Stanford Shoor is a Clinical Professor of Medicine and Rheumatology at Stanford University. He has conducted clinical research in Rheumatology and Internal Medicine and has more than 65 publications in medical journals but his emphasis is teaching and patient care. He is a key clinical faculty member in the Rheumatology Fellowship program and heads the Division’s programs in resident and medical student education. He is the Course Director of Rheumatology Grand Rounds. His special interests are sarcoidosis, evidence based medicine, patient self-care and practice improvement. He received the Department of Medicine division teaching award in 2012 and 2013 and has been honored as a Visiting Professor at Hiroshima University and the Muribushi Residency Program in Okinawa. He is proud of having received the “Moving Mountains” award from the Martin Luther King Jr. Foundation of Santa Clara County. He majored in History at Stanford University and has an interest in foreign languages, especially Italian, French and Spanish. He owes his skills to his mother, who was his high school French teacher and his father, who was a physician, but his sanity to his wife and three sons.
- Gout, Sarcoidosis, Vasculitis, SLE, RA
Clinical Professor, Medicine - Immunology & Rheumatology
Course Director, Rheumatology Grand Rounds (2020 - Present)
Member, Clinician Educator Appointments and Promotions Committee Dept of Medicine (2019 - Present)
Director Residency Rotation & Medical Clerkship, Division of Rheumatology (2011 - Present)
Honors & Awards
"Moving Mountains Award", Martin Luther King Jr. Foundation Santa Clara County (2014)
Rheumatology Teaching Award, Dept of Medicine, Stanford University (2012, 2013)
Mentoring and Teaching Award, Biodesign Program Stanford University (2012)
Visiting Professor, Okinawa Muribushi Residency Hospitals (2015)
Visiting Professor, Hiroshima University Hospital (2012)
Boards, Advisory Committees, Professional Organizations
Member, American College of Rheumatology (1985 - Present)
Member, Medical & Scientific Committee Northern California Arthritis Foundation (2011 - Present)
Fellowship: Stanford University Rheumatology Fellowship (1984) CA
Board Certification: American Board of Internal Medicine, Rheumatology (1984)
Board Certification: American Board of Internal Medicine, Internal Medicine (1982)
Residency: University of Washington Dept of Surgery (1982) WA
Internship: University of Washington Dept of Surgery (1980) WA
Medical Education: Stanford University School of Medicine (1979) CA
Community and International Work
Arthritis Foundation Medical and Scientific Committee
Opportunities for Student Involvement
Current Research and Scholarly Interests
Patient Centered Care in Rheumatic Disease
- Science of Medicine III-B
INDE 223B (Win)
- Independent Studies (5)
Graduate and Fellowship Programs
Immunology/Rheumatology (Fellowship Program)
- Corrigendum to 'TNF-alpha Inhibition for the Treatment of Cardiac Sarcoidosis' Seminars in Arthritis and Rheumatism. 2020 Jun;50(3):546-552. Seminars in arthritis and rheumatism 2021
Reactivation of Chagas Disease in a Patient With an Autoimmune Rheumatic Disease: Case Report and Review of the Literature.
Open forum infectious diseases
2021; 8 (2): ofaa642
Reactivation of Chagas disease has been described in immunosuppressed patients, but there is a paucity of literature describing reactivation in patients on immunosuppressive therapies for the treatment of autoimmune rheumatic diseases. We describe a case of Chagas disease reactivation in a woman taking azathioprine and prednisone for limited cutaneous systemic sclerosis (lcSSc). Reactivation manifested as indurated and erythematous cutaneous nodules. Sequencing of a skin biopsy specimen confirmed the diagnosis of Chagas disease. She was treated with benznidazole with clinical improvement in the cutaneous lesions. However, her clinical course was complicated and included disseminated CMV disease and subsequent septic shock due to bacteremia. Our case and review of the literature highlight that screening for Chagas disease should be strongly considered for patients who will undergo immunosuppression for treatment of autoimmune disease if epidemiologically indicated.
View details for DOI 10.1093/ofid/ofaa642
View details for PubMedID 33575423
View details for PubMedCentralID PMC7863873
Risk of Serious Infection Associated with Agents that Target T-Cell Activation and Interleukin-17 and Interleukin-23 Cytokines.
