Rheumatology

In 2020, the Division of Rheumatology continued to experience growth by substantially increasing the rheumatology presence in South Hadley, MA, where we now see 10 times the number of patients we did earlier this year. We continue to staff satellite specialty care centers in six locations throughout Connecticut: Danbury, Shelton, Stamford, Farmington, Glastonbury, and Hartford.

The division is staffed by four board-certified/boardeligible pediatric rheumatologists. Although Lawrence Zemel, MD, has now retired, he continues seeing patients for clinical care one day per month. We have a new psychologist on our team. Vanessa Laurent, PhD, has seamlessly replaced our former psychologist and her expertise enables us to continue to address the critical biopsychosocial factors affecting our patients. We have two nurses on our team who provide outstanding clinical care and participate in research through the Rheumatology Nursing Society.

The division remains clinically busy. We had 3,050 outpatient visits this year. Despite the impact of the Covid-19 pandemic and the decrease in the number of outpatients seen in March and early April, our division quickly pivoted to telemedicine. We were able to quickly resume full volumes of outpatient visits using this safe and effective method of patient care. Division chief Barbara Edelheit, MD, is now part of a team at Connecticut Children’s led by Sharon Smith, MD, that is looking at developing a telemedicine curriculum. In addition to outpatient visits, we also cared for 87 complex inpatients including many with multisystem inflammatory syndrome (MIS-C), the new post-inflammatory syndrome causing significant illness in children following exposure to Covid-19. Heather Tory, MD, MPH, CPPS, played a critical role as the Rheumatology lead in the pathway development for the care of these critically ill children.

Each of the division’s physicians continues with specific areas of expertise and focus, forming the basis of a robust team.

Dr. Edelheit continues her focus on education and mentorship, and she continues to encourage University of Connecticut residents to enter the underserved field of Rheumatology. Again this year, one of her mentees will graduate from our pediatric program and start fellowship training in Pediatric Rheumatology. The resident will graduate in 2021 and begin a fellowship at Cohen Children’s Medical Center in New Hyde Park, NY.

One of the division’s former UConn residents began her pediatric rheumatology fellowship at the Hospital for Special Surgery in New York. Two additional UConn pediatric residents are considering fellowship training in rheumatology. Dr. Edelheit continues to serve as a preceptor for a Clinical Immersion in the Community (CLIC) program student – a second-year University of Connecticut medical student who works with her for one half-day per week in the clinical setting where she provides him with the clinical immersion in the community and clinical exposure. This remains a source of strength for our division during a time when Pediatric Rheumatology is suffering from a work force shortage.

Dr. Tory continues her focus on safety and quality within our division while serving as associate quality director at Connecticut Children’s. Within the medical center, she serves as the co-chair of the Connecticut Children’s Specialty Group’s Clinical Quality and Providers IT Advisory Committee. She also serves as a member of the Connecticut Hospital Association Committee on Patient Care Quality. Within our division, she serves as our safety and quality expert and is a member of the American College of Rheumatology Quality Measures Subcommittee of the Quality of Care Committee. She is the chair of the Juvenile Dermatomyositis (JDM) Quality Measures Workgroup of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) under the Juvenile Dermatomyositis (JDM) Committee.

Dr. Blaine Lapin, MD, continues his focus on advocacy. He is serving on the American College of Rheumatology Special Committee on Pediatric Rheumatology for a three-year term (2019-2022). He also serves as medical director for the Local Leadership Board of the Connecticut Chapter of the Arthritis Foundation. Dr. Zemel continues his focus on Lyme disease. His chapter on the disease is included in the eighth edition of the Textbook of Pediatric Rheumatology. The division of Rheumatology remains committed to collaborative care at Connecticut Children’s. Dr. Edelheit together with Sherene Mason, MD, FAAP, MBA, in the division of Nephrology, successfully completed the first year of their combined Lupus Clinic to provide continued state-of-the-art care for children and young adults with systemic lupus erythematosus in a multidisciplinary setting. This clinic provides the patients and families care in a collaborative fashion between the divisions of Rheumatology, Nephrology, Psychology, and Adolescent Medicine. Plans are underway for collaborative care with the Division of Pediatric Ophthalmology, and in collaboration with Janine Collinge, MD, we will be starting a combined Rheumatology/Ophthalmology clinic in spring of 2021.

Our division continues to participate actively in research on a national level with the American College of Rheumatology. We also participate in research through the Childhood Arthritis and Rheumatology Research Alliance with participation in their registry as well as in several studies. The division has several active IRB-approved research studies.

PUBLICATIONS

Mrosak J, Banasiak K, Edelheit B, Lapin C, Tory H, Collins MS. Polymyxin-B hemoperfusion as a novel treatment for rapidly progressive interstitial lung disease in a pediatric patient diagnosed with anti-MDA5 juvenile dermatomyositis. J Clin Rheumatol. 2019 Nov 15. doi: 10.1097/ RHU.0000000000001191. Epub ahead of print. PMID: 31743264.

Rubinstein TB, Ogbu EA, Rodriguez M, Waqar L, Woo JMP, Davis AM, Lapin WB, Ng L, Treemarcki E, von Scheven E, Knight AM; CARRA Mental Health Workgroup. Prioritized agenda for mental health research in pediatric rheumatology from the Childhood Arthritis and Rheumatology Research Alliance Mental Health Workgroup. J Rheumatol. 2020 Nov 1; 47(11):1687-1695. doi: 10.3899/jrheum.190361. Epub 2020 Jan 15. PMID: 31941805.

Moran EJ, Lapin WB, Calame D, Bray M, Wright LN, Desai NK, Stein F, Marcus M. Degos disease: a radiological-pathological correlation of the neuroradiological aspects of the disease. Ann Diagn Pathol. 2020 Aug; 47:151545. doi: 10.1016/j. anndiagpath.2020.151545. Epub 2020 May 30. PMID: 32505971.

Tory HO, Zurakowski D, Kim S. Patient and physician discordance of global disease assessment in juvenile dermatomyositis: findings from the Childhood Arthritis & Rheumatology Research Alliance Legacy Registry. Pediatr Rheumatol. 2020;18(5).

STAFF

Barbara Edelheit, MD, Division Chief Blaine Lapin, MD Vanessa Laurent, PhD Heather Tory, MD, MPH, CPPS Lawrence Zemel, MD

Tegan Willard, RN Ann Mendicino-Wrynn, RN