Bio


Dr. Fairchild specializes in the diagnosis, evaluation and management of rheumatologic diseases. He has a particular interest in musculoskeletal ultrasound and heads the Division of Immunology and Rheumatology's Diagnostic and Interventional Musculoskeletal Ultrasound Clinic. Dr. Fairchild, received his Ph.D. from Georgetown University, and his M.D. from Columbia University College of Physicians and Surgeons. He completed internship and residency in the Department of Medicine at Stanford University. He continued on at Stanford, completing his fellowship in rheumatology and subsequently joined the faculty of the Division of Immunology and Rheumatology. He trained in rheumatologic musculoskeletal ultrasound through the USSONAR program and is certified in this technique through the American College of Rheumatology (RhMSUS certification). Dr. Fairchild’s research interests center on novel applications of ultrasonography in rheumatologic disease.

Clinical Focus


  • Rheumatology
  • Diagnostic and Interventional Rheumatologic Ultrasonography

Academic Appointments


Professional Education


  • Fellowship: Stanford Immunology and Rheumatology Fellowship (2017) CA
  • Board Certification: Rheumatology, American Board of Internal Medicine (2017)
  • Board Certification: Internal Medicine, American Board of Internal Medicine (2015)
  • Residency: Stanford University Internal Medicine Residency (2015) CA
  • Internship: Stanford University Internal Medicine Residency (2013) CA
  • Medical Education: Columbia University College of Physicians and Surgeons (2012) NY
  • PhD, Georgetown University, Host-Guest and Organometallic Chemistry (2008)

Current Research and Scholarly Interests


Dr. Fairchild’s research interests center on novel applications of ultrasonography in rheumatologic disease. Current active research endeavors include using ultrasound 1) to evaluate articular and soft tissue manifestations of systemic sclerosis, 2) to screen, detect and monitor of connective tissue disease associated interstitial lung disease, 3) and to examine the incidence of immune checkpoint inhibitor related adverse events and inflammatory arthritis. Additionally, Dr. Fairchild is engaged in collaborative work with other rheumatologic ultrasonographers nationally helping to develop consensus on ultrasonography protocols and fellowship training guidelines.

All Publications


  • Ultrasound Detection of Calcinosis and Association with Ulnar Artery Occlusion in Patients with Systemic Sclerosis. Arthritis care & research Fairchild, R., Chung, M., Sharpless, L., Li, S., Chung, L. 2020

    Abstract

    To investigate the ability of ultrasound (US) compared to radiographs in detecting calcinosis in hands/wrists of systemic sclerosis (SSc) patients, and assess US markers of pathologic perfusion.SSc patients were evaluated for calcinosis in the hands/wrists by X-ray and US. Presence or absence of calcinosis was recorded by patient, hand, and anatomical zone; sensitivity and specificity for calcinosis detection by US versus X-ray was determined. Bilateral US vascular measurements of ulnar artery occlusion (UAO) and finger pulp blood flow (FPBF) were obtained. For each hand, associations between markers of pathologic blood flow (UAO, FPBF, and a composite severity score of UAO and FPBF) and presence of calcinosis were assessed using generalized estimating equations.Of 43 SSc patients (19 diffuse, 24 limited), 39.5% had calcinosis on X-ray compared to 30.2% on US. Sensitivity and specificity for US was 61% and 95% by zone, 78% and 98% by hand, and 76% and 100% by patient, respectively. UAO was seen in 30% and 28% of left and right hands, respectively; FPBF was absent in ≥1 digit of the left and right hands in 49% and 44%, respectively. UAO was associated with X-ray identified calcinosis by hand (OR 8.08, 95% CI 2.45-26.60, p<0.001), whereas FPBF and the composite severity score were not significant. UAO was associated with calcinosis even in the absence of digital ulcers (OR 33.00, 95% CI 3.39-321.09, p=0.003).US was sensitive and highly specific in detecting calcinosis in SSc. UAO was strongly associated with X-ray identified calcinosis.

    View details for DOI 10.1002/acr.24327

    View details for PubMedID 32475057

  • Development and Assessment of a Novel Lung Ultrasound Interpretation Criteria for the Detection of Interstitial Lung Disease in Systemic Sclerosis. Arthritis care & research Fairchild, R., Chung, M., Yang, D., Sharpless, L., Li, S., Chung, L. 2020

    Abstract

    Interstitial lung disease (ILD) is a frequent complication of systemic sclerosis (SSc), and ILD screening, characterization, and monitoring are important for therapeutic decision-making and prognostication. Lung ultrasonography (LUS) is a potential alternative imaging modality for ILD detection. In this study, we develop and test a novel LUS examination technique and interpretation criteria for detecting SSc-ILD.LUS acquisition was performed by collecting short ultrasound movies at 14 lung positions. LUS interpretation criteria for SSc-ILD detection focused on visualized pleural changes. To assess the performance of our methodology for SSc-ILD detection, we prospectively enrolled SSc patients with high resolution computed tomography (HRCT) imaging within 3 months of LUS. LUS exams were scored independently by two blinded readers (one ultrasonographer and one non-ultrasonographer). The sensitivity and specificity for SSc-ILD detection was assessed and agreement was measured with Cohen's Kappa statistic.To test the performance of our LUS acquisition technique and interpretation criteria, 20 SSc patients were evaluated by LUS (278 lung zones) and HRCT. HRCT confirmed ILD in 9 patients (45%). LUS was positive for SSc-ILD in 11 patients (55%) with a sensitivity of 100% and specificity of 82% versus HRCT, with perfect agreement between the two readers (κ=1). Analysis by individual lung zones found excellent agreement between readers with 93.8% concordance and κ=0.82.We developed a novel LUS examination technique and interpretation criteria that are highly sensitive and specific for SSc-ILD detection in an SSc cohort, affording perfect agreement between ultrasonographer and non-ultrasonographer readers.

