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The R. J. Fasenmyer Center for Clinical Immunology

Founded in 2005, The R. J. Fasenmyer Center for Clinical Immunology at Cleveland Clinic has established itself as a premier center of clinical research, educational programs and service to the community.

This is in keeping with our core areas of focus:

  • Care of patients with complex autoimmune, autoinflammatory and immunodeficiency disease states
  • Research into autoimmune, autoinflammatory and immunodeficiency disease causes and treatments
  • Immunologic education to physicians, allied health professionals and the public
  • Community Outreach

As part of supporting our key directives, the Center has developed focused, innovative programming including live meetings and discussions, webcasts, podcasts, interactive and online monographs and online newsletters, reaching thousands of electronic visitors from around the world. In the process, the R. J. Fasenmyer Center has become the leading provider of CME at Cleveland Clinic. clevelandclinicmeded.com go to : rheumatology/immunology

Working collaboratively with multiple consultants and departments at the Cleveland Clinic, as well as with the Special Immunology Unit at Case Western Reserve University School of Medicine, the RJ Fasenmyer Center is breaking new ground in the care of paitents with complex disorders of the immune system and conducting important and innovative research. Their collaborative work in the field of HIV infection is particularly noteworthy as it expolores the seam between autoimmunity and chronic infection, a core focus of the center.


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Results: 6 Doctors

 

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Leonard Calabrese, DO
 

Leonard Calabrese, DO

No Patient Satisfaction Reviews
Calabrese, Leonard, DO
216.444.5632

Location(s): Cleveland Clinic Main Campus

Department: Rheumatologic and Immunologic Disease

Specialties: AIDS & HIV, Arthritis, Central Nervous System Vasculitis, General Infectious Diseases, Giant Cell Arteritis, Hepatitis B, Hepatitis C more

Type of Doctor: Adults Only

Surgeon: No

Education: Kansas City University of Medicine and Biosciences University of Health Sciences

 
James Fernandez, MD, PhD
 

James Fernandez, MD, PhD

4.8 out of 5
50 Patient Satisfaction Ratings 7 Comments
Fernandez, James, MD, PhD
216.444.6933

Location(s): Cleveland Clinic Main Campus

Department: Allergy and Clinical Immunology

Specialties: Allergies, Anaphylaxis, Bee Stings, Bronchitis, Chronic Rhinosinusitis, Medication Allergies, Egg Allergy more

Type of Doctor: Adults Only

Surgeon: No

Education: Case Western Reserve University School of Medicine

 
Carmen Gota, MD
 

Carmen Gota, MD

4.7 out of 5
129 Patient Satisfaction Ratings 16 Comments
Gota, Carmen, MD
216.444.5632

Location(s): Cleveland Clinic Main Campus

Department: Rheumatologic and Immunologic Disease

Specialties: Arthritis, Bursitis, Dermatomyositis, Fibromyalgia, Giant Cell Arteritis, Inflammatory Arthritis, Lateral Epicondylitis/tennis Elbow more

Type of Doctor: Adults Only

Surgeon: No

Education: University of Medicine & Pharmacy

 
Rula Hajj-Ali, MD
 

Rula Hajj-Ali, MD

4.8 out of 5
68 Patient Satisfaction Ratings 4 Comments
Hajj-Ali, Rula, MD
216.444.5632

Location(s): Cleveland Clinic Main Campus

Department: Rheumatologic and Immunologic Disease

Specialties: Arthritis, Arthritis of the Foot and Ankle, Arthritis Of The Hip, Arthritis Of The Knee, Arthritic Knee Problems, Benign Hypermobility Joint Syndrome, Bursitis more

Type of Doctor: Adults Only

Surgeon: No

Education: American University of Beirut Faculty of Medicine

 
M. Elaine Husni, MD, MPH
 

M. Elaine Husni, MD, MPH

4.8 out of 5
76 Patient Satisfaction Ratings 9 Comments
Husni, M. Elaine, MD, MPH
216.444.5632

Location(s): Cleveland Clinic Main Campus

Department: Rheumatologic and Immunologic Disease

Specialties: Arthritis, Arthritis of the Foot and Ankle, Arthritis Of The Hip, Arthritis Of The Knee, Arthritic Knee Problems, Autoinflammatory Syndromes, Bursitis more

Type of Doctor: Adults Only

Surgeon: No

Education: Boston University School of Medicine

 
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The R.J. Fasenmyer Education Center, housed on the 4th floor of the Crile Building, provides space for multidisciplinary educational activities. It is state-of-the-art and allows clinicians from all over the world to dial in for meetings and conferences. Residents and fellows rotate with members of the Center, seeing patients with autoimmune, autoinflammatory and immunodeficiency diseases.

