Vinod Chandran, MBBS, MD, DM, PhD, FRCPC

Dr. Chandran is a rheumatologist and clinician-scientist affiliated with the Schroeder Arthritis Institute, and the Departments of Medicine, Laboratory Medicine and Pathobiology and the Institute of Medical Science, University of Toronto. He holds an MD/PhD with specialties in internal medicine, immunology, rheumatology and genetic epidemiology.

Dr. Chandran currently serves as the Director of the Psoriatic Arthritis Research Program at the University Health Network. His research interests focus on the development of biomarker-based strategies to improve early diagnosis and prognosis of psoriatic disease (PsD; psoriasis and psoriatic arthritis [PsA]), as well as identify novel treatment targets through proteomics and mechanistic studies and strategies to reduce its impact on society.

Dr. Chandran’s research has been supported by grants from the Canadian Institutes of Health Research (CIHR), The Arthritis Society, the Krembil Foundation, the Arthritis Research Foundation, and the National Psoriasis Foundation. He has published extensively (>200 articles) on genetics/genomics/proteomics and clinical aspects of psoriatic disease classification, and his H-index is 59 (Google Scholar).

Abstract

Psoriatic arthritis, a spondyloarthritis, is a heterogeneous inflammatory arthritis associated with psoriasis. The heterogeneous and somewhat non-specific symptoms and signs make identifying psoriatic arthritis difficult. There are also no diagnostic markers. In the lecture, Dr. Chandran will describe the heterogeneous manifestations of psoriatic arthritis and the difficulties encountered in diagnosing this relatively common form of inflammatory arthritis. He will also discuss the classification criteria and discuss efforts to develop a diagnostic test.

Boulos Haraoui, MD, FRCPC

Dr. Haraoui received his medical degree from St. Joseph University (Beirut) in 1977 and trained in internal medicine and rheumatology in Montreal Canada. He completed a research fellowship at the Arthritis Branch of the NIH (Bethesda, Maryland) between 1982 and 1984. He later joined the department of rheumatology at the Centre Hospitalier de l’Université de Montréal.

Dr. Haraoui is the Past Chairman of the Scientific Committee of the Canadian Rheumatology Association (CRA). He is also a Past Chairman of the CRA Research Committee, previously known as the Canadian Initiative in Outcomes in Rheumatology Care (CIORA). With several colleagues, he established the Canadian Early Arthritis Cohort (CATCH), an ongoing National Cohort with more than four thousand patients. He served for several years on the board of the Laurentian Conference of Rheumatology, and 10 years as its Chair. Dr Haraoui has authored or co-authored more than 190 peer-reviewed papers and several book chapters. He has lectured extensively in North America, South America, Europe, the Middle East, North Africa, Australia and Asia.

Dr. Haraoui serves on several provincial, national and international educational and advisory committees, particularly with regard to issues pertaining to the diagnosis and management of rheumatoid arthritis. He was the recipient of the 2012 Quebec Rheumatologist Association award and the 2014 CRA Distinguished Rheumatologist award. He is a Master of the CRA since 2020.

Abstract

Psoriatic arthritis stands apart among the different IMIDs, due to its multiple clinical manifestations, involving the joints, the spine, the enthesis, the skin and the nails. Different immune and inflammatory mechanisms are involved in each target tissue with some overlaps. This heterogeneity requires different therapeutic agents to better suit individual patients. This brief review will shed some light on the mechanism underlying these different clinical manifestations to better inform clinicians in order to optimize treatment.

Ari Damla, MD 

Dr. Damla is an Assistant Professor at the Chobanian and Avedisian School of Medicine at Boston University and an Attending Radiologist at Boston Medical Center in the division of Musculoskeletal Radiology. Dr. Damla joined Boston University after completing his fellowship training in Musculoskeletal Radiology at McMaster University in Hamilton, Ontario in 2022. Beyond clinical expertise, Dr. Damla serves as the Clerkship Director and Education Lead for Radiology Medical Education at Boston University, passionately shaping the future of radiologists. His interests include Sports and Trauma imaging, Rheumatologic imaging, as well as Musculoskeletal intervention having recently co-authoring a book chapter on foot and ankle intervention. 

