Transcription:
Vasculitis: Advancing Translational Research and Precision Medicine

Melanie Cole, MS (Host):  Welcome. This is Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. Today we’re discussing vasculitis. Joining me is Dr. Anish Dua. She’s an associate professor of medicine in the division of rheumatology at Northwestern Medicine. Dr. Dua, it’s such a pleasure to have you join us today. Until just recently, the American College of Rheumatology recently collaborated with the Vasculitis Foundation to provide guidance on how to manage systemic vasculitis. Can you tell us a little bit about this process and what it means for patients?

Anisha Dua, MD, MPH (Guest):   I was able to be a part of this process and it was really actually quite exciting. The American College of Rheumatology and the Vasculitis Foundation are both organizations that have consistently advocated for patients and provided education for patients then also for providers that are caring for them. So the collaboration between these two groups, along with efforts of many physicians and patients who helped collectively share their experience will hopefully result in the development of guidelines that can be used widely to improve comfort with and with diagnosis and management of vasculitis. So I truly hope that it will lead to improved outcomes for our patients.

My role in the process was as part of the development group, I was a member of the literature review team and a leader of the patient panel. So going through this process I was amazed at the amount of information that’s been produced in terms of studying vasculitis. Having the opportunity to collaborate with others, trying to compile and analyze all of that information into guidelines that are actually understandable and can help direct patient care was super challenging but also very exciting. I think there's a lot more, of course, to learn and discover in vasculitis, but these guidelines really discover a nice path and a way for people that are managing these patients to have an idea of what really should be done in these complicated patients and complicated situations. So I think it’s a really big step forward for the vasculitis community and the collaboration between two organizations that have really worked together well to support vasculitis patients and providers is pretty exciting.

Host:   Well thank you for that answer, Dr. Dua. It’s an exciting time to be in your field. You recently joined Northwestern Medicine to lead the vasculitis clinical research program. Can you tell us a little more about this program and what makes it unique?

Dr. Dua:   So I joined Northwestern in April of 2019. One of the big impetus or one of the big reasons for my move here was really the opportunity to engage in the development of this vasculitis clinical research program. I previously directed the vasculitis center at University of Chicago. Here at Northwestern the infrastructure and the support for building this program, for building a clinical database for studying vasculitis was evident but also for really doing translational work as well. So we have really wonderful complex resilient patients and they cover a span of multiple different vasculitis. They come in with different types of presentations, different amounts of disease severity, different organs effected.

One of the unique aspects of the research program here is that we’ll be expanding the clinical research and watching these patients longitudinally to try to figure out what are some predictors for their prognosis, how do they respond to therapies. Along with that we’re going to be doing translational and functional genomic research that looks at actually some of the tissue from biopsies from these patients on a histologic and down to a single cell level. We’re hoping that by doing both of these side by side, we can discover more patterns and just get better insight into the path of physiology of these diseases. If that works then hopefully we’ll be able to get even more personalized medicine and deliver more targeted care of cross disease states in vasculitis. So that’s some of the stuff that the research program is working on. I do hope to expand more into making headway with involvement in clinical trials, but I think this database is a super exciting start.

One other thing is one of the fellows that I trained, who’s actually a fellow here now at Northwestern, will be going to Wisconsin for his faculty position. So we actually hope to collaborate across institutions to build up an even larger catchment area and really collaborate on research moving forward. So that’s kind of exciting as well.

Host:   Well it certainly is. The program focuses on engaging multidisciplinary teams to best treat the patient. What does that look like for the vasculitis team? Tell us why it’s so important for these patients?

Dr. Dua:   Management of vasculitis patients, it’s like completely a team sport. Some patients come in presenting with, like I mentioned, renal involvement, tracheal involvement, eye involvement. It really depends on what blood vessels effected and what organ that blood vessel feeds. So you can really have a plethora of different things going on in any given patient. I'm comfortable in making medication and management decisions about vasculitis overall, but I can't personally see into the back of their eyes if they have retinal involvement. I can't surgically go in and put a stint in their airway to help them breathe if they need to. So it’s really critical to understand, I think, and recognize what you know what you can do and equally important to know what you really need to depend on the rest of your team to help out with.

So one of the most exciting parts—and really rewarding parts—so building those collaborations with other leaders in medicine and other people in medical and surgical subspecialties. So here I feel like I’ll be able to rely on physicians in neurology and nephrology, pulmonary, ENT, ophthalmology, vascular surgery. These are across the board so many different subspecialties. To really manage a patient and manage them well you can't have tunnel vision and you really need to work with all of these other providers who are comfortable with what can be a pretty scary disease state. So I think that the multidisciplinary approach to this care is something that’s really critical. One of the reasons that patients really seek out care in vasculitis centers because you have that expertise across different disciplines. So that’s one thing that I think is really exciting and also really hope to help build over the next couple of years.