    View details for DOI 10.1002/acr.24338

    View details for PubMedID 32475026

  • Utility of B-type natriuretic peptides in the assessment of patients with systemic sclerosis-associated pulmonary hypertension in the PHAROS registry CLINICAL AND EXPERIMENTAL RHEUMATOLOGY Chung, L., Fairchild, R. M., Furst, D. E., Li, S., Alkassab, F., Bolster, M. B., Csuka, M. E., Derk, C. T., Domsic, R. T., Fischer, A., Frech, T. M., Gomberg-Maitland, M., Gordon, J. K., Hinchcliff, M., Hsu, V., Hummers, L. K., Khanna, D., Medsger, T. A., Molitor, J. A., Preston, I. R., Schiopu, E., Shapiro, L., Hant, F., Silver, R., Simms, R., Varga, J., Steen, V. D., Zamanian, R. T. 2017; 35 (4): S106–S113
  • Painful Panniculitis and Polyarthritis in Pancreatic Adenocarcinoma: A Case Report. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases Ku, S., Balijepally, R., Horomanski, A., Fairchild, R., Brown, R. A., Liao, C. E. 2020

    View details for DOI 10.1097/RHU.0000000000001408

    View details for PubMedID 32496359

  • Ultrasound Doppler and tenosynovial fluid analysis in tenosynovitis. Annals of the rheumatic diseases Aslam, F., England, B. R., Cannella, A., Sharp, V., Kao, L., Arnason, J., Albayda, J., Bakewell, C., Sanghvi, S., Fairchild, R., Torralba, K. D., Evangelisto, A., DeMarco, P. J., Bethina, N., Kissin, E. Y. 2020

    Abstract

    To assess Doppler ultrasound (US) and tenosynovial fluid (TSF) characteristics in tenosynovitis within common rheumatic conditions, as well as their diagnostic utility.Subjects with tenosynovitis underwent Doppler US and US-guided TSF aspiration for white cell count (WCC) and crystal analysis. Tenosynovial Doppler scores (DS) were semiquantitatively graded. TSF WCC and DS were compared using Kruskal-Wallis tests and logistic regression between non-inflammatory conditions (NIC), inflammatory conditions (IC) and crystal-related conditions (CRC). Receiver operating curves, sensitivity and specificity assessed the ability of WCC and DS to discriminate IC from NIC.We analysed 100 subjects from 14 sites. The mean age was 62 years, 65% were female, and the mean TSF volume was 1.2 mL. Doppler signal was present in 93.7% of the IC group and was more frequent in IC than in NIC group (OR 6.82, 95% CI 1.41 to 32.97). The TSF median WCC per 109/L was significantly higher in the IC (2.58, p<0.001) and CRC (1.07, p<0.01) groups versus the NIC group (0.38). A TSF cut-off of ≥0.67 WCC per 109/L optimally discriminated IC versus NIC with a sensitivity and specificity each of 81.3%. In the IC group, 20 of 48 (41.7%) subjects had a TSF WCC <2.00 per 109/L.A negative DS helps rule out IC in tenosynovitis, but a positive DS is non-specific and merits TSF testing. Unlike synovial fluid, a lower TSF WCC better discriminates IC from NIC. US guidance facilitates aspiration of minute TSF volume, which is critical for diagnosing tenosynovial CRC.

    View details for DOI 10.1136/annrheumdis-2020-216927

    View details for PubMedID 32213497

  • Development and Preliminary Validation of a Novel Lung Ultrasound Interpretation Criteria for the Detection of Interstitial Lung Disease in Patients with Systemic Sclerosis Fairchild, R., Yang, D., Chung, M., Sharpless, L., Li, S., Chung, L. WILEY. 2019
  • Ultrasound Evaluation of the Hands in Patients with Systemic Sclerosis: Osteophytosis Is a Major Contributor to Tender Joints Fairchild, R., Chung, M., Sharpless, L., Li, S., Hong, J., Sheth, K., Chung, L. WILEY. 2019
  • Ultrasound Detection of Calcinosis and Correlation with Ulnar Artery Occlusion in Patients with Systemic Sclerosis Fairchild, R., Chung, M., Sharpless, L., Li, S., Chung, L. WILEY. 2019
  • Musculoskeletal Ultrasound Scanning Protocol Consensus Statements on Scanning Conventions and Documentation in the U.S. Arthritis care & research Torralba, K. D., Choi, K. S., Salto, L. M., Fairchild, R., Cannella, A. C., Kissin, E. Y., Thiele, R., Evangelisto, A., Nishio, M. J. 2019

