MICHIGAN MEDICINE DIVISION OF RHEUMATOLOGY
Summer 2018
Dear alumni and friends,

Although you will be receiving a newsletter in the early fall, a few weeks before the American College of Rheumatology (ACR) meeting, this newsletter is my last one as chief of the Division of Rheumatology. I have already handed my clinical service chief duties to Dr. Wendy Marder and will be stepping down as division chief effective September 1, 2018, after 28 years in the role.

Our clinical programs, research funding, and annual number of scholarly publications have nearly tripled since the early 1990s. I am proud of the many discoveries in bench research and clinical investigation that have helped move the field of rheumatology forward. Our Fellowship Program continues to be very strong, now generally accepting four new trainees per year instead of three. It is gratifying to watch the careers of our former trainees develop and flourish, and we take great satisfaction in all of your accomplishments.

It has been especially pleasing for me to work with so many brilliant faculty. Every one of the assistant professors appointed to the instructional track at Michigan since 1990 have gone on, not only to achieve tenure, but to develop distinguished careers and make unique, widely recognized contributions to the field of rheumatology. Some have moved into leadership positions elsewhere, but we still consider them members of our division family.

As we look toward the future, one notable area of progress has been the more than 50-fold increase in the amount of philanthropic support available for academic programs. Several factors have gone into this success, not the least of which is the generosity of our alumni together with the close connection they feel for their years at the University of Michigan.

The new Giles Bole and Dorothy Mulkey Endowed Chair, for example, was developed almost entirely from alumni support. This chair is an important asset for the division as we enter the final stages of recruitment of a new division chief. Another key factor in growth has been the gratitude of our patients and their families for the outstanding care provided by all of our clinicians, including physicians, nurses, and clinical support staff.

After stepping down from my administrative responsibilities, I will continue full-time maintaining my involvement in patient care and focusing more on my laboratory research program. I want to again thank all of our alumni for their consistent support and engagement with our division - your dedication and vision ensure that our unit will have an exceptionally bright future as a leader and innovator in the field of rheumatology.

Please visit our rheumatology website to stay up to date on our latest work. Go Blue!

Sincerely,

David Fox, MD
Frederick G.L. Huetwell and William D. Robinson, MD Professor of Rheumatology
Chief, Division of Rheumatology
Department of Internal Medicine 
New Clinical Service Chief, Wendy Marder, MD
Dear alumni and friends,

Taking on the responsibilities of the clinical service chief for the Division of Rheumatology over the last year has made me even more aware of Dr. Fox’s dedication to our patients, faculty and nurses. He works tirelessly to ensure that all clinical care delivered in our division is both excellent and timely. Like all of us, I’ve learned so much from him about clinical rheumatology, and in the role of service chief, how to effectively facilitate consultative care in an environment where we face access challenges due to local and national work force shortage of rheumatologists. 

One of my early efforts as the new service chief has been to streamline the new patient triage process for providers referring patients to Michigan Medicine Rheumatology Clinics, and make sure that the most urgent patients continue to get prompt evaluation, particularly those referred to destination programs within our division such as the Scleroderma and Lupus programs. With Michigan Medicine’s partnership with Mid-Michigan and other healthcare affiliates across the state, we are receiving increased volume of referrals above and beyond the already large numbers we previously received as a major referral center. In order to accommodate these patients, we have added excellent new clinicians and mid-level providers in our Ann Arbor clinic locations, as well as at our large satellite expansions in Brighton and Northville.

Another focus of my attention as service chief has been to help with the planning phases of our move to the East Ann Arbor medical campus location which is planned over the next several years. We will be joining a new Comprehensive Musculoskeletal Center, which partners Rheumatology with Orthopedics, Physical Medicine and Rehabilitation, Radiology and other musculoskeletal services. This new care model will enhance our collaborations between services, improving patients care and opening countless opportunities for research, teaching and process improvement. 

As you can see, this is an exciting time for our division, but also bittersweet as Dr. Fox steps away from his leadership role. We will be planning a series of events over the next few months to celebrate his many accomplishments and thank him for his years of leading one of the top rheumatology programs in the country, including a celebration at the University of Michigan alumni reception at the ACR in Chicago. I hope you can celebrate with us.

