As we have come to understand that vasculitis can affect literally any organ system, the focus at Vanderbilt University Medical Center’s (VUMC’s) Vasculitis Clinic from the beginning has been on forging relationships with clinical collaborators from all specialties. They come from a variety of disciplines and have been called upon to help evaluate and manage manifestations of the disease.
“It is critical to have a multi-specialist group caring for patients with vasculitis. There are important skill sets that our colleagues have that complement our treatments,” Jason Springer, MD, MS, co-director of the vasculitis clinic said. “For instance, the ENT colleagues can do injections or dilations on areas of airway narrowing seen in granulomatosis with polyangiitis.” Dr. Springer is also Associate Professor of Medicine in the Division of Rheumatology and Immunology at Vanderbilt and started seeing patients in September 2020.
Along with clinic Co-Director Kevin Byram, MD, the two have worked together to further develop the vasculitis clinic, vasculitis education, and vasculitis research at VUMC.
Dr. Byram, who is also Associate Director of the Rheumatology Training Program and Assistant Professor of Medicine at Vanderbilt, had established working relationships with many of the specialists before Dr. Springer joined the university. “We have folks in nephrology, pulmonology, dermatology, cardiology, allergy/immunology, gastroenterology, neurology, infectious disease, ENT, hematology, genetics, obstetrics, and surgical disciplines that we can call on to help us in any particular case,” Dr. Byram noted.
The clinic was founded in 2018, and as it grows, Dr. Byram’s and Dr. Springer’s roles will likely evolve. Dr. Byram has put together the clinic’s registry and repository, which include patients with vasculitis who come through the clinic. Dr. Springer has been spearheading a couple of research projects in large-vessel vasculitis and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis.
“First and foremost, our goal is to provide high-quality care to patients with different forms of vasculitis,” Dr. Springer said. In addition to a multi-specialty approach, the clinic offers vasculitis education to providers, patients, and patients’ families, and regularly provides lectures to other divisions and trainees from all levels including medical students, residents, and fellows. The clinic’s hope is to be an active center in vasculitis research in not only investigator-initiated trials, but in multi-center studies with other vasculitis centers and pharmaceutical trials as well.
Dr. Byram remembers seeing his first patient with vasculitis in the ICU during his rotation as a resident at Vanderbilt. “I was amazed then, like I am now, of the patient’s bravery and just how dramatic these diseases can be,” he said. “I trained in general rheumatology at Vanderbilt and then trained with the Cleveland Clinic team in vasculitis before returning to Vanderbilt to establish the vasculitis clinic,” Dr. Byram added.
“The first time I had heard of vasculitis was when my father was diagnosed prior to starting medical school,” explained Dr. Springer. “I had early mentors who fostered my interest in vasculitis, and during my residency, I worked with Curry Koening, MD, at the University of Utah (U of U).” Dr. Springer would regularly join Dr. Koening in the vasculitis clinic at the U of U and it was at that point that vasculitis became his clinical interest. He completed his rheumatology and vasculitis fellowships at Cleveland Clinic where he worked with Alexandra Villa-Forte, MD, on his first project, which looked at the length of maintenance therapy in ANCA-associated vasculitis. He is also involved in research done as part of the Vasculitis Patient-Powered Research Network.
Vanderbilt’s Vasculitis Clinic has active research protocols that are ongoing, along with a wide range of research opportunities with varying degrees of commitment. Vasculitis patients can participate in the vasculitis registry, which simply involves collecting clinical information and possibly a blood sample during routine labs. There are also active clinical trials in which there is an intervention being studied. These are generally more intensive and require more commitment from the participant. A study coordinator helps assess the appropriateness of each patient for these studies, as well as discusses the studies in depth with patients.
Both doctors have served on the VF Board of Directors, as well as helped with the creation of the American College of Rheumatology/VF guidelines for the diagnosis and management of vasculitis. Currently, they have several research projects underway that involve large-vessel vasculitis and small-vessel vasculitis, and are organizing and enrolling their patients in the registry to study outcomes in vasculitis, as well as enrolling for multiple clinic trials.
A referral from an outside physician works well for patients; however, they can also contact the clinic directly and schedule an appointment. “We get some referrals from the VF, so that is another awesome resource,” Dr. Springer said.
On a side note, Dr. Byram also co-directs the Vanderbilt Undiagnosed Diseases Program and works with their geneticists to evaluate potential genetic causes of disease in patients with challenging presentations. The program is early on and continuing to grow in its effort.
Author: Nina Silberstein