St. Michael's Hospital Division of Rheumatology

Revised 2005-2006

Introduction:

St. Michael's Hospital is a major teaching hospital of 550 beds in downtown Toronto, fully affiliated with the University of Toronto.

The hospital Strategic Plan identifies 6 spires of excellence:

• Inner City Health
• Diabetes ComprehensiveCare
• Mobility (Arthritis, Fracture, MS)
• Minimally Invasive Surgery
• Trauma
• Cardiovascular

The Division of Rheumatology is part of the Arthritis Program in the Mobility Spire. Outpatient clinical activities take place in both the Martin Family Arthritis Care and Research Centre (Ground floor, Queen Wing), a multidisciplinary ambulatory unit, or on 3-Shuter, where the staff offices are located.

In the Martin Family Centre (MFC), rheumatology clinics may occur concurrently with specialized orthopedic, plastic and neurology clinics, thus facilitating interdisciplinary interaction at all levels. The unit also contains outpatient surgical suites, where procedures such as needle arthroscopy are performed. With the assistance of the nursing staff and front desk group who manage in patient intake and assessment, referral and test bookings the MFC provides an effective, timely and efficient environment for ambulatory care. Each exam room is stocked with the necessary equipment for joint aspiration and injection, including corticosteroid preparations ands anaesthetic solutions. Two polarizing microscopes are located in the physician offices on 3-Shuter for synovial fluid analysis. An X-ray machine is located in the Fracture Unit (across the hall on Queen Ground) thus facilitating diagnostic X-ray services on a timely basis in many cases. The hospital blood letting station and laboratory facilities are located nearby (2 nd Floor CCW) and all results and reports are recorded and available by secure password on the hospitals Clinical Database accessible by computer in the MFC.

Rheumatology in-patient and emergency room clinical activities are consultative. The staff (Drs. Perlin, Rubin , Rottapel, and Shupak) rotate on-service for two week blocks. On weekends and Holidays new Rheum consults are seen first by the SAR on call who then contact the staff attending for review. Patients with rheumatologic disease who require hospitalization are admitted under one of the four general medicine teams who have primary responsibility for their care (beds located on the 14th floor, Cardinal Carter Wing). The rheumatology rotation is very highly rated by the core medicine residents at the University of Toronto and we are generally assigned 2 core medical residents per month and several elective medical students in total each year.

The core medical residents assigned to the division for one or two-month blocks are responsible for in-patient consultations and review with the staff. Formal in-patient rounds are held twice weekly, but cases may require more urgent attention in the interval.

Divisional educational activities (both formative and as part of the ambulatory clinical activities) take place in a variety of venues (see attached schedule). The rheumatology staff also participate in specific internal medicine postgraduate inpatient educational activities such as Morning report and bedside teaching sessions. In addition to our significant commitments in the undergraduate teaching program, our rheumatologists give both the Tovee lecture for 4th year students and the Royal College Review lecture for PGY4 residents (by invitation) each year.

Faculty:

The GFT Rheumatologists currently located at SMH are:

Dr. Louise Perlin - Associate Professor of Medicine

Dr. Perlin is a clinician-teacher who is recognized for her outstanding teaching skills at the bedside both in the clinic and on the consultation service. She has 7-half days of clinics per week (on 3 Shuter), which are attended by house staff. She has won numerous teaching awards at the under- and post graduate levels. She is responsible for the overall education program in the Division of Rheumatology at SMH. She is also Program Director for Rheumatology at SMH, and a member of the Departmental Executive Committee. Dr. Perlin’s practice encompasses the broad spectrum of rheumatic disease, with a strong emphasis on inflammatory disorders, and her ambulatory activities take place on 3-Shuter

Dr. Robert Rottapel - Professor of Medicine

Dr. Rottapel is a clinician-scientist (CIHR Scholar) whose clinical base is at SMH. He spends Wednesday after noon once a month at SMH where he runs a clinic (MFC) and teaches core residents in rheumatology. He attends weekly rheumatology noon seminars and gives morning reports to core residents on rotation. His teaching focus is on utilizing basic science principles to elucidate the pathophysiology and rationale for treatment of rheumatic disorders. He has a special interest in the rheumatic manifestations of Hepatitis C.

