Prepared for a new age in rheumatology

The increasing incidence of autoimmune diseases is one of the more concerning and still confounding trends the medical world is watching today. Neck-in-neck with this, however, is a sharp rise in effective new iterations of current biologics as well as the launch of cell therapy approaches.

Thanks to this progress, patients have more effective therapies up front and many who have aged out of drug options are finding new opportunities to achieve remission.

The Division of Rheumatology and Immunology at The Ohio State University Wexner Medical Center, led by Wael Jarjour, MD, has demonstrated exceptional foresight in preparing to optimize the new opportunities, meeting three main goals:

1. Offering patients the most promising treatment for their individual condition
2. Striving to eliminate long waits and bureaucratic complications that impede care
3. Leading and enrolling patients in clinical trials at the front edge of evolving treatments

Eight specialized clinics and counting

Setting the Ohio State Wexner Medical Center’s services apart is the sheer number of individual clinics and the myriad resources brought to each patient to streamline diagnosis and treatment.

“Some universities may have a few specialized and multidisciplinary clinics, but there are very few that have as many as we do,” says Jisna Paul, MD, clinical director for Rheumatology. “We now have six locations for general rheumatology clinics, plus eight clinics focused on individual complex autoimmune diseases.”

Three of these specialized clinics opened in just the past four years.

Rheumatology Clinics at The Ohio State University Wexner Medical Center

• The Rheumatology Dermatology Clinic, addressing autoimmune skin conditions
• The Rheumatology/Ophthalmology Clinic, treating inflammatory eye conditions
• The Myositis Clinic, bringing in neurology/neuromuscular experts to workhand-in-hand with rheumatologists
• The Musculoskeletal (MSK) Ultrasound Clinic, performing diagnostic imagingand MSK ultrasound-guided joint procedures
• The Lupus Clinic: bringing together specialists in rheumatology, nephrology and neuroimmunology, who see patients concurrently or back-to-back, supported by clinical pharmacists
• The Psoriatic Arthritis Clinic, run by dermatology and rheumatology
• The Scleroderma Clinic: working with gastroenterology, pulmonary hypertension and vascular specialists
• The Vasculitis Clinic, joining rheumatologists, pulmonologists and nephrologists together to treat this complex condition

In the Pipeline

• The Sarcoidosis Clinic, combining rheumatologists, pulmonologists and cardiologists to optimize patient care
• The Osteoporosis Clinic, combining expertise from rheumatology and endocrinology to treat osteoporosis in patients with autoimmune disease.

“We have separate, cross-clinical huddles, where we discuss complex or difficult-to-manage cases,” Dr. Paul says. “For example, we have a monthly conference to discuss our lupus, vasculitis and sarcoidosis patients, and we also meet monthly with musculoskeletal radiologists to discuss complex cases. In my myositis clinic, I work closely with neuromuscular neurologists and members of the interdisciplinary team, including the physical therapist, nutritionist and geneticists, right there in the clinic.”

Instead of waiting for a consultation with another specialist, the multidisciplinary clinics offer a streamlined process.

“For example, when your patient has a condition that requires a dermatology consult, if you have to refer, your patient could wait for two or three months to get that consult, whereas here it can happen very quickly,” she says.

On the threshold of a powerhouse therapy

While, for many years, biologics have been used to treat almost all autoimmune diseases, cell therapy offers a powerful new twist to biologics treatment. Specifically, deployment of chimeric antigen receptor (CAR) cell therapy has demonstrated promising efficacy across various autoimmune diseases, extending hope for lessening disease burden and driving long-lasting remission for certain autoimmune diseases.

“Especially in the last 10-15 years, we have seen so many breakthroughs for many diseases like vasculitis, lupus and myositis, which has had very poor survival rates. The care of inflammatory arthritis like rheumatoid and psoriatic arthritis has also been revolutionized,” she says.

The Ohio State University Wexner Medical Center is leading multiple trials in cell therapy for myositis, scleroderma and vasculitis, and have imminent plans to start a lupus cell therapy trial.

“Our doctors who run the specialized clinics have experience in managing very complex problems in their area, and in many cases, they lead or have access to those clinical trials so their patients can get the most updated treatment in that particular field,” Dr. Paul says.

“With so many new biologics, and with cell therapy on the brink of exponential new applications, it is a much brighter time for patients with autoimmune diseases.”

Dealing with the drug tolerance limitation

Pending approval of cell therapy options, drug tolerance remains a limiting factor for maintaining remission in patients. Yet the expanding arsenal of currently used biologics — comprising monoclonal antibodies or small molecule inhibitors — is still pivotal in care.

She also supports the use of more natural, non-pharmaceutical treatments as complementary therapy to enhance remission.

Her clinics collaborate with the Ohio State Wexner Medical Center’s various lifestyle medicine clinics on changes such as eating a plant-based diet, that are shown to help control patients’ autoimmune disease. Internists and psychologists at the Chronic Pain Clinic and Integrative Health Clinic help patients with therapies like acupuncture, and cognitive behavioral therapy.

“Being a tertiary referral center, we see a lot of complex patients who have run out of treatment options,” Dr. Paul says. “The nature of our clinics, our huddles across specialties, and our research depth as an institution make a huge difference in number of options we can confidently offer.”