Clinical Assistant Professor, Medicine - Immunology & Rheumatology
Fellowship: Stanford University Rheumatology and Immunology Fellowship (2021) CA
Board Certification: American Board of Internal Medicine, Rheumatology (2021)
Board Certification: American Board of Internal Medicine, Internal Medicine (2019)
Residency: University of Colorado Internal Medicine Residency (2019) CO
Medical Education: University of Nevada School of Medicine (2016) NV
Evolution and impact of a dedicated ultrasound clinic on clinical rheumatology practice at an academic medical center.
Seminars in arthritis and rheumatism
2023; 63: 152276
Rheumatologic ultrasonography (RhUS) has grown in scope and application over the past 20 years. While many studies have shown the benefits of RhUS, few have investigated the efficacy of a dedicated clinic. This study explores the impact of a dedicated ultrasound clinic on patients and rheumatologists at an academic medical center (AMC).We analyzed claims data for patient visits, X-rays (XR), magnetic resonance imaging (MRI), and RhUS from an AMC with an established RhUS clinic, alongside two affiliated community medical practices (CMPs) without RhUS. We also analyzed RhUS clinic records on referral indication, procedures, results, and follow-up treatment changes. Pre- and post-RhUS visit patient surveys and referring physician (RP) surveys assessed experience and impact of the RhUS clinic.From 2018 to 2021, referrals to the RhUS clinic substantially increased. In parallel, XR and MRI orders changed by -76 % and -43 % respectively, compared with 163 % and -24 % at CMPs. Discordance between RP pre-RhUS assessments and RhUS results were common. Patient surveys showed RhUS led to increased disease understanding and impacted thoughts and decisions about their therapy. RPs found utility in RhUS across a range of indications and were confident with RhUS results.These findings suggest a dedicated RhUS clinic can be a valuable resource in clinical rheumatology practice. Implementation of a RhUS clinic at this AMC spurred rapid adoption of RhUS into clinical decision-making with notable benefits for patients and physicians alike. This may serve as a model for implementation of similar clinics at other institutions.
View details for DOI 10.1016/j.semarthrit.2023.152276
View details for PubMedID 37857047
Lung Ultrasound in Children with Systemic Juvenile Idiopathic Arthritis Associated Interstitial Lung Disease.
Arthritis care & research
OBJECTIVE: Lung disease associated with Systemic Juvenile Idiopathic Arthritis (sJIA-LD) is a potentially life threating complication in children with sJIA. Although high resolution computed tomography (HRCT) is considered the gold standard imaging modality for evaluating interstitial lung disease (ILD), lung ultrasound (LUS) has shown utility for ILD screening in adults with connective tissue diseases (CTD) at lower cost and without utilizing ionizing radiation. The goals of this pilot study were to describe LUS features in children with known SJIA-LD and to assess the feasibility of LUS in this population.METHODS: Children <18years with sJIA-LD and healthy controls were enrolled. LUS acquisition was performed at 14 lung positions. Demographic, clinical, and HRCT data were collected and reviewed. Feasibility was assessed through patient surveys. LUS findings were qualitatively and semi-quantitatively assessed and compared to HRCT findings.RESULTS: LUS was performed in 9 children with sJIA-LD and 6 healthy controls and took 12 minutes on average to perform. LUS findings in sJIA-LD included focal to diffuse pleural irregularity, granularity, and thickening, with associated scattered or coalesced B-lines, and subpleural consolidations. LUS findings appeared to correspond to HRCT findings.CONCLUSION: LUS in sJIA-LD reveals highly conspicuous abnormalities in the pleura and sub-pleura that appear to correlate with peripheral lung findings on HRCT. LUS is a feasible imaging tool in children even from an early age. This study suggests a potential role of LUS in sJIA-LD screening, diagnosis, and/or prognostication.
View details for DOI 10.1002/acr.24957
View details for PubMedID 35604884
A narrative review of imaging in calcinosis associated with systemic sclerosis.
Calcinosis is dystrophic calcification of the soft tissue which can lead to painful and debilitating disease. It is commonly seen in patients with systemic sclerosis (SSc). Imaging can assist in diagnosis, quantification of disease, and better pathophysiologic understanding of calcinosis. Traditionally, X-rays have been the most frequently used imaging modality for diagnosis; however, advances in ultrasound (US), computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) have led to greater ability to characterize these lesions and surrounding structures. This narrative review aims to describe the use of imaging for calcinosis in patients with SSc. Key Points Imaging is useful in the diagnosis of calcinosis, assessment of disease severity, and disease monitoring. X-ray is commonly used and offers high sensitivity and specificity, but both ultrasound and CT-scans are alternatives when greater anatomic detail is sought regarding surrounding structures. Investigational imaging modalities include dual energy CT-scans, cinematic rendering CT-scans, and PET- CT scans. Conventional MRI scans have less sensitivity and specificity for detection of calcinosis.
View details for DOI 10.1007/s10067-021-05696-6
View details for PubMedID 33755836
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
Prevalence of a Diagnosis of Osteopenia/Osteoporosis Amongst Patients with Systemic Sclerosis and Identification of Associated Clinical Factors
View details for Web of Science ID 000587568500395