Dr. Laurence Rubin - Division Head, Professor of Medicine

Dr. Rubin is a clinician-scientist who combines research in genetics of Metabolic Bone Disease/Osteoporosis and rheumatic inflammatory disorders with a broad-based clinical practice in Rheumatology (MFC) and Metabolic Bone Disease/Osteoporosis ( 61 Queen Street, 7th Floor- Centre for Diabetes and Osteoporosis). Fellows attend the Metabolic Bone Disease/Osteoporosis program weekly (Monday am) and rheumatology clinics are scheduled on Monday afternoons and Tuesdays with fellows and core residents in medicine. He is also a participant in the in patient consult service. A unique experience is “Outpatient Needle Arthroscopy”. Procedures are scheduled monthly, and provide trainees with the novel opportunity to visualize the internal “architecture” of the knee joint in patients with either degenerative or inflammatory disorders.

Dr. Rachel Shupak - Associate Professor of Medicine

Dr. Shupak is a clinician-educator. She has half-day clinics per week attended by undergraduate student, core residents and fellows. Her clinics take place on 3- Shuter or MFC. Her interests span the range of MSK issues, but her particular interests include myopathies and a unique Hemophilia - Arthritis program which she developed at SMH. As part of this latter program, Dr. Shupak is the only rheumatologist in Toronto offering radiation synovectomies of a variety of affected joint (P 32). Dr. Shupak has over the years been the referral source for adolescents with inflammatory muscle disease in transition from the HSC. She is also a consultant on the in-patient service. She has won 3 outstanding teaching awards at SMH.

Dr. Shahin Jamal – Clinical Associate July 2006, (fulltime staff January 2007)

She completed her Masters program in Clinical Epidemiology (Dec 2006) and joined full time thereafter. Her interest is in Early RA and access to care, as well as Clinical trials and she is an opinion leader in the development of Web based software for clinical data collection and analysis.

Dr. Millicent Stone - Assistant Professor of Medicine

Dr. Stone is a Clinician Investigator who joined the Division of Rheumatology on July 1, 2003. Her main clinical and research interests are in the investigation and treatment of Spondyloarthorpathy, specifically Ankylosing Spondylitis. Dr. Stone has gained an international reputation for her work assessing the utility and outcomes of biologic therapy in AS. She has recently relocated to Bath, England but will continue these efforts at SMH via regular visits, and in particular will be establishing clinical trials of these agents, analyzing measures of outcome and predictors of response.

Dr. Erin Morris – Assistant Professor of Medicine

Dr. Erin Morris joined the division in Sept 2009 as a teacher. She has completed the Master Teacher program of the Faculty of Medicine, University of Toronto. Her clinical interests include general rheumatology, osteoporosis, and maternal fetal medicine.

There are 3 part-time rheumatologists:

Dr. Julie Kovacs

Dr. Doreen Campbell

Both Dr. Gershon and Dr. Kovacs teach predominantly undergraduate students although it is possible that Dr. Kovacs will teach core residents as well. 

Educational Activities:

The formal educational fellowship activities include the biweekly intercity rounds and journal club, and the rheumatology division at SMH has a variety of formal and informal rounds (see attached schedule). The residents will present regularly at our Tues noon seminar (lunch provided), with a focus on using clinical cases as a starting point for a discussion on Pathophysiology and epidemiology of the disease. There is also an interactive session in the Metabolic Bone Clinic (Mondays at noon) with all the MBC staff (lunch provided).

As part of our multidisciplinary approach to arthritis you may interact with a number of other specialty staff::

Orthopedics:

Plastics

Radiology

Number and types of patients seen:

Number and Types of Consults:

On average, there are 5-10 consults per week, although there is fluctuation up and down.  These can be divided into:

• Acute monoarthritis (gout, pseudogout, septic arthritis)
• Inflammatory disorders (vasculitis, SLE, Reactive Arthritis)
• Regional pain syndrome

Ambulatory Multidisciplinary Clinics

• Hemophilic Arthopathy Clinic and Radiation Synovectomy (Shupak)
• Remicade IVIG Clinic weekly
• Early RA (weekly)

Rounds Schedule (attached separately) Save this document to disk