We hope to hear from you. We welcome your suggestions and comments on ways we can improve this newsletter or to answer any questions you have. Email us at rheumatology@umich.edu

Sincerely,

Wendy Marder, MD
Associate Professor of Internal Medicine and Associate Professor of Obstetrics & Gynecology
Service Chief, Division of Rheumatology Department of Internal Medicine
Join us as We Honor David A. Fox, MD
After 28 years as chief for the Division of Rheumatology,
Dr. Fox will be stepping down to devote more time to his research.

A member of the faculty at the University of Michigan Department of Internal Medicine since 1985, Dr. Fox has dedicated his work to the prevention and treatment of rheumatic disease. Since 1990, he has served as chief of the U-M Division of Rheumatology. In addition, Dr. Fox d irected the U-M Multipurpose Arthritis and Musculoskeletal Diseases Center from 1990-2000, the U-M Rheumatic Disease Core Center from 2001-2011, and since 2014, the U-M Clinical Autoimmunity Center of Excellence. In addition, he was the seventy-first president of the American College of Rheumatology (ACR) from 2007-2008 - the sixth ACR president from the University of Michigan.

Dr. Fox's research focuses on defining and characterizing pathways of human T cell activation, determining the role of these pathways in the pathogenesis of autoimmune disease, investigating T cell interactions with synovial fibroblasts, regulating autoimmunity with genetically modified dendritic cells, and understanding the role of interleukin-17 in arthritis. He is author of more than 230 scientific papers and book chapters and has served on the Editorial Board of Arthritis & Rheumatism and as an Associate Editor of the Journal of Immunology and the Journal of Clinical Investigation. He is a member of the American Society for Clinical Investigation and the Association of American Physicians.

To honor Dr. Fox's work and dedication, a celebration will occur:

October 20, 2018
ACR Alumni Reception, Chicago
Palmer House Hilton, Mezzanine Level
17 East Monroe Street
Chicago, IL 60603
7:00 pm - 9:00 pm
Faculty Spotlight - Amr Sawalha
Amr Sawalha, MD, graduated Medical School from the Jordan University of Science and Technology, in Irbid, Jordan. He completed his residency in internal medicine at the University of Oklahoma Health Sciences Center in Oklahoma City, and his rheumatology fellowship at the University of Michigan.

Dr. Sawalha and his team significantly contributed to establishing a role for epigenetic dysregulation in the pathogenesis of lupus. They also provided important insights from studying epigenetic changes in multiple other autoimmune diseases, including Sjogren’s syndrome, Behçet’s disease, giant cell arteritis, and systemic sclerosis. They have identified a role for DNA methylation changes in determining clinical disease heterogeneity, disease progression and flares, and differences in disease susceptibility between ethnicities in lupus patients.
 
Their work in lupus genetics has resulted in the discovery of two novel susceptibility genes in lupus: methyl-CpG-binding protein 2 (MECP2) and interleukin-21 (IL21), both of which have since been replicated repeatedly by other groups, and also extended to other autoimmune diseases.

In other work, Dr. Sawalha's lab provided evidence for gene-gene interaction in lupus risk and published a large lupus genetics study in African-Americans. They also performed the first systematic work to identify and predict specific clinical disease features in lupus based on genotypes, setting up the stage for personalized genomics in lupus.

Awards & Recognition
Eliza Tsou, PhD, was inaugurated as the Edward T. and Ellen K. Dryer Early Career Professor in Rheumatology. The professorship's intent is to support a faculty member in the first decade of his or her career as an independent researcher.

The Dryer Foundation stated, "Giving young faculty members a solid footing for success would have pleased the Dryers. Ed was a great believer in giving people a chance. He and Ellen would have been thrilled to support up-and-coming researchers and physicians."

Division Chief David Fox, MD stated, "The Division of Rheumatology is deeply grateful for the foundation’s foresight and commitment to progress. This professorship will give faculty members a solid footing from which to push their discoveries forward and build their careers. It will ensure that promising work toward curing arthritis continues."

(L to R): Husband, Yi-Chen Chen Tsou; son, Anthony Tsou; daughter, Annabelle Tsou; Eliza Tsou, PhD; and daughter, Alexis Tsou
(L to R): John Carethers, MD, MACP; Eliza Tsou, PhD; Carolyn Bradford, MD; David Fox, MD
J. Michelle Kahlenberg, MD, PhD, received the Department of Internal Medicine's Jerome W. Conn Award for Excellence in Research by a Junior Faculty Member.

