News

New Scleroderma Clinic at the University of Minnesota; Update on Sjogren’s, Lupus, and Arthritis Research

By Barbara Segal, M.D., Associate Professor, University of Minnesota Department of Medicine

A new clinic specially designed to provide comprehensive care to patients with scleroderma is being planned within the University of Minnesota’s Division of Rheumatic and Autoimmune Diseases, under the direction of Dr. Barbara Segal, M.D. The clinic is intended to evaluate patients with established disease, especially those who have internal organ involvement or severe complications. Examples include severe esophageal stricture, bowel motility disorders, lung problems such as pulmonary fibrosis and pulmonary hypertension, heart problems, corneal disease, calcinosis, and chronic ulcers. The need for a multispecialty scleroderma clinic is great because new therapies and evaluation strategies are under development to improve management and make possible the recognition of early severe disease. We believe the University of Minnesota is an ideal locus.

Scleroderma is a rare disorder (on the order of 400 per million prevalence). Because of its rarity, there is relatively little experience in the community with state of the art management or new therapeutic modalities. New treatments include sildenafil for digital ulcers, pulmonary HBP and dermal fibrosis, Prostacylin analogs for pulmonary HBP, new antifibrotic agents, and T cell activation antagonists.

Historically many patients had to travel outside the state in order to receive care from specialists experienced with their disease or to enroll in clinical trials. This new clinic is a unique service at Fairview-University Hospital that involves physicians, nurses, and therapists from a variety of disciplines. Additionally, being able to partner with community groups like the Scleroderma Foundation Minnesota Chapter (SFMC) and sharing expertise are added pluses.

Mission of the Division of Rheumatic and Autoimmune Diseases

Primary mission of the Division of Rheumatic and Autoimmune Diseases is delivery of cost effective, high quality diagnosis and treatment to patients with a wide range of musculoskeletal disorders. Our goals are comprehensive diagnostic evaluation of rheumatic diseases, timely intervention aimed at reducing disability associated with soft tissue injuries and arthritis, development of comprehensive management programs for patients with chronic rheumatic diseases, and patient education to improve self management and reduce recurrences of common musculoskeletal problems such as back and shoulder pain cooperative interaction across subspecialty lines – and cooperative interaction across subspecialty lines.

Patients can be self-referred or referred by a physician for consultation. The total spectrum of rheumatologic diseases are cared for in our outpatient and inpatient services. The Fairview-University rheumatology clinics are the locus for ambulatory teaching as well as clinical investigative studies. We are training rheumatology fellows to assess and treat musculoskeletal disorders early in their course and provide appropriate, cost effective, longitudinal care for patients with established rheumatic disease and arthritis.

New treatment strategies have been developed for patients with inflammatory arthritis, which have changed the traditional approach used in managing inflammatory joint disorders and significantly improved patient satisfaction and outcomes. The new model calls for earlier intervention and more aggressive use of established chemotherapy agents, as well as the application of novel biologic agents targeting specific cellular and cytokine targets. Our ongoing biomedical research is focused on gaining greater understanding of the autoimmunity that leads to systemic inflammatory diseases. We are engaged in discovering new treatments and potential cures. Within the next few years we anticipate we will be using new biologic therapies for the management of severe SLE and scleroderma.

Frontiers in Lupus Research

More than 250,000 Americans have been diagnosed with lupus, an autoimmune disease in which the patient’s immune system attacks its own tissues. In 2003, Timothy Behrens, M.D., and his team identified the distinct patterns of gene expression found in the blood cells of most people with lupus. “For the first time,” says Behrens, “we not only have a blood test to diagnose lupus, but we also have the potential to direct therapies in treating this disease.”

Recently, university associate professor Kathy Moser, Ph.D., received the prestigious Arthritis Foundation’s Investigator Award, a three-year, $74,000 annual grant, for her study aimed at identifying important genes causing SLE and explaining how the genes function. Her study is called "Isolating the Human SLE Susceptibility Gene on Chromosome 16q13," and has narrowed down the location of some of the genes involve in lupus. “We still do not know exactly what genes are involved,” Moser says, “but we’re very close and very excited that we will probably find the chromosome 16 gene during the course of this funding.”

Uncovering Mysteries of Immunity

Daniel Mueller, M.D., is professor and director of the Rheumatology and Autoimmune Diseases Division. Investigations carried out by Mueller are leading researchers to a better understanding of the biological nature of immune self-tolerance. The main goal of this research is to develop clinical strategies designed to re-institute immune self-tolerance in patients with autoimmune diseases.

Erik Peterson, M.D., assistant professor, and his group are focusing on molecules that control production of normal T cells in the thymus and addressing the roles of these proteins in development of experimental diabetes and lupus. Peterson and his team recently received a $90,000 National Institutes of Health (NIH) grant to study the molecular mechanism of action for the protein ADAP in T cell development.

New Strategies for Diagnosis and Treatment of Sjogren’s Syndrome

Sjogren’s Syndrome is an autoimmune disease in which the immune system preferentially attacks a person’s own moisture producing glands, such as those that produce saliva and tears. Common symptoms include dryness in the mouth and eyes. Sjogren’s Syndrome is often present in patients with other autoimmune diseases, including lupus, scleroderma, and rheumatoid arthritis. Dr. Kathy Moser’s research team is using powerful, cutting-edge technologies to gain new insight into the mechanisms and genetic factors that contribute to Sjogren’s Syndrome. Dr. Moser is the principle investigator in an NIH-funded longitudinal study of Sjogren’s Syndrome designed to detect new biomarkers and gene pathways involved the disorder’s causes. Dr. Segal, an associate professor at the University in the Division of Rheumatic Diseases, is a co-investigator in the Sjogren’s study. Her interests include investigating the cause of chronic fatigue, which often is a disabling symptom affecting patients with Sjogren’s and other autoimmune disorders. Additional studies are being planned to investigate the cause of fibromyalgia and chronic fatigue and explore the early events involved in the onset of autoimmune disease, including scleroderma and undifferentiated connective tissue disease.

Arthritis Center of the University of Minnesota

Over the past several years, our physician leaders have recognized the need to integrate clinical services provided by orthopedists, rheumatologists, radiologists, and physical medicine specialties to provide seamless care to patients with rheumatic diseases. Cooperative interaction of the physicians across specialty lines is necessary to facilitate comprehensive management and reduce costs. Currently our focus is on redesigning the care delivery process so that physicians from multiple disciplines can work together and efficiently provide care to persons with complex rheumatic disorders such as arthritis, osteoporosis, and autoimmune diseases.

The New Clinic

The scleroderma clinic is already scheduling patients. For more information about services or to make an appointment, call 612-625-8690 and identify yourself as a scleroderma patient.