THE HOSPITAL FOR SICK CHILDREN, Division of Rheumatology, 2005 - 2006
Division of Rheumatology
Staff Members
Dr. Brian Feldman
Dr. Bonnie Cameron
Dr. Ronald Laxer
Dr. Rayfel Schneider, Program Director
Dr. Earl Silverman
Dr. Lynn Spiegel
Dr. Shirley Tse
Dr. Rae Yeung
(416) 813-5828
(416) 813-6117
(416) 813-6117
(416) 813-6117
(416) 813-5828
(416) 813-6117
(416) 813-7654 x1809
(416) 813-8964
The Division of Rheumatology provides tertiary and quaternary care for the majority of children
with rheumatic diseases in Ontario and also provides advice and care for out-of-province children
as well as for some international patients.
Educational Goals and Objectives
To be able to take a complete history relevant to systemic rheumatic diseases and to the
musculoskeletal system.
To be able to perform a complete musculoskeletal examination and recognize the systemic signs
of rheumatic disease.
To be able to synthesize the history and physical findings to formulate a rheumatologic
differential diagnosis.
To understand the principles of rehabilitation therapy relevant to the rheumatic diseases.
To know the indications for and the interpretation of laboratory tests relevant to the rheumatic
To know the indications and contraindications of joint aspiration and injection.
To know the indications and contraindications and toxicity and pharmacotherapy of the
rheumatic diseases.
THE HOSPITAL FOR SICK CHILDREN, Division of Rheumatology, 2005 - 2006
To have an appreciation of the psychosocial impact of chronic rheumatic disease upon the patient
and his/her family.
Expected Duties
Electives participate with the post-core resident in the in-patient management of Rheumatology
patients, including the admitting history and physical examination.
Perform consultations on in-patients from other services (primarily elective residents).
Attend out-patient rheumatology clinics, assessing both new out-patient consultations and seeing
follow-up patients.
Participate actively in all academic activities, including clinical seminars, journal club and team
Patient Programs & Services Provided
Inpatient Service
The Division of Rheumatology is part of the Ward 6A Cluster sharing inpatient resources with
Nephrology, PAMOT and Gastroenterology/Nutrition. Extensive use of the Medical Day Care
Unit on 4C has resulted in only the most acutely ill and complex patients being admitted to Ward
6A. Patients requiring intravenous cyclophosphamide therapy for systemic lupus erythematosus
or vasculitis are also admitted for these infusions. There is a strong multidisciplinary approach to
inpatient care involving the entire healthcare team. The Division also provides a consultation
service to all medical and surgical services, the Emergency Department and the Pediatrics
Intensive Care Unit.
Medical Day Care Unit
The Division of Rheumatology makes extensive use of the Medical Day Care Unit thereby
reducing the number of admissions. Patients are admitted to the Medical Day Care Unit for wellplanned, expedited assessments (often multidisciplinary), investigations, infusions such as pulse
corticosteroids, intravenous immunoglobulin and infliximab. There is also a two-hour
Anesthesia time slot each week for joint injections performed in the Medical Day Care Procedure
Room. Some joint injections are performed with midazolam sedation.
Outpatient Service
The Rheumatology Ambulatory and Day Hospital Program is among the busiest in the North
America with close to 5,000 patient visits per year. The Rheumatology clinics are organized into
7.5 general Rheumatology clinics per week and 2.5 subspecialty clinics per week. Unique
multidisciplinary subspecialty clinics have been developed for systemic lupus erythematosus in
conjunction with Nephrology and Adolescent Medicine (weekly), systemic onset juvenile
rheumatoid arthritis (alternate weeks), juvenile dermatomyositis in conjunction with Neurology
THE HOSPITAL FOR SICK CHILDREN, Division of Rheumatology, 2005 - 2006
(alternate weeks), scleroderma in conjunction with Dermatology (monthly or bimonthly), and
spondylitis (monthly). These subspecialty clinics have been an important innovation in that they
have facilitated the integration of expert clinical care, research and educational activities for
relatively rare diseases in children. The clinics have all resulted in the development of clinical
care protocols and have spawned numerous research projects. They have become known both
nationally and internationally as a result.
Clinical Activities
All HSC clinics are held on the main floor, Clinic Area 9, and all are teaching clinics. They are
scheduled as follows:
1:00 - 5:00
General Rheumatology
Weekly General Rheumatology
1:00 - 5:00
10:00 - 2:00
Alternating Weeks
General Rheumatology
Morphea Clinic
Systemic JRA Clinic
Dermatomyositis Clinic
Lupus (weekly)
8:30 - 2:00
General Rheumatology
9:00 - 2:00
General Rheumatology
The Division of Rheumatology provides clinical service for inpatients and outpatients at
Bloorview MacMillan Centre where Dr. Brian Feldman is the Director of the Arthritis Program.
He conducts a general rheumatology clinic in the morning and sees inpatients and day patients in
the afternoon and provides teaching for the Bloorview MacMillan staff and trainees.
THE HOSPITAL FOR SICK CHILDREN, Division of Rheumatology, 2005 - 2006
Educational Activities
The Division of Rheumatology has an extremely strong commitment to educational activities at
all levels. The University of Toronto, Pediatric Rheumatology Subspecialty Residency Program,
is one of two fully accredited Royal College programs in Canada.
Pediatric Fellow
Pediatric Fellow
Pediatric Fellow
Pediatric Fellow
Pediatric Fellow
Departmental Fellow
Departmental Fellow
Pediatric Fellow
Pediatric Fellow
Jonathan Akikusa
Khalid Al-Husayn
Tadej Avcin
Serdar Cantez
Sandrine Compeyrot
Davinder Singh-Grewal
Lucia Nukumizu
Yonatan Butbul
Elizabeth Stringer
Weekly Academic Events
8:30 - 9: 30 a.m.
Sign Over Rounds
Rm. 8244
12:00 p.m.
Radiology Rounds
Rheumatology Academic Half-Day
Room 6711
8:00 - 12:00 a.m.
(Intracity-Wide Rounds, Pediatric Core Curriculum, Fellow’s Rounds,
Journal Club, Pathology Rounds, M&M Rounds)
8:00 - 9:00 a.m.
Basic Science of Immunology/Rheumatology Seminar Series
Room 8244
9:00 – 10:00 a.m.
HSC Grand Rounds
Main Auditorium
Team Rounds
Room 6711
2:30 - 3:30 p.m.