The award honors the memory and research prowess of Jerome W. Conn, MD (1907-1994), who spent his entire professional career at the University of Michigan, and whom is known for the first description of primary hyperaldosteronism in a patient with the surgical finding of a 4-centimeter adrenal gland tumor in 1954. This later became known as Conn syndrome. 

In addition, Dr. Kahlenberg was recently honored as an A. Alfred Taubman Emerging Scholar . The A. Alfred Taubman Medical Research Institute at the University of Michigan supports some of today's most aggressive medical science researchers.

Lupus Research Alliance Novel Grant Award Recipients
Jason Knight, MD, PhD -“Tracing the Path to Organ Damage”

Dr. Knight has identified a new player in the development of lupus and its complications - neutrophil elastase. His Novel Research Grant will reveal whether elastase is a good target for the development of a new type of treatment for people with lupus that can protect against autoimmune responses, kidney disease, and blood clotting events. Read more .
Amr Sawalha, MD - “Taking Down the DNA Ornaments”

Dr. Sawalha is studying how the EZH2 protein changes the DNA in immune cells to make them more likely to launch an autoimmune attack on a person’s body. Importantly, several drugs that turn off this protein are already in clinical trials as potential cancer treatments. The results of Dr. Sawalha’s research could provide support for testing these new drugs to treat people with lupus as well. Read more .
Adam Kilian, MD was grand prize winner at the American College of Physicians National Research Contest this past April for his research poster on “Complex Care Maps: Empowering Colleagues to Deliver Patient-Centered Care.”

Dr. Kilian and colleagues developed an innovative cross-continuum intervention process and a succinct tool called a Complex Care Map© that addresses fragmentation in the health system and links providers to a comprehensive individualized analysis of the patient story and root causes for frequent access to health services. 

Each subject served as his/her own historical control. When predicted costs were compared to actual costs 12-months post intervention on the initial 300 high-need high-cost patients who were enrolled, the gross charges decreased by more than $5 million, healthcare utilization decreased, and patient health outcomes and provider satisfaction improved - all while the operating margin improved by 73%. 

This process is one of the most successful interventions in the country for reducing costs and utilization while improving care for high-need, high-cost patients yet which does not sacrifice funding for non-profit healthcare organizations. This intervention has now been implemented by hundreds of hospitals nationwide. Read more .
Rajat Gupta, MD (former student in Dr. David Fox's lab) was interviewed by Circulation Research as part of their " promising young investigator " series. Dr. Gupta credits his interest in science and medicine to Yoshi Morita, a U-M postdoctoral fellow who taught him how to perform experiments.

Gupta stated, "Yoshi was very meticulous and had high standards. I just loved working with him. That experience really changed my course from wanting to be a community doctor to wanting to be a scientist who addresses medical questions."

Today, Dr. Gupta is a postdoctoral research fellow at the Broad Institute of the Massachusetts Institute of Technology (MIT) and Harvard. Read more .
Faculty Promotions
David Fox, MD, received a named professorship - The Frederick G.L. Huetwell and William D. Robinson, MD Professor of Rheumatology.
J. Michelle Kahlenberg, MD, PhD, was promoted to associate professor of internal medicine, with tenure.
Seetha Monrad, MD, was appointed assistant dean for assessment, evaluation and quality improvement.
Research
Our research programs include the Lupus Program and the Scleroderma Program. In addition, several of our faculty members conduct research through the Chronic Pain & Fatigue Research Center. Learn more .
Joseph Holoshitz, MD, discusses how environmental pollutants combined with the presence of the HLA gene can increase the risk and severity of rheumatoid arthritis and bone destruction. Read more .
Seetha Monrad, MD, was senior author of the study - 2015 American College of Rheumatology Workforce Study: Supply and Demand Projections of Adult Rheumatology Workforce - that was published in the Arthritis Care & Research journal.
Patient Initiatives
As #12 in the nation for rheumatology care, we focus on the diagnosis and management of rheumatic and musculoskeletal diseases. Learn more .
Scleroderma Patient Tour
On June 19, Dr. Dinesh Khanna and team hosted a patient tour of the scleroderma lab, and provided the group of 19 with an update on the latest breakthroughs in scleroderma research, as well as the vision of the peer mentoring team.

