In October 2022, Yale Department of Internal Medicine’s Section of Rheumatology, Allergy & Immunology established a Yale Medicine Myositis Program—an interdisciplinary clinic geared to caring for people with this complex condition that can affect almost every system in the body.
Section Chief Richard Bucala, MD, PhD, Waldemar Von Zedtwitz Professor of Medicine (Rheumatology) and professor of pathology, Yale School of Medicine, and of epidemiology (microbial diseases), Yale School of Public Health; along with Clinical Chief of Rheumatology, Allergy & Immunology Vaidehi Chowdhary, MBBS, MD, felt there was a need for a clinic focusing specifically on the disease. The concept took shape when two rheumatologists with a strong interest in myositis—Harjinder Chowdhary, MBBS, MD, and Oana Zaha, MD—got on board and became the clinic’s directors.
Myositis is an autoimmune disease that involves chronic inflammation of the muscles. It is something of an umbrella term for a variety of individual conditions (including polymyositis, dermatomyositis, and necrotizing myopathy, among others) that can affect the limbs, skin, and other organs. Complications of the disease can include a debilitating loss of strength, functionality and mobility; when it affects the lungs and heart, it can be life-threatening.
According to Harjinder Chowdhary, a rheumatologist with 17 years of experience and a Yale community faculty member, the understanding of the condition has become more sophisticated than it once was, thanks to the development of technologies that allow for early diagnosis and more tailored treatment of patients.
“In the past 15 to 20 years, we've been able to define multiple antibodies which can cause these conditions,” Chowdhary says. “We decide on what type of condition we are dealing with based on the antibody profile we are seeing in the patients. Since the field has become more complex, it's important to create a clinic focused on myositis so we can collaborate with other doctors like neurologists, skin doctors, and lung doctors.”
Zaha came to Yale in 2015 as a clinical assistant. She initially saw patients with interstitial lung disease (ILD) and eventually branched out into general rheumatology. She continues to find myositis (which is commonly associated with ILD) very interesting and is excited to start the myositis clinic.
“When we walk into the [exam] room, we don't know what we are dealing with,” Zaha says. Myositis, or the idiopathic inflammatory myopathies, are very heterogeneous types of conditions. There is skin, joint, lung and muscle involvement, and each patient is different depending on the antibody type.
“Every patient is unique and can have a different combination of symptoms, which can change over time. Someone can present with the skin rash without the muscle component, or they can have the muscle weakness along with lung inflammation without the skin component. So that's why it becomes very complicated, because all three things may not present simultaneously when you see a patient. Usually, the treatment is targeting the organ that's flaring at that particular moment.”
Chowdhary says their goal is to establish the clinic as a center of excellence. It is hoped it will become one of a few specialized myositis centers in the country, offering a team of dedicated specialists from diverse areas such as neurology, pulmonology, dermatology, pathology, and genetics to provide comprehensive patient care. Eventually, the team would like to work with basic researchers and perform clinical trials to understand the pathogenesis of the disease.
Another goal is to educate colleagues and primary care physicians about the condition to improve awareness about myositis and hopefully get patients diagnosed earlier in the disease process.
“These patients can become very sick very fast,” says Chowdhary. “We have some cures for these conditions but is an evolving process. We are very passionate in what we do. With experience, compassion and care, I think we will make a difference in these patients’ lives.”
The Section of Rheumatology, Allergy and Immunology is dedicated to providing care for patients with rheumatic, allergic and immunologic disorders; educating future generations of thought leaders in the field; and conducting research into fundamental questions of autoimmunity and immunology. To learn more about their work, visit Rheumatology, Allergy & Immunology.