Dr. Lisa Rider

Author: NIHOD

(MUSIC) I'm Lisa Rider and we're in the National Institute of Environmental Health Sciences at NIH in the Clinical Research Center in Bethesda. We're currently studying autoimmune disease and trying to understand how these diseases come about. We're particularly focused on a rare autoimmune disease called myositis which means muscle inflammation. I grew up in a small family. My parents were both professionals. I was very encouraged to pursue education to a high level. I went to school at Duke University and while studying chemistry there was inspired to get involved with laboratory research. During my pediatric residency...became very interested in pediatric rheumatology extending those studies from the laboratory to the clinic so to speak.

I saw very a sick patient with juvenile dermatomyositis who was in intensive care unit...who had extremely severe weakness, trouble swallowing, severe lung disease, and open sores in her skin and she nearly died. We had to do all kinds of rescue treatments to keep her alive and have her recover from her illness. When I came to the NIH to do more basic research on white blood cell signaling I became very interested in some of the similarities between the children and adults which hadn't previously been appreciated and trying to make that connection. Myositis is a very debilitating, chronic autoimmune disease. Most patients have problems with muscle weakness, which can be progressive. Some patients just have difficulty running or playing, but as it goes on the attack of immune cells on the muscle causes patients to have trouble with climbing stairs, lifting things overhead, combing their hair. Eventually they may have such a severe weakness that they have trouble getting out of bed or toileting and bathing.

We have been very involved with a number of different studies...first trying to understand the different forms of myositis...understanding that this is not just one condition but a number of conditions really defined by unique genetic and environmental factors and unique autoantibodies. These are proteins that the patients make against their own tissues. These are Gottron's papules, which are one of the characteristic rashes of dermatomyositis. The raised red plaques over the extensor surfaces of the joints and may occur not just on the knuckles, but the elbows, knees, and ankles as well.

From that we're trying to develop new treatments. It's a very rare autoimmune condition. Only a few hundred children in the country develop this condition each year. So we've conducted some of the largest studies on this disease and one of the ways we've done that is by collaborating with a number of researchers and physicians, both here in the United States and internationally. We've set up large research consortiums to help researchers work together to make better progress. And we would spend quite a bit of time with the patient in the clinic. I might spend several hours taking their story or doing their full examination..

Dr. Lisa Rider

Really trying to understand all the ways the illness has affected them. And then let me have you lift up your head as long as you can. Good job. OK..you're doing great! Keep it going. Keep it going.

Keep it going. OK...you can stop. This time we'll take a look at how strong your muscles are. Ok.

So if you can hold up your arms really strong for me...don't let me push them down. Great. Great. Ok. Let's take a look at your fingernails here...OK. Remember how they were a little bit dilated...those blood vessels...and we're looking at how they're changing over time. Then I might spend time trying to get in touch with the different test results that the patients had...trying to piece together all the different ways that the disease is affecting them.

This is the first time I saw an outpatient using this. The patient has no clinical response at first. We have a number of collaborations here at the NIH Clinical Center with other researchers or our imaging group in radiology working on new novel imaging modalities, or our Rehab Medicine people who are working on better ways to assess the muscle strength in function, because myositis is such a rare disease that we try to work together to make better progress. And I'm looking forward in the future to really uncover more of the genetic and environmental factors and that will enable us to develop better treatments. Right now we have no approved therapies for juvenile myositis and in my lifetime I really hoping that will have approved treatments. My mentor Paul Plots always said, " Chance favors the prepared mind." And I think getting a solid education and then keeping your mind open to all the opportunities that come through.

Always asking questions. Always trying to be on the cutting edge. And really...I think it's been a dream come true. (music).

Dr. Lisa Rider

(MUSIC) I'm Lisa Rider and we're in the National Institute of Environmental Health Sciences at NIH in the Clinical Research Center in Bethesda. We're currently studying…

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