Dr. Eliza Tsou and lab manager, Phil Campbell, led the lab tours. Dr. Tsou explained how she hopes her work will benefit patients, and gave a presentation on her research, “Key Features of Scleroderma Pathogenesis.”

Patient and peer mentor, Sheri Hicks, also spoke to the group about how every gift matters – in moving things forward – whether it’s a gift of time, talent or treasure. She spoke about her diagnosis of scleroderma, and how she suspected her father had it as well, and referred him to Dr. Khanna, who confirmed the diagnosis.

Click here for more information on the University of Michigan Scleroderma Program.
Scleroderma Patient Gives Back
Scleroderma patient Mackenzie DuBois talks about her experiences with the condition and how she is now giving back through education and support for other patients as a scleroderma peer mentor. Click here to read her story.
Patient Hosts Fundraiser for Scleroderma Research Fund
(L to R): Chris Edwards, WXYZ-TV Weatherman; Dinesh Khanna, MD, MSc; Sheri Hicks, organizer; John Carethers, MD, MACP; Dee Furlong, supporter.
(L to R) : Sheri Hicks, organizer; Dinesh Khanna, MD, MSc; Chris Edwards, WXYZ-TV Weatherman.
On October 21 st , Sheri Hicks, U-M scleroderma peer mentor and director of the Kicks for Hicks group, hosted a spaghetti dinner and silent auction fundraiser at her church in Farmington Hills, Michigan. The dinner was prepared by her father, Ronald Harworth, who recently passed away.

The event was emceed by WXYZ-TV weatherman Chris Edwards. Over 60 organizations and individuals donated gifts and services for the silent auction, which provided just over $16,00 toward scleroderma research. 

Dr. Dinesh Khanna gave a talk to the crowd of over 200 about scleroderma.

“There are currently no FDA-approved medications for scleroderma,” he explained.

The research team hopes to provide new treatments to patients in the next decade, and are striving for a cure.
In Memoriam, Ronald Harworth, 1942 – 2018

Ronald Harworth was a patient of Dr. Dinesh Khanna. He was a jack of all trades, an avid golfer, and a great supporter of the U-M Scleroderma program, helping to organize fundraisers, inspire gifts to the Scleroderma Research fund from family, friends and colleagues, and even served as a scleroderma peer mentor, helping newly diagnosed patients navigate the challenges of everyday life with scleroderma.

Dr. Khanna remembers Ron fondly:
“I first met Ron when his daughter referred him to me for a possible diagnosis of scleroderma. He had been a great supporter of our Program and our research for years before, and now found himself with the disease. Ron, along with his daughter Sheri, were champions of scleroderma research and held many fundraisers to support our research program. It was important to Ron to help others, whether it was through his duties as a police officer earlier in his life, or to make a batch of his delicious spaghetti and meatballs for a crowd of 200 for the Scleroderma Fundraiser in early 2018 where Sheri and he raised over $16,000. The Scleroderma Program will miss Ron but continue his vision to find a cure for Scleroderma!” - Dinesh Khanna, MD, MSc

The Division of Rheumatology would like to offer our heartfelt thanks to the Hicks family for hosting the spectacular event, and express our deepest condolences for Ron’s passing.
Making a Difference Nominations From Our Patients!

Andrew Vreede, MD
“Thank you for saving my life by diagnosing me with celiac disease. My quality of life is so much better now!” (August 16, 2018)

Sosa Kocheril, MD
“I would like to say how much I like Sosa Kocheril and Vanessa Scowden as my doctors. They genuinely care about me and my issues and make me feel special. They go above and beyond to help and I really appreciate them as my health care professionals!” (June 11, 2018)

Martin Garber, MD
“You listened to me, examined all my symptoms and heard my physical complaints after months of other doctors not being able to diagnose me. You prescribed medication that provides relief, and you are genuinely happy I feel better. Thank you, Dr. Garber. You are fantastic! I look forward to follow-up appointments with you.”  (May 25, 2018)
Education
Congrats to Our Graduating Fellows!

Jessie Alperin, MD, is going into private practice with her dad, Dr. Neil Alperin.