    Abstract

    There has been increased engagement with ultrasound in rheumatology (RhUS) in the United States with more physicians being trained and certified, its inclusion in fellowship training curricula, and as criteria in the evaluation of rheumatic disease patients. European rheumatology and Radiology-determined standards have largely driven the execution of RhUS; how this translates to American rheumatology practice has not been examined. A 2011 rheumatology-driven consensus on documentation, scanning conventions, and tiered-mastery designation for anatomic region views was developed, which served as the framework for training, and clinical research validation. This study aims to update this consensus to reflect current utilization of musculoskeletal RhUS evaluation in the United States.A 3-round Delphi method study was conducted using a 96-item questionnaire sent via Qualtrics® to 101 respondents experienced in RhUS education and scholarship. The target participant number was 38. High agreement was defined as ≥ 85% agreement on each item. McNemar's chi-square statistic tested for changes in agreement in responses. Comments were reviewed for content analysis.46 respondents completed all three rounds. 80% and 100% of documentation and scanning convention statements, respectively, reached high agreement. Comments reflected the need for rheumatology-defined and disease-specific "complete scan" and "limited scan" definitions, separate from radiology-defined definitions.Many scanning conventions from 2011 remain relevant in current practice. There is a need to determine rheumatology-defined descriptions for common procedural terminology codes for "complete" and "limited" scans that accurately reflect the current state of RhUS. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1002/acr.24005

    View details for PubMedID 31199596

  • Consensus Statements on Scanning Conventions and Documentation in Musculoskeletal Ultrasound Torralba, K., Nishio, M., Thiele, R. G., Fairchild, R., Choi, K., Salto, L., Cannella, A. C., Kissin, E. WILEY. 2018
  • Strongyloides Hyperinfection After Immunosuppression in an Immigrant From El Salvador: A Case for Early Diagnosis and Treatment. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases Hoppenfeld, M. S., Kennedy, V., Sheth, K., Chang, A., Nelson, J., Fairchild, R. M. 2018

    View details for PubMedID 30074914

  • Consensus-Building on a Rheumatology Musculoskeletal Ultrasound Scanning Protocol for Rheumatology Fellowship Programs Torralba, K., Nishio, M., Thiele, R. G., Fairchild, R., Choi, K., Salto, L., Cannella, A. C., Kissin, E. Y. WILEY. 2017
  • Utility of B-type natriuretic peptides in the assessment of patients with systemic sclerosis-associated pulmonary hypertension in the PHAROS registry. Clinical and experimental rheumatology Chung, L., Fairchild, R. M., Furst, D. E., Li, S., Alkassab, F., Bolster, M. B., Csuka, M. E., Derk, C. T., Domsic, R. T., Fischer, A., Frech, T., Gomberg-Maitland, M., Gordon, J. K., Hinchcliff, M., Hsu, V., Hummers, L. K., Khanna, D., Medsger, T. A., Molitor, J. A., Preston, I. R., Schiopu, E., Shapiro, L., Hant, F., Silver, R., Simms, R., Varga, J., Steen, V. D., Zamanian, R. T. 2016: -?

    Abstract

    To assess the utility of B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) in detecting and monitoring pulmonary hypertension (PH) in systemic sclerosis (SSc).PHAROS is a multicenter prospective cohort of SSc patients at high risk for developing pulmonary arterial hypertension (SSc-AR-PAH) or with a definitive diagnosis of SSc-PH. We evaluated 1) the sensitivity and specificity of BNP≥64 and NT-proBNP≥210 pg/mL for the detection of SSc-PAH and/ or SSc-PH in the SSc-AR-PAH population; 2) baseline and longitudinal BNP and NT-proBNP levels as predictors of progression to SSc-PAH and/or SSc-PH; 3) baseline BNP≥180, NT-proBNP≥553 pg/mL, and longitudinal changes in BNP and NT-proBNP as predictors of mortality in SSc-PH diagnosed patients.172 SSc-PH and 157 SSc-AR- PAH patients had natriuretic peptide levels available. Median BNP and NT-proBNP were significantly higher in the SSc-PH versus SSc-AR-PAH group. The sensitivity and specificity for SSc-PAH detection using baseline BNP≥64 pg/mL was 71% and 59%; and for NT-proBNP≥210 pg/mL, 73% and 78%. NT-proBNP showed stronger correlations with haemodynamic indicators of right ventricular dysfunction than BNP. Baseline creatinine, RVSP > 40 mmHg, and FVC%:DLco% ratio ≥1.8 were associated with progression from SSc-AR-PAH to SSc-PH but no association with individual or combined baseline BNP and NT-proBNP levels was observed. Baseline and follow-up BNP or NT-proBNP levels were not predictive of death, however, a composite BNP/NT-proBNP group predicted mortality (HR 3.81 (2.08-6.99), p<.0001).NT-proBNP may be more useful than BNP in the detection and monitoring of PAH in SSc patients, but additional studies are necessary.

    View details for PubMedID 27908301