Autoimmune diseases are complicated conditions that can impact many organ systems in a patient. Typical models of care with providers spread out in different offices can lead to delays in diagnosis and slow down treatment options, while confusing patients as to who is making the decisions. At the University of North Carolina at Chapel Hill’s (UNC’s) new Multidisciplinary Vasculitis and Connective Tissue Disease Clinic, specialists work together to come up with plans for patients on the spot. There’s no waiting for someone else to weigh in and no delay in getting a unified plan for treatment into action. But most importantly, patients are active participants in their care decisions when everyone is in the room at the same time.
UNC’s Multidisciplinary Vasculitis and Connective Tissue Disease Clinic opened in September 2021 and has been the vision of Ronald J. Falk, MD, an international expert in vasculitis and glomerular disease. There are often three to four doctors in the room who see a patient, take turns asking questions, conduct an examination, and then order labs or other imaging studies that can be done on-site. At the end of the visit, the doctors discuss their findings with the patient, make referrals, order medications or other tests as needed, and make recommendations for follow-up visits. The clinic also provides educational materials for the patient, and providers explain who to contact for questions or problems between visits, and what to watch for in terms of worsening or new disease symptoms. The hope is that patients can understand their disease as best as possible so that they can be engaged in their care and potentially offer peer-support to others.
Vimal Derebail, MD, is Associate Professor of Medicine in the Division of Nephrology and Hypertension and the UNC Kidney Center and one of the clinic’s nephrologists. “This clinic is a fantastic resource,” Dr. Derebail said. “Rather than waiting for the assessments of our colleagues over multiple visits, we have the opportunity to discuss a patient’s care in real time so that all providers are on the same page. Patients get a unified recommendation for their care, and we providers benefit from the ongoing opportunity to learn from our colleagues in other disciplines.”
“We each bring a unique perspective and experience in the care of patients with autoimmune diseases,” said rheumatologist Nicole M. Orzechowski, DO, RhMSUS, who played a key role in establishing the clinic. Dr. Orzechowski is Associate Professor of Medicine and Medical Director at UNC’s Rheumatology Specialty Clinic, Division of Rheumatology, Allergy and Immunology, Thurston Arthritis Research Center. “I think there was a great need for a clinic like this at UNC,” she continued. “We care for many patients with autoimmune disorders who see multiple specialists separately, and with moving into our new multispecialty clinic building at Eastowne, we had an opportunity to increase collaboration and communication among specialists—always with the goal of improving the health of our patients.”
The clinic’s primary focus is anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis and similar diseases of small vessel vasculitis but also intends to include those diseases where disciplines would overlap, including lupus and other connective tissue diseases. “Every member of our team is specialized in these disorders and passionate about caring for the people who experience them. This allows us to cover the spectrum of our patients’ autoimmune disease across various organ systems in a single visit, in a modern and well-equipped facility,” said dermatologist Galen T. Foulke, MD, who was also instrumental in creating the clinic. Dr. Foulke is Assistant Professor of Dermatology, Co-Director, UNC Rheumatology/Dermatology Clinic, and Co-Director, UNC Multidisciplinary Vasculitis Clinic.
“Skin involvement is often the first or second most common organ impacted by most of the diseases we treat,” Dr. Foulke said. “Additionally, certain autoimmune conditions leave characteristic findings on the skin. An experienced dermatologist can confirm or rule out certain autoimmune conditions with visualization of the skin alone. Skin features of autoimmune diseases are sometimes treated differently than internal manifestations and having a dermatologist knowledgeable about these differences is key to managing these patients at the highest level.”
Ashley G. Henderson, MD, is a pulmonologist who sees patients at the multidisciplinary clinic and has been an integral part of the clinic’s launch. Her role is to assess patients with pulmonary vasculitis, typically ANCA-associated vasculitis and similar forms of small-vessel vasculitis that are most likely to involve the lung. “We still happen to be in the tobacco belt, so sometimes their lung disease is because they have COPD or asthma, or something completely unrelated to vasculitis. And sometimes it is ALL vasculitis,” she noted. Vasculitis patients are extremely complicated because not only does it affect multiple organ systems, sometimes it can be very vague in its presentation, making it hard to diagnose. Even if you know the diagnosis, it can be hard to know the best treatment. Dr. Henderson is Associate Professor of Medicine, Division of Pulmonary Diseases and Critical Care Medicine; Pulmonary & Critical Care Medicine Fellowship Program Director.
“We have had a long-standing disease registry for patients with vasculitis, lupus and other diseases that may be seen in this clinic,” Dr. Derebail added. “This registry has been in existence for > 30 years. We also collaborate with multiple other institutions and patient advocacy groups and support clinical trials in many of these disease states.” The clinic provides an outstanding training opportunity for early learners in nephrology, dermatology, rheumatology, and pulmonology to learn about all aspects of these diseases. “It’s also a great clinic for learning at all levels of training because 1) these are rare diseases so they may not be seen elsewhere, and 2) we all learn from each other so I encourage my fellows to come when they can,” Dr. Henderson added.
The Multidisciplinary Vasculitis and Connective Tissue Disease Clinic is currently scheduling appointments one half-day per week for both new and established patients. Referrals to the clinic should be made through the UNC Kidney Center.
Author: Nina Silberstein