Infectious disease clinics of North America
2020; 34 (2): 179–89
Co-stimulatory T-cell inhibitors are used in the treatment of rheumatoid arthritis and to prevent rejection of renal transplants. Inhibitors of the intereukin (IL-17) cytokine are indicated for psoriasis, psoriatic arthritis and ankylosing spondylitis and anti- IL-23 drugs for psoriasis. Serious infections occur in 4.2% to 25.0% of co-stimulatory inhibitors and 1.0% to 2.0% with IL-17 or IL-23 inhibitors. Underlying disease, steroid dose greater than 7.5 to 10.0 mg, and comorbidities influence risk in individual patients. Opportunistic infections or reactivation of tuberculosis are rare.
View details for DOI 10.1016/j.idc.2020.02.001
View details for PubMedID 32444009
Development and validation of a rheumatologist satisfaction with practice scale: The rheumatologist satisfaction scale.
2019; 98 (48): e18114
There is a paucity of succinct measures of physician satisfaction. As part of a Performance Improvement Project, we developed and piloted a simple questionnaire to determine rheumatologists satisfaction.Thirty 5 rheumatologists in the academic or private setting were sent opened-ended questions to determine the factors that made them satisfied or dissatisfied with respect to their rheumatology practice. From the responses we formed 14 questions 1 to 10 scale centering on satisfaction and dissatisfaction that was piloted in 30 rheumatologists and subsequently validated in 173 rheumatologists within the US and Latin America.Our combined sample included 173 rheumatologists (55 English and 118 Spanish-speaking respondents). The mean satisfaction for the combined sample was 6.92 (standard deviation=1.1, range 4.08-9.62). The strongest contributors to physician satisfaction were "Seeing interesting and challenging cases" (8.6 ± 1.5) and "The ability to make a difference in patient's life" as well as "Establishing long term relationship with patients" (8.39 ± 1.5). The strongest contributors to physician dissatisfaction were "Getting inappropriate referrals not in the scope of practice" (4.3 ± 2.13) and "Time spent on documentation" (4.5 ± 2.59). The scale had good reliability, relatively normal distribution, and little or no redundancy among items.A simple and practical questionnaire to measure physician satisfaction, in particular rheumatologists satisfaction, was developed, piloted and successfully validated on a predominately academic sample of rheumatologists within the US and Latin America. This scale will serve as a means to identifying potential barriers to the implementation of performance improvement projects in the practice of Rheumatology.
View details for DOI 10.1097/MD.0000000000018114
View details for PubMedID 31770236
Novel Approach to the Treatment of Cardiac Sarcoidosis with TNF-alpha Inhibition
View details for Web of Science ID 000507466900378
- Abatacept in Steroid-Dependent Minimal Change Disease and CD80-uria. Kidney international reports 2019; 4 (9): 1349–53
N-myristoyltransferase deficiency impairs activation of kinase AMPK and promotes synovial tissue inflammation.
N-myristoyltransferase (NMT) attaches the fatty acid myristate to the N-terminal glycine of proteins to sort them into soluble and membrane-bound fractions. Function of the energy-sensing AMP-activated protein kinase, AMPK, is myristoylation dependent. In rheumatoid arthritis (RA), pathogenic T cells shift glucose away from adenosine tri-phosphate production toward synthetic and proliferative programs, promoting proliferation, cytokine production, and tissue invasion. We found that RA T cells had a defect in NMT1 function, which prevented AMPK activation and enabled unopposed mTORC1 signaling. Lack of the myristate lipid tail disrupted the lysosomal translocation and activation of AMPK. Instead, myristoylation-incompetent RA T cells hyperactivated the mTORC1 pathway and differentiated into pro-inflammatory TH1 and TH17 helper T cells. In vivo, NMT1 loss caused robust synovial tissue inflammation, whereas forced NMT1 overexpression rescued AMPK activation and suppressed synovitis. Thus, NMT1 has tissue-protective functions by facilitating lysosomal recruitment of AMPK and dampening mTORC1 signaling.
View details for PubMedID 30718913
TNF-alpha inhibition for the treatment of cardiac sarcoidosis.
Seminars in arthritis and rheumatism
Tumor necrosis factor alpha (TNF-α) inhibitors are increasingly being used for treating refractory cardiac sarcoidosis. There is a theoretical risk, however, that these therapies can worsen heart failure, and reports on efficacy and safety are lacking.We conducted a retrospective review of all cardiac sarcoidosis patients seen at Stanford University from 2009 to 2018. Data were collected on patient demographics, diagnostic testing, and treatment outcomes.We identified 77 cardiac sarcoidosis patients, of which 20 (26%) received TNF-α inhibitor treatment. The majority were treated for progressive heart failure or tachyarrhythmia, along with worsening imaging findings. All TNF-α inhibitor treated patients demonstrated meaningful benefit, as assessed by changes in advanced imaging, echocardiographic measures of cardiac function, and prednisone use.A large cohort (n = 77) of cardiac sarcoidosis patients has been treated at Stanford University. Roughly one-fourth of these patients (n = 20) received TNF-α inhibitors. Of these patients, none had worsening heart failure and all saw clinical benefit. These results help support the use of TNF-α inhibitors for the treatment of cardiac sarcoidosis based on real-world evidence and highlight the need for future prospective studies.