Abstract

This lecture, tailored for rheumatologists, provides a thorough examination of the imaging findings of Psoriatic Arthritis (PsA) from the perspective of a Musculoskeletal Radiologist. Recognizing the diverse clinical manifestations of PsA, the session begins with an overview of the pivotal role of imaging in both diagnosis and ongoing monitoring. The discussion navigates through various imaging modalities, placing particular emphasis on the strengths and intricacies of techniques such as Magnetic Resonance Imaging (MRI), X-ray, and ultrasound.

The lecture explores essential topics, starting with the detailed analysis of synovial and tenosynovial involvement. Special attention is given to how imaging, especially MRI, can unveil the patterns and extent of inflammation, contributing significantly to early diagnosis and influencing treatment decisions. Enthesitis is then examined, highlighting the role of imaging, including ultrasound and MRI techniques, in detecting and characterizing enthesitis, offering valuable insights into disease activity and severity.

The spectrum of bone changes In PsA, encompassing erosions to new bone formation, is thoroughly evaluated, elucidating how imaging findings contribute to our understanding of disease progression and guide therapeutic strategies. The lecture also addresses the challenges in differential diagnosis, emphasizing key features crucial for distinguishing Psoriatic Arthritis from other rheumatologic conditions.

Illustrative case studies and practical examples are interwoven throughout the presentation to enhance the audience’s proficiency in interpreting imaging findings specific to Psoriatic Arthritis. The overarching goal is to foster collaboration between radiologists and rheumatologists, thereby improving diagnostic accuracy, optimizing treatment approaches, and ultimately elevating patient outcomes within the complex landscape of Psoriatic Arthritis.

Rajaa Chatila, MD, MHPE  

Dr. Chatila is an associate professor of medicine, at the Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University and faculty member in the department of Internal Medicine and Gastroenterology division at the Lebanese American University Medical Center-Rizk Hospital since 2009. Since joining LAU School of Medicine, she has been the coordinator of the gastroenterology module for second year medical students.  she delivered physiology lectures and clinical science lectures and prepared the PBL scenarios for the entire gastroenterology module.  Between 2010 till 2011, she was acting head of division of gastroenterology at LAUMC-RH.  She held the position of Program Director of the Internal Medicine Residency program at LAU-SOM between 2013 till 2017.  In February 2016, she was appointed Assistant Dean for Graduate Medical Education at LAU School of Medicine.

Dr. Chatila graduated from the American University of Beirut with a BS-Biology in 1989 then earned a Medical Degree diploma in 1993.  Then, completed residency training in Internal Medicine at St. Raphael Hospital, Yale University, in 1996, followed by fellowship in Gastroenterology and Hepatology at Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT. USA which she completed in 1999.  Since her return to Lebanon, she has worked in several medical centers.  She sat on several committees as member and headed (head of research and ethics committees, elected head of the medical staff committees in two different hospitals, member and co-chair of mortality morbidity committee, member peer review committee, member of the SOM curricular committee, member of the expert panel at the LOP and member of the scientific committee of LSGE congress).  She was a member of the LSGE Hepatology committee, SAC committee, LAU library committee.  She is head of the GME committee for residency and fellowship programs.  She is a member of the GME research subcommittee, GME development committee and LAU Strategic Plan oversight committee.

She is American board certified in Internal Medicine and in Gastroenterology. Society memberships include: ECCO, World Gastroenterology Organization and the Lebanese Society of Gastroenterology. She assisted and participated in numerous educational activities, awareness campaigns, webinars and have attended numerous conferences as invited speaker and moderator of sessions.  I have always been actively involved in teaching and assessment of medical students, residents and fellows.  In September of 2021, she acquired a master’s degree in medical education from Keele University. She has been an advisor to several students and residents.

Dr. Chatila also published in peer review medical journals. She is currently involved in clinical research investigating: colorectal cancer, irritable bowel syndrome, gastroesophageal reflux disease, residency burnout and predictors of achievement in medical education.

Abstract

Psoriasis is a chronic, autoimmune systemic inflammatory disorder that may affect the skin and the joints.  The liver in patients with psoriasis may also be affected in three different ways:

• As a consequence of the systemic manifestations of psoriasis and the milieu associated with it, be it the metabolic syndrome of autoimmunity
• Coincidental concurrent liver diseases independent of psoriasis
• Adverse reactions due to the treatments used in psoriasis

In this presentation, the risk factors of liver disease among patients with psoriasis, the pathophysiology of liver disease specific to psoriasis, disease presentation and complications and how to approach of treatment in these patients will be discussed.

