Description of Research Expertise

My research focuses on understanding juvenile idiopathic arthritis (JIA), in particular its manifestations of uveitis and temporomandibular joint (TMJ) arthritis.

Uveitis, inflammation of the eye, commonly occurs in rheumatologic diseases and may affect up to 20% of children with JIA. Uveitis can be vision threatening, and, historically, resulted in blindness. Children with uveitis are treated with a combination of topical corticosteroids and other immunomodulatory therapies. Yet there is limited research describing the impact of these medications on the natural history of uveitis. I have described how quickly uveitis is controlled, and how long disease control is sustained under anti-TNF-alpha inhibitors. I currently study the outcomes of children treated with the expanded repertoire of biologic agents now used for uveitis. I am collaborating with pediatric rheumatologists and ophthalmologists from across the country to study comparative effectiveness of different treatment options (Childhood Arthritis & Rheumatology Research Alliance, CARRA and American Association of Pediatric Ophthalmology and Strabismus, AAPOS), likelihood of disease reactivation with medication discontinuation and assessing for biomarkers predictive of JIA-uveitis (site-PI of NIH sponsored studies).

Between 39 to 87% of children with JIA develop TMJ arthritis during the course of their disease. TMJ arthritis can damage the mandibular condyles and interfere with mandibular growth in children who have not reached skeletal maturity. Because of this, it can result in orofacial pain, growth abnormalities (overbite, small jaw, jaw asymmetry) and functional limitations. Together with specialists from oral and maxillofacial surgery, I am examining: the long term effects of TMJ arthritis on facial deformity and dysfunction in adults with JIA. I collaborate with orthodontists, oral and maxillofacial surgeons and radiologists locally, nationally and internationally to improve the diagnosis of TMJ arthritis (CARRA and TMJaw).

I approach research questions by combining my clinical training in pediatric rheumatology, background in basic immunology (PhD in regulatory T cell development), and rigorous training in pharmacoepidemiology (Masters of Science in Clinical Epidemiology). In the long term, I plan to use the results from these studies to inform the development of standardized screening and treatment guidelines for children with JIA.

Description of Clinical Expertise

I care for children with a wide range of autoimmune and auto-inflammatory diseases. These diseases include: Juvenile idiopathic arthritis (JIA), systemic lupus erythematosus, juvenile dermatomyositis, idiopathic uveitis, vasculitides, periodic fever syndromes, and Chronic non-infectious osteomyelitis. I have particular interests in non-infectious uveitis and inflammatory TMJ-arthritis. Along with an ophthalmology colleague, Dr. Stefanie Davidson, I co-founded and co-direct one of the few combined rheumatology-ophthalmology uveitis clinics in the nation. In the Uveitis Coordinated Care Clinic (UCCC) we bring the most up-to-date understanding of uveitis therapies to the clinic while simultaneously providing more streamlined, high quality care to patients and their families. We collaborate with ophthalmology and rheumatology colleagues nationally to improve care for pediatric uveitis (Childhood Arthritis and Rheumatology Research Alliance and American Association for Pediatric Ophthalmology and Strabismus).