View details for DOI 10.1016/j.semarthrit.2019.11.004
View details for PubMedID 31806154
Development and Pilot of a Patient Satisfaction Scale in Rheumatology
View details for Web of Science ID 000447268902493
Development and Validation of a Rheumatologist Satisfaction with Practice Scale -"the Rheumatologist Satisfaction Scale" (RSS)
View details for Web of Science ID 000411824104275
Incidence and Prevalence of Juvenile Idiopathic Arthritis Among Children in a Managed Care Population, 1996-2009
JOURNAL OF RHEUMATOLOGY
2013; 40 (7): 1218-1225
Few studies based in well-defined North American populations have examined the occurrence of juvenile idiopathic arthritis (JIA), and none has been based in an ethnically diverse population. We used computerized healthcare information from the Kaiser Permanente Northern California membership to validate JIA diagnoses and estimate the incidence and prevalence of the disease in this well-characterized population.We identified children aged ≤ 15 years with ≥ 1 relevant International Classification of Diseases, 9th edition, diagnosis code of 696.0, 714, or 720 in computerized clinical encounter data during 1996-2009. In a random sample, we then reviewed the medical records to confirm the diagnosis and diagnosis date and to identify the best-performing case-finding algorithms. Finally, we used the case-finding algorithms to estimate the incidence rate and point prevalence of JIA.A diagnosis of JIA was confirmed in 69% of individuals with at least 1 relevant code. Forty-five percent were newly diagnosed during the study period. The age- and sex-standardized incidence rate of JIA per 100,000 person-years was 11.9 (95% CI 10.9-12.9). It was 16.4 (95% CI 14.6-18.1) in girls and 7.7 (95% CI 6.5-8.9) in boys. The peak incidence rate occurred in children aged 11-15 years. The prevalence of JIA per 100,000 persons was 44.7 (95% CI 39.1-50.2) on December 31, 2009.The incidence rate of JIA observed in the Kaiser Permanente population, 1996-2009, was similar to that reported in Rochester, Minnesota, USA, but 2 to 3 times higher than Canadian estimates.
View details for DOI 10.3899/jrheum.120661
View details for Web of Science ID 000321993800028
View details for PubMedID 23588938
- Osteoarthritis, Exercise, and Knee Replacement JOURNAL OF RHEUMATOLOGY 2012; 39 (4): 669-671
Proceedings of the European American Rheumatology Association Immunotherapy in Rheumatic Diseases - Science and Clinical Practice, February 25-28, 2009-Sonoma, CA, USA
1st Conference of the European-American-Rheumatolog-Association-Immunotherapy-in-Rheumatic-Diseases -Science & Clinical Practice
ELSEVIER FRANCE-EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER. 2009: 433–34
Evidence is often insufficient to answer questions in clinical practice. In an effort to fill these "gaps" between clinical investigation and daily conundrums, practicing rheumatologists use experience, logic, pathophysiology, individual patients and collegial consultation. In order to capture this science of clinical practice, a group of European and American clinicians and clinician investigators worked in investigative teams or Study Sections, each devoted to utilizing the science of clinical practice to address and critical clinical questions in Rheumatoid Arthritis, Imaging, Vasculitis and Gout that are inadequately answered by published evidence. Conclusions were summarized by a method of debate and discussion. It is anticipated that by defining uncertainty and using such an analytical and experiential method, rheumatologists can assist themselves in solving problems in their daily practice.
View details for DOI 10.1016/j.jbspin.2009.05.002
View details for Web of Science ID 000268468100025
View details for PubMedID 19541524
Myocardial Infarction and Its Association with the Use of Nonselective NSAIDs: A Nested Case-Control and Time-to-Event Analysis.