Additionally, the Center actively supports several fellowship positions including one in the Center for Vasculitis Care and Research and in 2015 the first combined fellowship in both rheumatic immunology and infectious diseases.

The R.J. Fasenmyer Annual Lectureship brings world leaders in the field to Cleveland Clinic. Every other year the lectureship is incorporated into the highly-successful and well-attended Biologics Summit, which is held on Cleveland Clinic's main campus. Throughout the year, the Center sponsors numerous visiting professors at the Cleveland Clinic, bringing world leaders in the field to the campus.

The Basic Immunology course is held on the 1st Wed of every month during the academic year. It is open to clinicians and researchers from all specialties and has as its instructors not only Dr Calabrese but thought leaders from Cleveland Clinic and around the world.

The Fasenmyer web site at www.ccfcme.org is the largest non-profit site for Rheumatology CME in the world. It has given out over 36,000 CME certificates and hosts over 85,000 learner visits per year. Educational kiosks, detailing "what you can do to maintain a healthy immune system" as well as breaking news from the field of immunology and infectious diseases, are now incorporated into new state of the art patient exam rooms in the Department of Rhematology at A-50 (Crile Building).

A critical element of the Fasenmyer Center's core functions is to support allied events and non-profits in the community. Over the years the Center has been involved with numerous agencies providing strategic support. Knowing that carrying out our mission should be a collaborative and widespread effort, the Center has cultivated relationships with these agencies, who have missions that align to our own. These agencies have included The Free Clinic, The AIDS Task Force, Ursuline Piazza and Recovery Resources.

Central Nervous System Vasulitis
Multidisciplinary Clinic Facilitates Timely Approach for a Challenging Disease

By Rula Hajj-Ali, MD and Leonard Calabrese, DO

Cleveland Clinic has been a leader in care and research in the field of central nervous system (CNS) vasculitis for more than 25 years, developing criteria for its diagnosis that are widely employed today. We have recently established a multidisciplinary team which is highly qualified to evaluate and treat patients with suspected CNS vasculitis. Taking a multidisciplinary approach is enormously important in evaluating these patients to safeguard the right diagnosis in this tremendously challenging disease.

Vasculitis affecting the CNS remains one of the most complex forms of vascular inflammatory disease, with multiple factors contributing to our relative lack of understanding, including its rarity, the lack of an efficient non-invasive test, a paucity of pathological material to study and the absence of animal models simulating the disease.

Vasculitis affecting the CNS can be classified into primary and secondary forms. Primary angiitis of the CNS (PACNS) is vasculitis confined to the CNS, including brain and spinal cord, and their coverings. Secondary vasculitis of the CNS implies vascular inflammation of CNS as part of a larger process such as an infection, connective tissue disease or other systemic disorders.

Diagnostic challenges

While several tools are available to assist in the diagnosis of CNS vasculitis, many challenges remain to assess critically the diagnostic sensitivity and specificity of these tools. Diagnostic studies include routine laboratory testing, cerebrospinal fluid assessment, neuroimaging studies, cerebral angiography and biopsy of CNS tissues. Screening laboratory studies performed on blood have little positive predictive value. Also, the specificity of these tests is too low to secure a diagnosis. Various tests for chemistries, autoantibodies and cultures and other investigations are useful for ruling out infectious, systemic inflammatory diseases and other hereditary syndromes.

Timely diagnosis is extremely important to ensure accurate treatment before irreversible brain damage occurs. Few clinicians are highly experienced with this disease. The care and diagnosis of these patients requires a team of experts that is not only familiar with this disease but also with its mimics to ensure an accurate diagnosis and work up.

At Cleveland Clinic’s R.J. Fasenmyer Center for Clinical Immunology, our multidisciplinary team includes neurologists with interest in cerebrovascular and neuro-immunologic diseases, neuroradiologists and interventional radiologists, neurosurgeons, infectious disease specialists and rheumatologists. This clinic provides personalized, complete care that is coordinated with the right providers by eliminating needlessly long delays between appointments. This allows patients to meet the medical team with expertise in CNS vasculitis to optimize and improve their outcomes.

Cleveland Clinic’s current work in CNS vasculitis, profiled here, extends and draws on our more than 25 years of experience in caregiving, research and education in this field.