Host:   Well while we’re talking about that multidisciplinary approach and what’s exciting, what are you and your colleagues are Northwestern Medicine doing to advance the understanding in treatment of systemic vasculitis. What's some exciting research? Tell us what's going on?

Dr. Dua:   One of the things I was talking about was a research project that we’re looking at looking specifically at giant cell arteritis and getting some of the temporal artery tissue to see if we can find different patterns that help us figure out which are the patients that are going to have more aggressive disease, what might be their response to therapies. So we’re trying to look at on a cellular level some of that information, but also in terms of clinical trials that’s something that I really hope to expand in and get more involved in here. I participated in clinical trials prior to coming here in vasculitis. New medication, Avacopan, was recently approved to try to treat ankle vasculitis and maybe steroid sparing. The landscape in terms of treatments for vasculitis has really been phenomenally changing over the last 10 years or so with more understanding of the physiology of what’s going on in these diseases. We’ve been able to develop more drugs, more targeted drugs, less side effects, better outcomes for our patients. So I think participation in some of these clinical trials is really important. Like I said, I've done it at other institutions, so I hope to expand our reach into the clinical trials here at Northwestern.

Alongside that, really, like I said, developing that database of patient information so that way we can ask pertinent clinical questions. Also really leveraging some of our department’s expertise in functional genomics and RNA sequencing to try to figure out on a cellular level are there patterns that really are going on in these patients that can help us figure out classification systems or ways to treat or ways to manage that are not just based on large scale things that we have always kind of relied on like clinical symptoms. So just getting more and more in detail and getting more understanding of that cellular level of what’s going on vasculitis I think is something that we can do here at Northwestern that can't necessarily be done in a lot of other places. So I'm excited to move that forward. So I think all of those things are moving parts. Having been here for a little short of a year, so far I've definitely gotten a lay of the land in terms of other providers who are interested in vasculitis and excited to see these patients and excited to contribute to the research and clinical care of the patients with vasculitis.

Host:   It’s so interesting, Dr. Dua. So what else would you like—As we wrap up, what else would you like providers to know about optimizing effective treatment among patients with vasculitis and when you really feel it’s important that they refer to the experts at Northwestern Medicine?

Dr. Dua:   Now luckily there are a lot of actually different treatment options that we can use for our patients with vasculitis depending on what type of blood vessels involved, what organs are involved, how extensive their disease is. It can be scary to try to guide these patients because it’s not a very common diagnosis. So you want people who are comfortable talking about what patients should be looking for and what the side effects of these medicines are, what the possible side effects of having the disease are. The goal with all of these therapies is really to try to get the disease under control with using just the right amount of medication. Not too much, not too little. Just enough to keep things under control and not cause toxicities. Because all of the medicines we use are generally immune medications and immune targeted, there are a lot of things that we need to pay attention to and look out for. We worry about infections in our patients. We worry about a lot of different toxicities from our medicines.

I do think that when people are caring for vasculitis patients in the communities, if they feel any sort of level of discomfort even if it’s a matter for having someone else lay eyes on them and get that interdisciplinary input I'm happy to comanage with other rheumatologists in the community. I also just think that as the landscape changes, you really have to be on top of what’s coming down the pike with new medications and luckily being able to focus on vasculitis, I can be aware of what’s available for our patients and enroll them in new clinical trials. Get them cutting edge care whenever that’s required. There's certain features that sort of jump out to different referring providers as concerning for vasculitis. So if there's concern for vasculitis and you're not sure about how to make the workup, we’re happy to do that here as a team to get the right diagnosis and start care. I think overall, we’re very collaborative. I have a really great group of other physicians working with me at Northwestern. We will happily evaluate patients. Help them figure out what their pathway is, what to expect, what treatments might work or might not work, and then let there be a good communication and a good flow of information that way we can make sure that patients are served best, which is really the goal of anybody in medicine. So I think that we can commit to that sort of relationship with the community and with any referrals coming in and commit to that level of focus and expertise for our patients.

Host:   Thank you so much Dr. Dua for coming on and sharing your incredible expertise on this topic. That wraps up this episode of Better Edge, a Northwestern Medicine podcast for physicians. To refer your patient or for more information on the latest advances in medicine, please visit our website at nm.org to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. For more health tips and updates, please follow us on your social channels. I'm Melanie Cole.