The Permanente journal
2008; 12 (1): 16-22
Objective: In April 2005, the US Food and Drug Administration issued a public health advisory warning to health care clinicians about the cardiovascular (CV) safety of nonsteroidal anti-inflammatory drugs (NSAIDs). Although the warning about cyclooxygenase-2 selective NSAIDs was anticipated, little data exists about the CV safety of nonselective NSAIDs. We analyzed data from a group of NSAID users to determine if specific nonselective agents were associated with an increased risk of myocardial infarctions (MIs) and sudden cardiac death (SCD).Design: A nested case-control design was used to study NSAID users ages 18 to 84 years. Cases were defined by a hospital admission for MI or an out-of-hospital SCD. Study control subjects were matched for age, sex, current Kaiser Permanente membership, and geographic location (Northern or Southern California). Odds ratios (OR) were estimated using conditional logistic regression.Results: Our base population included 1,394,764 NSAID users. From this population we identified 8143 cases and 31,496 matched study control subjects. The median time to event was <100 days for all NSAIDs. Two nonselective NSAIDs were associated with increased odds of adverse CV outcomes: indomethacin (OR, 1.27; 95% confidence interval, 1.04-1.56) and naproxen (OR, 1.14; 95% confidence interval, 1.00-1.30).Conclusion: Our results suggest that some nonselective NSAIDs are associated with an increased risk of MI and SCD. We found the increased risk to be small compared with the risk associated with rofecoxib. Cardiovascular events occurred early in therapy. Caution is warranted with some nonselective NSAIDs, especially those for which other studies have found evidence of risk.
View details for PubMedID 21369507
Athletes, nonsteroidal anti-inflammatory drugs, coxibs, and the gastrointestinal tract.
Current sports medicine reports
2002; 1 (2): 107-115
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most common self-administered and prescribed drugs taken in the United States. From 30% to 50% of those using these medications experience some degree of gastrointestinal (GI) side effect. Independent of NSAID use, a majority of athletes suffer GI symptoms, most of which has been documented in endurance athletes. Studies of NSAID use in patients with chronic osteo- and rheumatoid arthritis have defined a set of factors that can identify those who are at higher risk of serious GI events. Using such a model, clinicians can choose either to discontinue NSAID use, or prescribe a lower-risk NSAID or coxib (rofecoxib, celecoxib), prophylaxis with misoprostol, or proton pump inhibitor. Coxibs have been designed to decrease GI ulceration and bleeding by selective inhibition of cyclooxygenase-2, and offer an option for patients at high risk of GI hemorrhage. There are data suggesting that rofecoxib may be associated with an increased risk of myocardial infarction, and until further data are available, caution should be used when considering its prescription to patients at high risk of cardiovascular events.
View details for PubMedID 12831719
Self-care and the doctor-patient relationship
2002; 40 (4): 40-44
View details for Web of Science ID 000174779100007
DEVELOPMENT AND EVALUATION OF A SCALE TO MEASURE PERCEIVED SELF-EFFICACY IN PEOPLE WITH ARTHRITIS
ARTHRITIS AND RHEUMATISM
1989; 32 (1): 37-44
There is evidence that the psychological attribute of perceived self-efficacy plays a role in mediating health outcomes for persons with chronic arthritis who take the Arthritis Self-Management Course. An instrument to measure perceived self-efficacy was developed through consultation with patients and physicians and through study of 4 groups of patients. Tests of construct and concurrent validity and of reliability showed that the instrument met appropriate standards. Health outcomes and self-efficacy scores improved during the Arthritis Self-Management Course, and the improvements were correlated.
View details for Web of Science ID A1989R917000006
View details for PubMedID 2912463
A COGNITIVE-BEHAVIORAL TREATMENT FOR RHEUMATOID-ARTHRITIS
1988; 7 (6): 527-544
This experiment tested a cognitive-behavioral rheumatoid arthritis treatment designed to confer skills in managing stress, pain, and other symptoms of the disease. We hypothesized that a mediator of the magnitude of treatment effects might be enhancement of perceived self-efficacy to manage the disease. It was predicted that the treatment would reduce arthritis symptoms and possibly would improve both immunologic competence and psychological functioning. The treatment provided instruction in self-relaxation, cognitive pain management, and goal setting. A control group received a widely available arthritis helpbook containing useful information about arthritis self-management. We obtained suggestive evidence of an enhancement of perceived self-efficacy, reduced pain and joint inflammation, and improved psychosocial functioning in the treated group. No change was demonstrated in numbers or function of T-cell subsets. The magnitude of the improvements was correlated with degree of self-efficacy enhancement.
View details for Web of Science ID A1988R935000004
View details for PubMedID 3063517
- DEVELOPMENT OF AN INSTRUMENT TO EXPLORE PSYCHOLOGICAL MEDIATORS OF OUTCOME IN CHRONIC ARTHRITIS TRANSACTIONS OF THE ASSOCIATION OF AMERICAN PHYSICIANS 1984; 97: 325-331