Advancing Our Knowledge through Research

Through this clinic, we focus not only on patient care but strive to clarify the mechanisms and pathogenesis of CNS vasculitis. We are building a repository of clinical data, radiologic findings and biological samples from patients with CNS vasculitis and its mimics. Our goals include the investigation of long-term outcomes, discovery of biomarkers and exploration of radiologic studies that may distinguish CNS vasculitis and other mimics.

By investigating biomarkers to aid in the diagnosis and develop therapeutic targets against CNS vasculitis, we hope to better distinguish it from other cerebral arteriopathies. This, in turn, may lead to reduced costs and morbidity, more effective diagnosis and, ultimately, identification, of appropriate therapies.

The Team

Our team includes rheumatologists Rula Hajj-Ali, MD, (Director of the Clinic) and Leonard Calabrese, DO (R.J. Fasenmyer Chair of Clinical Immunology); cerebrovascular neurologists Ken Uchino, MD, and M. Shazam Hussain, MD; neuro-radiologists Ferdinand Hui, MD, and Stephen E Jones, MD; neuro-immunologists Alexander Rae-Grant, MD, Robert Bermel, MD, and Mary Alissa Willis, MD; neurosurgeon Mark Bain, MD; and infectious disease specialists Tricia Bravo, MD, and Adarsh Bhimraj, MD.

Dr. Hajj-Ali is a staff physician in the Center for Vasculitis Care and Research, Department of Rheumatic and Immunologic Diseases. Dr. Calabrese is Director of the R.J. Fasenmyer Center for Clinical Immunology in the Department of Rheumatic and Immunologic Diseases.

Autoinflammatory Disease
Autoinflammatory Disease

By Qinping Yao, MD

Autoinflammatory diseases, or periodic fever syndromes, are newly grouped rheumatic conditions. Most are hereditary, caused by genetic abnormalities. Diagnosing and managing them can be complex and challenging, and patients often struggle to find specialized care. Cleveland Clinic provides adults with autoinflammatory diseases the specialized help they need.

The R.J. Fasenmyer Center is one of few centers in the United States to offer expert knowledge and management of these disorders, supported by genetic testing and counseling as well as groundbreaking research.

Diagnostic Challenges

Autoinflammatory Diseases are not the same as autoimmune diseases. Typically, patients with autoinflammatory diseases do not have autoantibodies for autoimmune diseases such as lupus.

Patients with autoinflammatory diseases may experience recurring fever, rash, joint pain or swelling, chest or abdominal pain, and eye redness, pain, or dryness.

Autoinflammatory diseases may be mimicked by a wide variety of autoimmune, infectious and other systemic disorders and thus a sound diagnosis is essential for crafting specific therapies.

Services

In collaboration with our colleagues in Pathology & Laboratory Medicine, Genomic Medicine and Lerner Research Institutes, we offer adult autoinflammatory disease patients the most advanced services available. In addition to proper diagnosis and treatment, we offer genetic testing on-site, providing faster results at a more reasonable cost, genetic counseling, and scientific research of the diseases.

We treat adults with:

  • Periodic Fever syndromes
  • NOD2-associated autoinflammatory Disease (NAID)
  • Blau Syndrome
  • Familial Mediterranean fever (FMF)
  • Cryopyrin-associated periodic syndromes (CAPS)
  • Tumor necrosis factor receptor-associated periodic syndrome (TRAPS)
  • Hyperimmunoglobulin D syndrome (HIDS)
  • Adult-onset Still’s disease
  • Pyogenic arthritis, pyoderma gangrenosum and acne (PAPA) syndrome
  • Undiagnosed fever, rash, joint pain or swelling
Advancing Our Knowledge through Research

To understand how the autoinflammatory diseases occur or are triggered will unravel more effective treatment for these diseases. Our current research effort focuses on potential mechanisms by which the new disease NAID occurs. This translational project involves interdisciplinary collaboration between basic scientists at Lerner Research Institute and rheumatologists at Cleveland Clinic.

The Team

Our team is headed by rheumatologist Qingping Yao, MD, PhD. Dr. Yao has authored numerous publications about adult autoinflammatory diseases and is the only Ohio member of the International Society of Systemic Autoinflammatory Diseases. In 2011, he led the discovery of NOD2-associated autoinflammatory disease (NAID). Collaborators of Dr. Yao on patient care and research are Felicitas Lacbawan, MD, Head of Molecular Genetics Pathology (MGP) and Program Director of the MGP Fellowship, Rocio Moran, MD, Medical Director of General Genetics Clinics at Cleveland Clinic’s Center for Personalized Genetic Healthcare and Head of Pediatric Genetics, and Christine McDonald, PhD, Associate Staff in Pathobiology.

