Chief, Rheumatology/Allergy Section, VA Palo Alto Health Care System (2006 - Present)
Honors & Awards
Rheumatology Division Teaching Award, Stanford University Dept of Medicine (2008)
Fellowship: Stanford University School of Medicine (1989) CA
Board Certification: American Board of Internal Medicine, Rheumatology (1986)
Fellowship: University Of Missouri (1986) MO
Board Certification: American Board of Internal Medicine, Internal Medicine (1982)
Residency: Creighton University-School of Medicine (1982) NE
Internship: Creighton University-School of Medicine (1980) NE
Medical Education: Creighton University-School of Medicine (1979) NE
MPH, The University of California at Berkeley, Epidemiology (1987)
Evaluation and management of polymyositis.
Indian journal of dermatology
2012; 57 (5): 371-374
Polymyositis (PM) is one of the inflammatory myopathies, disorders characterized pathologically by the presence of inflammatory infiltrates in striated muscle. The principal clinical manifestation of PM is proximal muscle weakness. The cause of PM is unknown, but current evidence suggests that it is an autoimmune disorder. PM can affect people of any age, but most commonly presents between the ages of 50 to 70. PM is rarely seen in people younger than 18 years of age, and is twice as common among females than males. PM is more common in blacks than in whites. The overall prevalence of PM is 1 per 100,000. Muscle weakness may develop suddenly or more insidiously over a period of weeks to months. The classic symptom of PM is proximal weakness, which may manifest as difficulty holding the arms over the head, climbing stairs, or rising from a chair. Weakness of the striated muscle of the upper esophagus may result in dysphagia, dysphonia, and aspiration. The chest wall muscles may be affected, leading to ventilatory compromises. Involvement of cardiac muscle may lead to arrhythmias and congestive heart failure. Dermatomyositis (DM) is closely related to PM, and both are distinguished primarily by the occurrence of characteristic skin abnormalities in the former. PM and DM may be associated with a variety of malignancies. PM may also occur as part of the spectrum of other rheumatic diseases like systemic lupus erythematosus and mixed connective tissue disease. Moreover, inflammatory myopathy may be caused by some drugs (procainamide, D-penicillamine), and viruses, most notably the retroviruses. Corticosteroids and immunosuppressive agents are the mainstays of therapy for PM. The principal goals of therapy are to improve strength and improve physical functioning. Many patients require treatment for several years. The 5-year survival rate for treated patients is in the order of 95%. Up to one-third of PM patients may be left with some degree of residual muscle weakness.
View details for DOI 10.4103/0019-5154.100479
View details for PubMedID 23112357
View details for PubMedCentralID PMC3482800
- Chapter 9: An overview: Use of traditional anti-arthritic drugs and update on drug development Arthritis: Pathophysiology, Prevention, and Therapeutics. Ed: Bagchi, Moriyama, and Raychaudhuri. CRC Press. Boca Raton, FL. 2011; 1: 125-137
PSYCHOLOGICAL SYMPTOMS IN PRIMARY FIBROMYALGIA SYNDROME - RELATIONSHIP TO PAIN, LIFE STRESS, AND SLEEP DISTURBANCE
ARTHRITIS AND RHEUMATISM
1990; 33 (8): 1279-1283
Twenty-five subjects with primary fibromyalgia syndrome and 22 subjects with rheumatoid arthritis were compared on measures of psychological distress, pain, health status, life stress, sleep disturbance, and coping strategies. Higher levels of psychological distress were found in the primary fibromyalgia syndrome group, but the degree of life stress was shown to be a significant covariate.
View details for Web of Science ID A1990DV71700030
View details for PubMedID 2390130
PREDISPOSING FACTORS IN POLYMYOSITIS-DERMATOMYOSITIS - RESULTS OF A NATIONWIDE SURVEY
JOURNAL OF RHEUMATOLOGY
1989; 16 (9): 1218-1224
Utilizing case-control methods, we surveyed 322 persons who experienced the onset of polymyositis-dermatomyositis (PM-DM) during calendar years 1985 and 1986, in an effort both to test specific hypotheses, and to generate new hypotheses regarding antecedent risk associations for the disease. Data obtained by recall of events during the 12 months before disease onset in cases, and an identical time period in sex matched sibling controls, suggest that important questions for further study include the roles of antecedent heavy muscular exertion and emotional stress as risk factors for PM-DM. Furthermore, it appears that vaccinations, toxic exposures and symptoms of allergic phenomena, throat infection, and upper respiratory infection are either neutral or are negatively associated with risk of PM-DM, findings which also raise important new etiologic questions, or perhaps lay old ones to rest. Malignancy was infrequently noted.
View details for Web of Science ID A1989AV08900011
View details for PubMedID 2810279
Acute alcoholic myopathy and ruptured popliteal cysts. The pseudothrombophlebitis syndrome revisited.
1986; 83 (12): 797-800
View details for PubMedID 3508254
TUBULORETICULAR INCLUSIONS IN SYSTEMIC LUPUS PNEUMONITIS - REPORT OF A CASE AND REVIEW OF THE LITERATURE
ARCHIVES OF PATHOLOGY & LABORATORY MEDICINE
1984; 108 (7): 599-600
Tubuloreticular inclusions have been described with sufficient frequency in certain tissues of patients with systemic lupus erythematosus (SLE) to make the finding of such inclusions helpful in making a diagnosis of this disorder. The finding of such inclusions in lung biopsy specimens, however, has been distinctly rare. We report herein the ultrastructural findings in the case of a young woman with active systemic LE showing tubuloreticular inclusions within lung and kidney biopsy specimens.
View details for Web of Science ID A1984SX14800026
View details for PubMedID 6329130