Dr. Horomanski specializes in the diagnosis and treatment of rheumatologic diseases. She received her undergraduate degree from Case Western Reserve University, medical degree from Wright State University, and completed her Internal Medicine residency and Rheumatology fellowship at Stanford University. She is the Director of the Stanford Vasculitis Clinic where she manages the complex care of patients with all types of vasculitis and works closely with partners in related specialties. She has a specific interest in clinical trials and a Graduate Certificate in Epidemiology and Clinical Research. Dr. Horomanski also received training in musculoskeletal ultrasound from the USSONAR program and is an integral part of Stanford's Diagnostic and Interventional Musculoskeletal Ultrasound Clinic. Additional areas of research include the application of ultrasound in the study and management of rheumatologic diseases.
- Diagnostic and Interventional Rheumatologic Ultrasonography
Clinical Assistant Professor, Medicine - Immunology & Rheumatology
Graduate Certificate, Stanford University, Epidemiology and Clinical Research (2020)
Fellowship: Stanford University Immunology and Rheumatology Fellowship (2020) CA
Residency: Stanford University Internal Medicine Residency (2015) CA
Medical Education: Wright State University (2015)
Board Certification, American Board of Internal Medicine, Internal Medicine (2018)
Medical Education, Wright State University, School of Medicine (2015)
Bachelor of Arts, Case Western Reserve University, Biology; Spanish Language (2011)
- Response letter to the editor. Seminars in arthritis and rheumatism 2021
Ultrasound evaluation of the hands and wrists in patients with systemic sclerosis: Osteophytosis is a major contributor to tender joints.
Seminars in arthritis and rheumatism
2021; 51 (4): 735-740
OBJECTIVE: To evaluate the prevalence and clinical associations of ultrasound (US) findings of inflammatory arthritis and joint and soft tissue pathology in patients with systemic sclerosis (SSc).METHODS: The hands and wrists of 43 SSc patients and 35 age-balanced controls were evaluated by clinical exam and musculoskeletal US. Synovial and tenosynovial pathology were assessed using semi-quantitative Gray Scale (GS) and Power Doppler (PD) scoring. US evaluation for osteophytes, erosions, ulnar artery occlusion, and median nerve cross-sectional areas was performed. Tender joints (TJ), swollen joints (SJ), modified Rodnan skin score (mRSS), digital ulcers, contractures, and calcinosis were evaluated. Concordance between US and physical exam findings at each joint region were assessed, and associations between their severity were analyzed.RESULTS: TJs and SJs were present in 44.2% and 62.8% of SSc patients, respectively. Inflammatory arthritis, defined as having both GS>0 and PD>0, was observed in 18.6% of SSc patients and no controls. There was a high concordance by joint region between GS synovial hypertrophy and osteophytes (kappa=0.88) as well as TJs (kappa=0.72). SSc patients had more osteophytes compared to controls (48.8% vs 22.9%, p=0.018) as well as higher osteophyte severity (p=0.033).CONCLUSIONS: Despite a high percentage of tender and swollen joints, less than 20% of SSc patients met criteria for inflammatory arthritis on US. The high concordance of osteophytes with GS synovial hypertrophy and tender joints suggest that osteophytosis may be a significant contributor to joint pain in SSc patients.
View details for DOI 10.1016/j.semarthrit.2021.04.020
View details for PubMedID 34144383
Prevalence and significance of pulmonary disease on lung ultrasonography in outpatients with SARS-CoV-2 infection.
BMJ open respiratory research
2021; 8 (1)
The majority of patients with SARS-CoV-2 infection are diagnosed and managed as outpatients; however, little is known about the burden of pulmonary disease in this setting. Lung ultrasound (LUS) is a convenient tool for detection of COVID-19 pneumonia. Identifying SARS-CoV-2 infected outpatients with pulmonary disease may be important for early risk stratification.To investigate the prevalence, natural history and clinical significance of pulmonary disease in outpatients with SARS-CoV-2.SARS-CoV-2 PCR positive outpatients (CV(+)) were assessed with LUS to identify the presence of interstitial pneumonia. Studies were considered positive based on the presence of B-lines, pleural irregularity and consolidations. A subset of patients underwent longitudinal examinations. Correlations between LUS findings and patient symptoms, demographics, comorbidities and clinical outcomes over 8 weeks were evaluated.102 CV(+) patients underwent LUS with 42 (41%) demonstrating pulmonary involvement. Baseline LUS severity scores correlated with shortness of breath on multivariate analysis. Of the CV(+) patients followed longitudinally, a majority showed improvement or resolution in LUS findings after 1-2 weeks. Only one patient in the CV(+) cohort was briefly hospitalised, and no patient died or required mechanical ventilation.We found a high prevalence of LUS findings in outpatients with SARS-CoV-2 infection. Given the pervasiveness of pulmonary disease across a broad spectrum of LUS severity scores and lack of adverse outcomes, our findings suggest that LUS may not be a useful as a risk stratification tool in SARS-CoV-2 in the general outpatient population.
View details for DOI 10.1136/bmjresp-2021-000947
View details for PubMedID 34385149
View details for PubMedCentralID PMC8361701
Barriers to Influenza Vaccination in Patients at a Tertiary Care Rheumatology Clinic
View details for Web of Science ID 000587568503135
- Painful Panniculitis and Polyarthritis in Pancreatic Adenocarcinoma: A Case Report. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases 2020
Deciding which way to go: how do insects alter movements to negotiate barriers?
Frontiers in neuroscience
2012; 6: 97
Animals must routinely deal with barriers as they move through their natural environment. These challenges require directed changes in leg movements and posture performed in the context of ever changing internal and external conditions. In particular, cockroaches use a combination of tactile and visual information to evaluate objects in their path in order to effectively guide their movements in complex terrain. When encountering a large block, the insect uses its antennae to evaluate the object's height then rears upward accordingly before climbing. A shelf presents a choice between climbing and tunneling that depends on how the antennae strike the shelf; tapping from above yields climbing, while tapping from below causes tunneling. However, ambient light conditions detected by the ocelli can bias that decision. Similarly, in a T-maze turning is determined by antennal contact but influenced by visual cues. These multi-sensory behaviors led us to look at the central complex as a center for sensori-motor integration within the insect brain. Visual and antennal tactile cues are processed within the central complex and, in tethered preparations, several central complex units changed firing rates in tandem with or prior to altered step frequency or turning, while stimulation through the implanted electrodes evoked these same behavioral changes. To further test for a central complex role in these decisions, we examined behavioral effects of brain lesions. Electrolytic lesions in restricted regions of the central complex generated site specific behavioral deficits. Similar changes were also found in reversible effects of procaine injections in the brain. Finally, we are examining these kinds of decisions made in a large arena that more closely matches the conditions under which cockroaches forage. Overall, our studies suggest that CC circuits may indeed influence the descending commands associated with navigational decisions, thereby making them more context dependent.
View details for DOI 10.3389/fnins.2012.00097
View details for PubMedID 22783160
View details for PubMedCentralID PMC3390555