Primary Immunodeficiency
Multidisciplinary clinic for complex and underdiagnosed immunologic diseases

By Jim Fernandez, MD PhD, and Leonard Calabrese, DO

Immunodeficiency is a state where the immune system’s ability to fight infections is compromised or absent. Patients with immunodeficiency frequently suffer from recurrent infections but also have an increased incidence of autoimmune disease, hematologic disorders, chronic pulmonary issues and increased risk of malignancies. Due to this complex and varied presentation of disease, immunodeficiency is often difficult to diagnosis and manage. Because of this complexity, the R.J. Fasenmyer Center for Clinical Immunology has established a clinic and team specifically devoted to diagnosis and care of immunodeficiency.

Immunodeficiency disease can be classified into primary or secondary. Patients with primary immunodeficiency have an inherent defect in the immune system that most likely will persist lifelong; while secondary immunodeficiency may be temporary if the underlying cause is discovered and resolved.

Services

Here at the Cleveland Clinic we frequently care for a large array of primary immunodeficiencies.

We treat adults with:

  • CVID
  • Hypogammaglobulinemia
  • Specific antibody deficiency
  • CD4 lymphocytopenia
  • Complement deficiency
  • Cyclic neutropenia
  • NK cell deficiency
  • Chronic granulomatous disease
  • Many other defects resulting in immune dysfunction
Diagnosis

The diagnosis of primary immunodeficiency is challenging and in many cases difficult to make. Patients on average have symptoms related to their immunodeficiency for over 13 years prior to the correct diagnosis. Diagnostic studies may include laboratory testing, vaccine challenges, pulmonary imaging studies, and biopsy of lymph nodes or bone marrow. Laboratory studies performed on blood are frequently performed as diagnostic or screening measures prior to more invasive tests. Because some primary immunodeficiencies manifest in adulthood, routine blood work may need followed over time to make a correct diagnosis.

Timely and correct diagnosis is extremely important to ensure accurate treatment. Delayed or incorrect diagnosis frequently result in increased days of work missed, increased cost to health care, hospitalizations and even long term damage to the lungs or other organs.

To aid in prompt and accurate diagnosis, the Cleveland Clinic’s R.J. Fasenmyer Center for Clinical Immunology has established a multidisciplinary team experienced in immune dysfunction which includes immunologists, rheumatologist, infectious disease specialists, pulmonologists, hematologists, oncologists and gastroenterologists. This allows for a more coordinated nature of care and strives to optimize and improve outcomes.

Advancing Our Knowledge through Research

In addition to striving to provide world class care for patients with immunodeficiency, a goal of the R.J. Fasenmyer Center for Clinical Immunology is to advance our understanding of these diseases through research. The Cleveland Clinic is currently an enrolling site for the United States Immunodeficiency Network (USIDNET). By enrolling our patients in the USIDNET, we can build a registry capable of unmasking trends and predictors related to specific immunodeficiencies. As we build a larger population of patients with primary immunodeficiency, we plan to be active participants in clinical trials related to these diseases.

Other active efforts include investigation into the discovery of biomarkers for earlier diagnosis, refining of current laboratory testing for more accurate diagnosis and predictors of outcomes, and investigation of different therapeutic options for complications of immunodeficiency such as enteropathy.

The Team

Our team includes Allergy and Immunologist Jim Fernandez MD, PhD, Immunologist/Rheumatologist Leonard Calabrese, DO (R.J. Fasenmyer Chair of Clinical Immunology) and Rula Hajj-Ali, MD. Our team also includes an array of specialists for select complications including: infectious disease specialist, Dr. Carlos Isada MD, gastroenterologist, Dr. Aaron Brzezenski MD PhD, hematology/oncologist, Dr. Alan Lichtin MD and Dr. Brad Pohlman MD, and pulmonologist, Dr. Dan Culver MD.

Dr. Fernandez is an associate staff physician in the Department of Allergy & Immunology. Dr. Calabrese is Director of the R.J. Fasenmyer Center for Clinical Immunology in the Department of Rheumatic and Immunologic Diseases.

Retroperitoneal Fibrosis
Retroperitoneal Fibrosis

By Dr. Carmen Gota, MD

Retroperitoneal fibrosis (RPF), also known as Ormond disease, is a rare condition, reported in 0.1 per 100000 person –years. Retroperitoneal fibrosis results from proliferation of inflammatory tissue around the abdominal aorta and other retroperitoneal organs, such as the ureters, the inferior vena cava, or the kidneys. Patients present with dull back pain, or with symptoms of urinary tract infection secondary to ureteral obstruction, and/or with lower extremity edema, secondary to inferior vena cava compression.

