Focus Area: Complex Rheumatology

If diagnosing and treating rheumatic diseases were not already challenging enough for even the most common rheumatic conditions, then, as most rheumatologists know, it is even more difficult to effectively deal with the specialty’s uncommon diseases—ranging from myositis and Sjogren’s syndrome to vasculitis and Wegener’s granulomatosis.

Dr. Calvin R. Brown, Jr, MD: professor of medicine and training program directorMore than a decade ago, the Northwestern University Feinberg School of Medicine Division of Rheumatology began building a complex rheumatology program to provide a valuable resource to referring physicians confronted with patients for whom they frequently had no definitive answers. Established by the late Walter Barr, MD, a pioneer in this area of rheumatology, the program utilized the vast resources of Feinberg’s academic medical center to develop a network of medical and surgical specialists with expertise in some of the more obscure rheumatic diseases that can, nonetheless, dramatically affect the lives of those afflicted with them. Today, the depth and breadth of the program, under the leadership of Calvin R. Brown, Jr., MD, professor of medicine, is unparalleled, making Feinberg a premier center for the diagnosis and treatment of the complex rheumatology patient.

Simplifying the Complexity with Shared Knowledge

“Complex rheumatic diseases produce a number of symptoms and affect many different systems within the body. They often require a broad variety of expertise with specialists who have shared knowledge and experiences with these conditions that the practicing rheumatologist may have only seen a few times or, perhaps, never,” says Brown, who has spent much of his career focusing on complex rheumatic diseases. “Here at Feinberg, if a complex rheumatology patient comes to us with a skin problem, for example, we can quickly draw upon the expertise of dermatology specialists with experience treating the skin manifestations not only of rheumatic diseases, but also of the particular complex condition we are addressing.”

In addition to dermatology, the clinical program has developed relationships with experts in neurology, interventional radiology, orthopaedic surgery, nephrology, and pathology—all of whom have had experience with rheumatic diseases. An innovative pre-appointment management system introduced within the Division of Rheumatology allows for either an individual consultation or a team approach with these patients in a timely and efficient manner. The program also offers the latest technologies under one roof, from advanced imaging techniques and neuromuscular testing to state-of-the art laboratory services, providing biochemical, immunologic, and pathologic analysis of blood, tissue, and specimens. “We take clinical details from many different channels, direct it into one distinct channel of diagnosis and treatment, and then fan that information back out to a team of specialists we have assembled that can best treat the illness and all of its related symptoms,” says Brown. “Our goal is to help referring physicians recognize and/or confirm diagnoses of complex rheumatic conditions, coordinate information, and provide appropriate care.”

Dr. Darcy Majka, MD, assistant professor of medicine, consults with Dr. Brown
Program director of the Division of Rheumatology’s fellowship program, Brown has spent the past 20 years in graduate medical education. His specialization in complex rheumatic diseases has not been lost on his former trainees, who he credits for strengthening the complex rheumatology program. Says Brown, “As they have become practicing physicians, they know they can always seek the advice of their teachers and mentors when faced with a clinical conundrum. We are more than happy and able to serve as a resource center for these complex cases for both our alumni as well as others in the community near and far.” Advancing the diagnosis and treatment of relatively rare, complex rheumatic conditions requires the ongoing efforts of dedicated experts to achieve any measure of success. Feinberg’s Division of Rheumatology remains committed to focusing on the substantial unmet needs of patients with complex rheumatic conditions and has plans to develop a research focus in the next several years.