Rheumatology

Research continues to carry a prominent role in the Divisions productivity. The NIH sponsored grant through the Research in Minority Center program (RCMI) finished after 5 years of funding. The two projects being headed by members of the Division of Pediatric Rheumatology continue along with the core investigators in this project. Dr. Kara Yamamoto is heading the Immunogenetics of Systemic Lupus Erythematosus project, and Dr. David Kurahara is heading the Immunogenetics of Acute Rheumatic Fever project. The collaborations with established researchers have been strengthened with this grant. For Dr. Kurahara the mentored relationship with Dr. Madeleine Cunningham, a world-renowned specialist in streptococcal cross-reactive antibodies in Oklahoma City, has continued. The activity is being headed by Dr. Elizabeth Tam, Pulmonologist and Dr. Karen Yamaga, Immunologist who have been excellent mentors in this effort. Dr. Claude LeSaux rounds out the team with her work with fibrotic injury in Asthma. The projects continue with the help of a new collaborator at the Medical School, Dr. Diane Taylor who is studying immune responses toward malaria, has helped the ARF team develop new assays to study autoimmune responses in Rheumatic Fever.

Dr. Kurahara and Dr. Yamamoto recently got an article accepted for publication investigating the socioeconomic factors in Acute Rheumatic Fever, and the contribution of ethnicity to the development of this illness. Dr. Kurahara will be presented work on a family with Rheumatic Fever, and the epitope mapping of their antibody responses to human cardiac myosin at the Lancefield meeting in Australia in September of 2005.

Clinically the service has continued to grow and expand. There still remains a large demand for Pediatric Rheumatologic expertise. New patient referrals and follow-up appointments remain strong with nearly 140 to 180 new referrals each year. The neighbor island outreach remains very busy with more demand for evaluating different types of joint pain in children. A publication describing these clinics and the prevalence of certain childhood illnesses in the State has been submitted and is currently under review by the Journal of Rheumatology.

The Shriners Hospital for Children Juvenile Rheumatoid Arthritis program continues into another year with further growth. Dr. Kurahara remains the program director. This collaborative program between Shriners and Kapi’olani has truly benefited children with arthritis in the State. Multi-disciplinary care at Shriner’s is provided to these children at no cost to the patients or to their insurance carriers. An annual camp for children with arthritis was held again with staff from both Shriner’s and KAPI’OLANI helping the children. The Neighbor island outreach would not be possible without the support of both the Kapi’olani Foundation and Shriners Hospital. The foundations providing financial support for these clinics include the First Hawaiian Bank Foundation, Alexander and Baldwin Foundation, the Gamar Foundation, and the Vidhna Foundation.

The relationship with our Division and Shriners Hospital has been strengthened more recently. Dr. Yamamoto continues to serve as Pediatric Director of Clinical Services there, and is assisting with Pediatric services within the hospital. The children being admitted at Shriners often have multiple medical problems, and Dr. Yamamoto’s efforts to provide top quality Pediatric care have been appreciated.

The Kapi’olani Children’s Specialty Center continues to develop to serve children with complex medical conditions, including Behavioral & developmental problems, Kawasaki syndrome, Immunodeficiency’s, illnesses associated with Prematurity conditions, Cardiac, Neurologic, ENT, Allergy, Surgical, and Adolescent medical problems. In the past, the majority of patients seen have been Pediatric Rheumatology patients, but now with the spacious center and centralized clinic space more specialty clinics are being discussed and planned for. Dr. Kurahara serves as its Medical Director.

Besides the busy clinical and research activities of the Division, the members have remained very involved with the training and education of the Medical Students and the Residents. Dr. Kurahara is currently developing a manuscript of Pediatric Resident research projects that revealed approximately 85% of the projects were published in some fashion, which is much higher then seen in the literature. In addition, the average number of projects done by the residents was 1.7, during the last 5 years. So not only were most residents able to publish their research, but many did at least 2 projects. Both Drs. Yamamoto and Kurahara were also involved with Clinical Skills teaching of the Medical students, resident selection, and teaching at all levels of the training program. The Pediatric Rheumatology rotation remains a popular month for both Pediatric Residents and Medical Students interested in Pediatrics and Orthopedics. Many residents and students rotated through the rotation in the last year. Dr. Yamamoto is also the lead faculty for the third year residents’ Shriners rotation, which focuses on Children with Special Health Care Needs and Cultural Sensitivity.