Diagnostic Challenges

The etiology of RPF is unknown, about 2/3 of cases are idiopathic, and 1/3 secondary to other conditions. A retroperitoneal mass can occur in patients taking certain kinds of drugs, those who underwent radiation therapy, and can be associated with malignancies, and infections.

The diagnosis is made through imaging of the abdomen, either with CT scan or MRI. Imaging studies demonstrate the presence of the peri-aortic mass, and often show medially displaced ureters, with secondary hydronephrosis.

The imaging data is not definitive for RPF, and the diagnosis needs to be confirmed by obtaining a tissue sample. This can be done through a CT guided biopsy or through laparascopic surgery. Because the mass is located in the retroperitoneum, most patients are detected late, when they develop symptoms due to compression of neighboring organs.

Advancing Our Knowledge through Research

Little is known about the cause, the pathologic mechanisms that perpetuate the inflammation, and trigger the fibrosis, or about the optimal treatment.

In some patients, RPF is part of IgG4 related disease, a new entity associated with infiltration of tissues by IgG4 positive plasma cells. Such patients may have also autoimmune pancreatitis or disorders of salivary, or lacrimal glands, retro-orbital tumor, and blood tests may show an increase in IgG4 levels.

Our goal is to create a registry of patients with RPF that will allow us to understand better the natural history, clinical and histologic presentations, response to therapy as well as the causes of RPF.

Through our research we plan to explore the relationship between RPF and IgG4 related disease, to find answers to questions such as: how many cases of RPF are associated with increased IgG4?; does the presence of increased IgG4 plasma cells influence prognosis and treatment?; and what is the best method to diagnose IgG4 related disease?

The Team

The diagnosis and treatment of RPF require a multidisciplinary team, including rheumatology, radiology, urology and pathology. Laboratory tests may be helpful in indicating the presence of non specific inflammation, secondary renal failure and anemia.

Our RPF team includes Dr. Leonard Calabrese (rheumatology, immunology) , Dr Carmen E Gota (rheumatology), Dr Stephen S. Billings (pathology), Dr. Eric Klein (urology) and Dr Jihad Kaouk (urology).

HIV Disease
Multidisciplinary clinic for care of a complex disease

By Betsy Kirchner, CNP and Leonard Calabrese, DO

Since the first reports of pneumocystis pneumonia in young gay men in 1981, researchers and clinicians have recognized that they were dealing with a novel disease. Over the years that understanding has evolved to our knowledge now that HIV not only affects the immune system, it affects every organ system in the body. In addition, the social and economic aspects of the disease can also be challenging. We recognize that fighting HIV is not just prescribing antiretroviral medicine; it is treating the whole person and helping them navigate the complexities associated with being HIV+.

Despite all of the medical advances made since the early days of the virus, there is still no cure for HIV disease. Our goal is to help our patients attain and maintain their healthiest selves possible.

Our Team & Services

Here at the Cleveland Clinic we care for a large cohort of HIV+ women and men.

Our multidisciplinary clinic includes:

  • More than 10 board-certified infectious disease specialists
  • Nurse Practitioners and Physician Assistants with years of experience treating HIV+ adults
  • A dedicated pharmacologist who reviews the medications for every outpatient and inpatient encounter and reviews the need for preventive services including immunizations
  • Social workers who can assist patients with drug assistance programs, Ryan White services, medication counseling, early intervention, case management, mental health, support groups and education for patients and their families
  • Physicians in other subspecialties who are familiar with the complexities involved in treating HIV+ patients (e.g. cardiologists, orthopedic surgeons, nephrologists, hepatologists, gastroenterologists, endocrinologists, and others)
  • A dermatologist/immunologist with training in immunodeficiency states
  • A pulmonologist/immunologist who runs a dedicated immunodeficiency clinic
  • A team of colorectal specialists housed within the Infectious Disease department for anal and colorectal disease management and cancer screening
  • A nutrition department available for outpatient consultations regarding healthy eating habits
Advancing Our Knowledge through Research

In addition to striving to provide world class care for patients with HIV, a goal of the R.J. Fasenmyer Center for Clinical Immunology is to advance our understanding of HIV through research. The Cleveland Clinic is currently actively involved with both primary immunodeficiency and HIV-specific research. Our collaborations with CWRU have led to numerous breakthroughs in the understanding of CD4+ functionality.

To refer a patient, please contact the Infectious Disease Department at 216.444.3606.

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