Division of Rheumatology and Immunology

The Division of Rheumatology, Allergy and Clinical Immunology at Duke University Medical Center, under the leadership of Dr. E. William St. Clair, Professor of Medicine and Immunology, is committed to providing outstanding care of patients with the full range of rheumatic and musculoskeletal diseases, promoting programs of excellence in basic and clinical research, and offering state-of-the-art training to medical students, house officers, fellows, and other health professionals. In the pursuit of these goals, the Division has refined its systems for the delivery of clinical care while investing resources to enhance its teaching and research programs. The last year has seen major initiatives that will facilitate future programmatic development.

The Division strives to provide efficient, cost-effective, and compassionate care for patients with rheumatic disease. This goal requires a major investment in information systems because of the complexity of seeing patients in a managed care environment and the need for communication among providers to improve longitudinal care. Toward that end, the Division has been working on computer systems to better access data for patient care and simplify record keeping. Furthermore, the Division has been working cooperatively with other services caring for patients with rheumatic disease to share information systems and achieve more uniform and streamlined care.

The area of regional musculoskeletal disease and sports medicine has received major emphasis in the past year. Dr. Nicholas Kredich, Professor of Medicine, has developed an innovative clinic in conjunction with the Division of Orthopedics. This clinic provides a team approach for patients whose condition benefits by combined medical and surgical evaluation and the intensive use of modalities such as physical therapy. Since patients can be seen simultaneously by a rheumatologist and orthopedist, the clinic provides efficiency and speed in patient evaluation and can eliminate visits and duplication of testing. Other clinical initiatives in the Division include enhancement of the Outreach Program which allows divisional members to see patients in community settings and bring subspecialty care to small cities in North Carolina and nearby Virginia. Since patient outcomes can be improved by early diagnosis and treatment, improving access of patients to subspecialists has important benefits in reducing pain and disability.

In the teaching area, the Division has been a leader in incorporating house officers into subspecialty clinics and expanding training opportunities for individuals interested in primary care and general internal medicine. Given the frequency of musculoskeletal problems seen in general practice, it is critical that providers have adequate instruction in the essentials of rheumatological diagnosis and treatment. At Duke, Dr. St. Clair has built a program to provide expanded opportunities for trainees to work under the direct supervision of members of the Private Diagnostic Clinic. As evidenced by the awards received by divisional members for their teaching, these activities have been very valuable and esteemed by students.