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Leslie
E. Kahl, M.D. Professor of Medicine Department of Medicine Rm 6304 Kingshighway Bldg. Campus Box 8045 Office Phone: 314-362-6844 |
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The field of Rheumatology offers countless challenges and rewards to the clinician. Most of our patients have chronic diseases which may be painful or disabling. Their clinical presentation may have been subtle or unusual, and the diagnosis delayed. In many, the pathogenesis of the illness remains elusive, and the treatment is thus somewhat less than precise. On the other hand, these are also the very patients for whom the caring and compassionate physician can make the most difference. Education of both the patient and family is the cornerstone of treatment; many of our patient relate an immediate reduction in their discomfort with just this simple step. We have the opportunity to develop and nurture long-term supportive relationships with our patients, and to experience their gratitude with the outcomes. Although the patient's diagnosis may not be immediately evident, the diagnostic challenge provides a constant intellectual stimulus and opportunity to hone clinical skills. The multisystem nature of the diseases we treat, and the toxicities of the therapies we prescribe, call upon all of the skills of the well-trained internist. Each patient and each disease require an individualized approach, so that the clinician continually looks deeper and further for the answers; there is no room for stagnation but, instead, endless opportunity for expanding the knowledge base. Many new treatments have become available for our patients in the last year, and many even more promising ones await. This is indeed an exciting time to be a Rheumatologist! My current role in the Rheumatology Division is in the areas of patient care and the education of trainees. I have a busy clinical practice, and all of my patient care responsibilities are tied to teaching -- students, residents and fellows are always alongside in the clinic and on rounds in the hospital. I am also responsible for coordinating the rheumatology training of our medical students, with a formal curriculum in rheumatology and instruction in the musculoskeletal examination. Recently, I have had the opportunity to broaden my educational role by serving as chair of the Advisory Group for the American Medical Women's Association (AMWA) Arthritis Education Initiative. The Advisory Group created a standardized curriculum on arthritis and trained 20 Master Faculty to use it. These Master Faculty will, in turn, provide arthritis education to an anticipated 2000 primary care practitioners. I have also been involved in clinical research, predominantly in patients with SLE. Using our large database of SLE patients, we have been able to address important clinical questions in lupus including infections and malignancy related to treatment with cyclophosphamide, frequency and outcome of herpes zoster infection, and cardiac tamponade. We participated in the multicenter study of DHEA in SLE, and look forward to future clinical trials for this fascinating disorder. Case Studies 1. Radis CD, Kahl LE, Baker GL, Wasko MC, Cash JM, Gallatin A, Stolzer BL, Agarwal AK, Medsger TA Jr., Kwoh CK. Effects of cyclophosphamide on the development of malignancy and on long-term survival of patients with rheumatoid arthritis. A 20-year followup study. Arthritis & Rheumatism. 38(8): 1120-7, 1995 Aug. Abstract 2. Lefkowith JB, Kiehl M, Rubenstein J, DiValerio R, Bernstein K, Kahl L, Rubin RL, Gourley M. Heterogeneity and clinical significance of glomerular-binding antibodies in systemic lupus erythematosus. Journal of Clinical Investigation. 98(6): 1373-80, 1996 Sep 15. Abstract 3. Pryor BD, Bologna SG, Kahl LE. Risk factors for
serious infection during treatment with cyclophosphamide and high-dose
corticosteroids for systemic lupus erythematosus. Arthritis &
Rheumatism. 39(9):1475-82, 1996 Sep. Abstract
4. Lefkowith JB, Kiehl M, Rubinstein
J,
DiValerio R, Bernstein K, Kahl L, Rubin RL, and Gourley M:
Heterogeneity and clinical significance of
glomerular binding antibodies in SLE. J.
Clin. Invest. 1996; 98:1373-80 Abstracts
1. Fisher EB, Bickle C, Harber K,
Hughes CR,
Jeffe DB, Kahl LE, La Greca MA: Benefits of directive and nondirective
support
are moderated by severity of circumstances. Society
of Behavioral Medicine, |
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