Carole Bitar, MD, FAAD

Dr. Bitar completed her medical school at the University of Balamand in Lebanon with a full scholarship for academic excellence and graduated summa cum laude with distinction. She then completed her dermatology residency training at Tulane University School of Medicine in New Orleans.

Dr. Bitar also completed one year of dermatopathology fellowship at the University of Michigan, Ann Arbor.
Currently, Dr. Bitar is Associate Professor in dermatology and dermapathology at Tulane University. Her focus is on complex medical dermatology including psoriasis, autoimmune and bullous diseases. Dr. Bitar also served as PI and Co-PI on multiple clinical trials in the dermatology department studying psoriasis, atopic dermatitis, dermatomyosis and cutaneous T-cell lymphoma.

Abstract

In this lecture, the different manifestations of psoriasis on the skin with a focus on pustular psoriasis and the new treatment option with spesolimab will be highlighted. Additionally, focus will be shed on how to pick the appropriate systemic therapy based on the patient’s comorbidities.

Nisrine Al Ghazal, MD 

Dr. Nisrine Ghazal is a senior endocrinology specialist and endocrinology head of department at Mediclinic Middle East- Dubai. She is an adjunct clinical lecturer at Mohammed Bin Rached University of Medicine and Health Sciences. 

She is a graduate of the American University of Beirut. She has a special interest in diabetes education and started the Diabetes Wellness Program in Mediclinic.

She has several publications in well renowned journals including JBMR, JGME and International Journal of Endocrinology among others.

She is the holder of the Nayil Al Harith Fellowship award and is a member of the Alpha Omega Alpha Honor Medical society.

Abstract

It has been reported that 24 to 58% of patients with psoriatic arthritis have metabolic syndrome as compared to 15 to 24% of individuals from the general population. The elevated prevalence of metabolic syndrome may account for the increased cardiovascular risk observed with psoriatic arthritis. In fact, the latter patients have a 55% higher probability of developing cardiovascular diseases. Moreso, psoriatic arthritis patients with metabolic syndrome have been reported to exhibit higher disease activity scores, the reasons behind that link will be elaborated.

Mechanisms: There is accumulating evidence showing shared inflammatory pathways between metabolic syndrome components and psoriatic arthritis with the overexpression of pro-inflammatory cytokines being the root cause. Alteration of the gut microbiome is an emerging cause as well. Prolonged exposure to exogenous glucocorticoids is an obvious metabolic syndrome trigger.

Diabetes: Inflammatory cytokines, including TNF, IL-6, and IL1 have been linked to insulin resistance in the liver, adipose tissues, and skeletal muscles and consequently an increased risk of diabetes.

Hypertension: The odds ratio of high blood pressure was higher in individuals whose psoriasis is severe which emphasizes the significant contribution of inflammation in arterial stiffness.

Obesity: Obesity appears to be a significant risk factor for both the development of psoriatic arthritis and psoriasis, and this risk seems to be weight dependent. Obesity has also been associated with poor treatment outcomes and decreased rates of remission in psoriatic arthritis patients undergoing treatment with TNF inhibitors.

Lipidemia: A higher prevalence of dyslipidemia was observed in psoriatic arthritis patients although inflammation can lower serum LDL levels. Psoriatic arthritis patients exhibit qualitative alterations in their lipid profiles leading to atherogenesis such as an HDL reduction and an increase in lipoprotein A.

It is plausible then, that a good control of psoriatic arthritis may lead to an amelioration of the underlying inflammatory process and the metabolic syndrome burden. Similarly, an improvement of metabolic syndrome has been associated with reaching minimal disease activity status in psoriatic arthritis. Hence disease modifying antirheumatic drugs exposure may ameliorate cardiovascular risks in psoriatic arthritis patients. By the same logic, could GLP1 agonists aid in reducing disease burden in patients with psoriatic arthritis? A “multi-morbidity centered” scheme would then be the ideal way to approach those patients.