Adult and Pediatric Rheumatology Fellowships

The mission of the Saint Louis University rheumatology fellowship training program is to produce physicians that are clinically competent in the field of rheumatology, are capable of working in a variety of settings and possess habits of lifelong learning to build upon their knowledge, skills and professionalism.

Adult and Pediatric Rheumatology Training

The trainees who successfully complete this program will be fully trained and equipped to function as clinical rheumatologists, clinician educators or clinician scientists, depending on the individual career goals of the individuals. Our research is centered on studies of Systemic Lupus Erythematosus on Regulatory T-cells, Systemic Lupus Erythematosus on Interferon Signatures, Systemic Lupus Erythematosus on Syk and Immune Complexes, Juvenile Idiopathic Arthritis on Isotypes of Anti-CCP Antibodies, and Rheumatoid Factors and Glycosylation.

We are active participants in the Corrona Registry and CARRA (Childhood Arthritis and Rheumatology Research Alliance) Network and have established an active clinical trial program.

Our training program is one of the highest regarded nationally in both adult and pediatric rheumatology by the American College of Rheumatology. Our fellowship program is accredited for both Pediatric and Adult Rheumatology training through the American College of Graduate Medical Education and our program is uniquely able to train fellows that have completed either an internal medicine residency, medicine-pediatric residency or pediatric residency.

Our Faculty

All of our faculty members are teaching faculty and work with fellows during clinics and during consult rotations. We have a patient base of over 2,000 adults and over 1,200 children with rheumatic diseases. Our outpatient clinics are located at the Saint Louis University Doctor’s Office Building, SLUCare Des Peres and SSM Health Cardinal Glennon Children’s Hospital.

Our Patient Populations

We care for adult and pediatric patients with a broad range of rheumatic diseases including rheumatoid arthritis, systemic lupus erythematosus, scleroderma, Sjogren’s disease, myopathies, vasculitis, inflammatory arthritis, crystal-induced arthritis, periodic fever syndromes and metabolic bone disease.

Our pediatric clinics are overseen by Peri Hickman Pepmueller, M.D., Reema Syed, M.D., and Terry L. Moore, M.D.

We have the largest children's arthritis center in St. Louis, the largest in the state of Missouri and the eighth largest in the country. Our inpatient service is a consultation service performed at both the SSM Health Saint Louis University Hospital and SSM Health Cardinal Glennon Children's Hospital with about 200 consults per year.

Pediatric Program Strengths

The pediatric rheumatology fellowship at Saint Louis University Medical Center is one of the oldest in the country. It is one of the original 12 accredited by the ACGME in 1992. The Pediatric Clinic at SSM Health Cardinal Glennon Children’s Hospital is the eighth largest in the country.  

We have seen over 6,000 pediatric patients in the past 16 years, including almost 4,000 from the state of Missouri and 2,000 from the state of Illinois. The program has two new and follow-up patient clinics on Mondays and Thursdays at SSM Health Cardinal Glennon Children’s Hospital and pediatric patients are also seen daily at the Saint Louis University Doctors Office Building and Des Peres Hospital.

Research

The Pediatric fellowship program also has an active research program involving studies of juvenile arthritis and systemic lupus with over 200 publications and 200 presentations over the last 20 years being presented on these topics. Research grants funded by the National Institutes of Health (NIH) have been obtained for studies in juvenile arthritis and multiple studies have been performed in patients with childhood systemic lupus and other connective tissue diseases.

Research projects continue with studies on rheumatoid factor and anti-CCP antibodies and their isotopes and different epitopes. Studies continue on systemic lupus patients looking at regulatory T cells and cellular function and this is funded until 2017 by an R01 grant from the NIH. The program is accredited for two positions.

Curriculum

Didactics

We have a strong didactic curriculum and our faculty are enthusiastic teachers. We aim to improve and innovate our educational curriculum each year.

Arthritis and Immunology Conference

This conference is held on a weekly basis throughout the year and focuses on the basic core knowledge of clinical manifestations, clinical presentations, pathophysiology and management of rheumatologic diseases or systemic diseases with rheumatic manifestations. Topics such as pharmacology, exercise and sports related injuries, physical medicine and neurology are also included. Also, during this conference, each fellow will present an evidence-based review on the topic of their choice twice yearly.

CARE Question Sessions

These sessions are held bimonthly during the second semester. Each fellow will rotate and present review board-style questions with supporting medical literature during the discussion of the answers.

Musculoskeletal Radiology Conference
This conference is held jointly with attending physicians, fellows and residents from the division of radiology and division of rheumatology on a monthly basis. Rheumatology fellows and attendings select cases for presentation and review. Emphasis is placed on integrating clinical presentation and radiographic findings.
Immunology Basic Science Conference
This conference occurs on a monthly to every other month basis and includes didactics focusing on cellular elements of the immune system, inflammatory mechanisms, immune responses, immunomodulation and immunoregulation.
Clinical Case Conferences
Clinical case conferences are held weekly. Rheumatology fellows, rotating rheumatology residents and attendings rotate and present a complex clinical case with group discussion of the differential diagnoses followed by an evidence-based review of the literature and question and answer. Incorporated in the clinical case conferences will be cases presented by each fellow with emphasis on Morbidity and Mortality as it pertains to rheumatic disease.
Journal Club
 Journal Club will occur on a monthly basis and will involve the attendings and fellows presenting a pertinent article of original research on a rotating basis. A subsequent discussion and critique of the methodology and results are included.
Research Conference
This conference is held on a monthly basis on average. Faculty in rheumatology or faculty in other disciplines performing research relevant to rheumatology will present and discuss their ongoing research. In addition, discussion of topics pertinent to clinical and bench research will occur.
Board Review Didactic
A separate board review didactic supervised by Katherine Temprano, M.D., will occur at least bimonthly with all fellows that will include textbook chapter discussion (using Hochberg as the main educational text) in conjunction with the American College of Rheumatology (ACR) Image Bank, and other board review material.
Other Educational Opportunities
Other educational endeavors include a yearly Rheumatology Objective Structured Clinical Exam (ROSCE) and a monthly Injection Clinic supervised by Katherine Temprano, M.D., where fellows will gain additional experience in both large and small joint aspiration and injection techniques, soft tissue injections, polarized microscopy and synovial fluid analysis.