Research Programs

Systemic Sclerosis Research Programs

The systemic sclerosis(SSc)-related research program is directed by Dr. Tracy Frech and is dedicated to the interdisciplinary assessment of systemic sclerosis (SSc), which is an autoimmune disease characterized by vasculopathy with resultant fibrosis.  

The close clinical care partnerships of rheumatology, pulmonary, dermatology, cardiology, and gastroenterology resulted in our VUMC SSc program being recognized as a treatment center of excellence by the National Scleroderma Foundation in 2022.  

Both Dr. Frech and Dr. Rishi Naik serve on the National Scleroderma Foundation Medical Advisory Board advising the Board of Directors on matters requiring scientific judgment as it relates to research and patient care. Our VUMC research program has pharmaceutical trials and registry options for our SSc patients. Registry options include CONQUER and a VA Merit Award project “SSc Vasculopathy: Improved clinical monitoring and treatment” that provides serial microvascular measurements obtained during routine clinic practice and models vasculopathy through inducible pluripotential stem cell generation.   

Education and workforce development in SSc assessment is a focus of our outcomes-based research program, which is highlighted by an annual Nashville Capillaroscopy Conference hosting international faculty and learners across the US.   

Capillaroscopy Program

Capillaroscopy is a non-invasive diagnostic technique that involves the microscopic examination of the capillaries, the smallest blood vessels in the body, usually at the nailfold of fingers.

This method is particularly useful for microvascular evaluation due to several key advantages: 

  • Non-invasiveness: Capillaroscopy is a safe and non-invasive procedure that does not require any blood samples or tissue biopsies. This makes it suitable for repetitive examinations, monitoring disease progression, and assessing treatment efficacy. 

  • Visualization of Microcirculation: Capillaroscopy provides a direct visualization of the microcirculation, allowing for the detailed examination of capillary structure and blood flow in real-time. This is crucial for evaluating the health of small blood vessels, which play a vital role in various diseases, including rheumatologic and autoimmune disorders. 

  • Early Detection of Microvascular Abnormalities: Microvascular abnormalities often precede macrovascular complications in various medical conditions. Capillaroscopy enables the early detection of subtle changes in the capillary bed, which can be indicative of underlying systemic diseases or microvascular disorders. Early identification allows for prompt intervention and management. 

  • Quantitative Assessment: Capillaroscopy allows for quantitative assessment of various parameters, such as capillary density, capillary dimensions, and the presence of abnormal capillary shapes. These measurements provide valuable information about the severity and progression of microvascular abnormalities. 

  • Monitoring Disease Progression and Treatment Response: The ability to observe changes in the microvasculature over time makes capillaroscopy a valuable tool for monitoring disease progression and assessing the effectiveness of therapeutic interventions. This is particularly relevant in conditions where microvascular involvement is a key feature. 

  • Diagnostic Aid: Capillaroscopy serves as a diagnostic aid in several medical fields, including rheumatology, dermatology, and vascular medicine. It can assist in distinguishing between different connective tissue disorders and autoimmune diseases based on characteristic capillary patterns. 

In summary, capillaroscopy is a valuable technique for microvascular evaluation due to its non-invasiveness, ability to visualize the microcirculation, early detection capabilities, quantitative assessment, and its role in monitoring disease progression and treatment response.   

Rheumatology Musculoskeletal Ultrasound Program

    The program provides diagnostic ultrasound exams and ultrasound-guided procedures to aid with early diagnosis and treatment of rheumatic conditions and can be particularly useful in identifying common hand pathologies seen in patients with systemic sclerosis.

    This weekly clinic at both The Vanderbilt Clinic and Nashville Veterans Affairs is led by rheumatologist  Dr. Erin Chew, who has advanced training and certification in musculoskeletal ultrasound.  

    The mission of the Rheumatology Musculoskeletal Ultrasound Program is to: 

    • Provide patients with point-of-care, affordable diagnostic imaging and US-guided procedures at the time of their rheumatology visit.  
    • Provide musculoskeletal ultrasound exposure and training to rheumatology fellows and medical trainees at Vanderbilt University.  
    • Advance research to understand of the role of musculoskeletal ultrasound for diagnosis and follow up of patients with rheumatic conditions.