Danielle Barnes, MD, is moving to Columbus, Ohio, work plan uncertain.

Rithy Padda, MD, will be a staff physician for Promedica in Toledo, Ohio.

Andrew Vreede, MD, will be a Clinical Assistant Professor at Michigan Medicine and Ann Arbor Veteran's Hospital.
Introducing Our New Fellows!

Jacqueline Madison, MD
Residency:  University of Michigan, Internal Medicine & Pediatrics
Medical School:  University of Michigan

Hong Shi, MD
Residency: Montefiore Mount Vernon Hospital, New York
Medical School:  Tongji Medical University, China

Aaron Stubbs, MD
Residency: Case Western, Cleveland, Ohio
Medical School:  Wayne State University

Learn more about the Rheumatology Fellowship Program .
Upcoming CME Event
Update in Rheumatic Diseases
Saturday, November 10, 2018
8:00 am - 4:20 pm
The Kensington Hotel, Ann Arbor, Michigan
Course Director: Dinesh Khanna, MD, MSc
For complete details and to register, click here .

Dinesh Khanna, MD, MSc , was recently featured by Colleague Connection for his presentation on Systemic Sclerosis-Interstitial Lung Disease: Who to Treat, When to Treat, and for How Long ?

Colleague Connection is a Michigan Medicine online source to the latest in medical research, CME opportunities, and news which health professionals can use in their practices.
In Memoriam
William Mitchell Mikkelsen, MD , 1923 - 2018

Dr. William Mikkelsen had a clinical residency and traineeship in Internal Medicine at the University of Michigan Hospital in 1953. He joined the staff of the U-M Medical School in 1954 where he remained until he retired as Professor of Internal Medicine
in 1989.

Dr. Mikkelsen was on the staff at the Rackham Arthritis Research Unit and the University of Michigan Division of Geriatrics after it was formed by Dr. Ivan F. Duff.

Dr. Mikkelsen’s research involved a number of drug trials of rheumatic disease medications. He led the rheumatic disease components of the Tecumseh Community Health Study, especially gout, uric acid metabolism, and osteoarthritis. Dr. Mikkelsen served as a member of the University of Michigan’s Periodic Health Appraisal Unit, and later as its director from 1966 to 1988. He was on the editorial board of Arthritis and Rheumatism from 1967 to 1981, eventually serving as chief editor. 

Dr. David Fox remembers Dr. William Mikkelsen:
Dr. Mikkelsen laid the foundation for our commitment to understanding the epidemiology of rheumatic diseases. His work led to subsequent studies by Mary Fran Sowers in the Tecumseh cohort. In recent years, the MILES cohort, created by Emily Somers, PhD, to study the epidemiology of lupus, has become the main focus of our epidemiology work.”
Stephen Luigi Piazza, 1956 – 2018

On February 26, 2018, the world lost a great man after a long battle with cancer. Stephen Luigi Piazza was Senior Director of Mortgage Loans with Quicken Loans, served on the Advisory Board of the Downtown Boxing Gym and even co-hosted a weekly radio program about the revitalization of Detroit, “Opportunity Detroit.”

Most of us around the Division knew Stephen through is generous philanthropy. He was a strong supporter of the Lupus program over the years, raising $500,000 to directly support lupus research through personal gifts, as well as over 1,200 gifts from colleagues, friends and others.

Dr. Joe McCune, Director of the UM Lupus program remembers Stephen fondly, “ We are deeply saddened by the loss of Stephen Luigi Piazza, a wonderful man with a wide range of philanthropic interests including research to improve the care of patients with systemic lupus. The Mary Catherine Piazza Memorial Fund for Lupus Research (as established by Stephen in memory of his wife) has been instrumental in allowing our Lupus Program to support young investigators pursuing patient centered clinical and laboratory research, and has been a key factor and sustaining momentum and productivity of our lupus research group. He was a warm and generous person who inspired others to work a little bit harder to help their fellow human beings. Stephen will be greatly missed.

Stephen and his family created the Mary Catherine Piazza Memorial Fund to support the Lupus program at the University of Michigan, its mission to improve diagnosis and treatment of lupus, educate the next generation of physicians, and advance understanding of lupus research. In his life, Stephen generously matched each donation made to support the fund. To donate to this fund, please visit the