to Hospitals & Health Networks, the journal of the American Hospital Association (AHA).

UPMC also is one of the winners of the 2011 Most Wired Innovator Awards for its development of eVisits, a Web-based system for providing secure “electronic housecalls” to patients. This pioneering approach to health care is available to patients of most UPMC primary care physicians and provides a safe, convenient and cost-effective alternative to in-person visits or phone calls for more than 20 conditions. eVisits, using physician-created, structured questionnaires, are integrated into UPMC’s extensive electronic medical records (EMRs) to ensure continuity of patient care.

The awards will be presented at the 2011 Health Forum and AHA Leadership Summit in San Diego, July 17 to 19.

“UPMC is a long-time leader in adopting, developing and commercializing smart technology that improves care for patients. We are honored to be consistently recognized for these achievements by Hospitals & Health Networks and proud of the dedicated team of clinicians and technologists at UPMC who have made this possible,” said Daniel Drawbaugh, chief information officer of UPMC.

The 13th annual Most Wired Survey and Benchmarking Study included more than 1,300 hospitals and health systems across the country and measured the use of technology in clinical quality and safety, business and administrative functions, and ambulatory and community services.

Over the past five years, UPMC has invested more than $1.3 billion in technology to support clinical excellence and administrative efficiency as it creates new models of accountable care. UPMC is one of the nation’s earliest and most sophisticated users of EMRs. Children’s Hospital of Pittsburgh of UPMC in 2009 was the first pediatric facility in the nation to achieve HIMSS Stage 7 status for its virtually paperless environment and the most comprehensive use of EMRs, while seven other UPMC hospitals are Stage 6, as measured by HIMSS Analytics, a subsidiary of the Healthcare Information and Management Systems Society.

Last year, UPMC ranked fifth in the InformationWeek500, a list of the nation’s top technology innovators across all industries, and also was honored with the Healthcare Innovation Award for creating a system that allows radiologists and physicians to access imaging studies from across UPMC to better care for patients.

Pitt School of Nursing Study Finds Poor Sleep Quality Associated With Greater Pain And Disability In Rheumatoid Arthritis Patients

PITTSBURGH, Feb. 22, 2011 – Poor sleep quality correlated with higher levels of depressive symptoms, more severe pain, increased fatigue and greater functional disability in patients with Rheumatoid Arthritis (RA), according to a study by researchers at the University of Pittsburgh School of Nursing recently published in the Journal of Clinical Sleep Medicine. The study suggests that addressing sleep problems may have a critical impact on the health and quality of life of patients with RA.

Faith S. Luyster, Ph.D., assistant professor, School of Nursing, led the study of 162 patients with RA. Participants completed several questionnaires, which asked about their sleep quality, depression, fatigue, functional disability and pain severity.

Results showed that sleep quality had an indirect effect on functional disability after controlling for age, gender and number of comorbidities. According to results of one of the questionnaires, the Pittsburgh Sleep Quality Index, 61 percent of patients were poor sleepers and 33 percent reported pain that disturbed their sleep three or more times per week.

“Not sleeping well at night can contribute to greater pain sensitivity and fatigue during the day, which in turn can limit a patient’s ability to engage in activities of daily living and discretionary activities,” Dr. Luyster said. “These results highlight the importance of addressing sleep complaints among patients with RA. By treating sleep problems either pharmacologically or behaviorally, symptoms and activity limitations associated with RA may be reduced.”  

Collaborators on the study were Jacqueline Dunbar-Jacob, Ph.D., R.N., F.A.A.N., dean, School of Nursing, and Eileen Chasens, D.S.N., R.N., assistant professor, School of Nursing.

RA is an inflammatory disease affecting about 1.3 million U.S. adults, and causes pain, swelling, stiffness and loss of function in the joints. Dis­turbed sleep has been found to be a major concern among persons with RA.

The study was funded with grants from the National Institute of Health.