Pediatric Rheumatology; Pediatrics
I diagnose, and care and advocate for, children with rheumatic diseases such as systemic lupus, juvenile dermatomyositis (JDM), vasculitis and juvenile idiopathic arthritis. I have particular expertise in JDM. I am careful and thoughtful in my approach to my patients who have chronic, complex rheumatologic diseases, because these illnesses have major effects on all aspects of my patients’ lives. My goal is to meet the complex needs of my patients and their families by working to control disease activity, preserve normal physical, social and emotional growth and development, minimize chronic disability and deformity and achieve disease remission. I understand the everyday difficulties families of children with rheumatic diseases often encounter, and I help them cope with the challenges of hospitalization, frequent outpatient visits and long-term treatment that includes injectable medications. I educate my patients and their families as much as possible, to help foster cooperation and compliance with my care. I also customize my patients’ care by paying special attention to the psychosocial aspects of illness that can negatively influence adapting to chronic rheumatic diseases: e.g., depression, anxiety and sleep disturbance. I coordinate a team of health care professionals in rheumatology, physical therapy, occupational therapy and psychology to address these coexisting conditions with my patients and their families. Additionally, I support families as they make teachers and other school personnel aware of their children’s daily needs. My research focus is JDM. My goal is to understand its etiology and why its manifestation is different from one patient to another. Another goal is to advance physicians’ ability to diagnose and care for patients with rheumatologic disease—research that will ultimately make a difference in patients’ quality of life. Medical students, residents and fellows are welcome to work with me on research projects. I work with pediatric residents during their monthlong elective in rheumatology, teaching them how to diagnose and treat rheumatic disease. I also work with immunology fellows during their rotation in rheumatology. I help them develop an understanding of the presentations, natural history and complications of rheumatologic conditions in children. I also help trainees better understand autoimmunity and biologics—particularly, the mechanisms of how biologics work and how they are applied in patient care.
Pediatric Rheumatology; Pediatrics
I have a broad interest in rheumatic diseases in children. I am particularly interested in juvenile idiopathic arthritis (JIA) and improving the time frame over which we can achieve remission in this family of illnesses. With newer medications, we are making significant progress, but we still have much to learn. I also have a keen interest in children with systemic lupus and inflammatory muscle disease. Over time, because of my own Native American ancestry (Mohawk), I have particularly enjoyed the opportunity to work with indigenous American children, whose expression of rheumatic disease and treatment response are slightly different from the broader population. We hope that tribal health systems will see our pediatric rheumatology service as the “go-to” place for children with arthritis and related illnesses. I spend most of my time doing research, and my laboratory focuses on mechanisms through which genes and so called “DNA dark matter” are turned off and on through the course of successful therapy in JIA. We study these processes using state-of-the-art ChIP-sequencing, DNA methylation sequencing, and RNA sequencing techniques. These projects consist of collaborating with colleagues at the New York State Center of Excellence in Bioinformatics (COE). I also spend considerable time working with indigenous American communities on a broad range of child health issues. I currently chair the American Academy of Pediatrics Committee on Native American Child Health, which has a strong interest in why rheumatic diseases are so common and severe in indigenous American children. We are particularly focused on so-called epigenetic factors, stemming from historical traumas and cultural dislocation that may play a role in how rheumatic diseases are expressed in indigenous children. One of the most rewarding parts of my career has been the opportunity to mentor talented Native American students and assist them in developing their interests in science and medicine. Previous students include a veritable “Who’s Who” among young Native American physicians, and I am working to establish and foster partnerships for UB with local colleges and tribes to develop a rich resource of Native American physician scientists in New York State.