May 7, 2014


Interviewer: What exactly is rheumatology? We'll examine that next on The Scope.

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Interviewer: Dr. Tracy Frech is a rheumatologist at the University of Utah. What is a rheumatologist?

Dr. Tracy Frech: So a rheumatologist is a doctor that specializes in autoimmune diseases. Your immune system is a good system if it's fighting off infections, or patrolling the bodies for cancers. If it's attacking cells for no good reason and multiple organs, primarily the joints, then a rheumatologist can help determine how to best suppress the immune system so that doesn't happen.

Interviewer: So would a rheumatologist be involved in HIV and AIDS?

Dr. Tracy Frech: Fantastic question. No, those would be infectious disease doctors specializing because in that case your immune system is not functioning because of a virus.

Interviewer: Okay.

Dr. Tracy Frech: In autoimmune diseases, the etiology for why the immune system is not functioning is really not clear and so the way that you would treat an autoimmune disease would be to suppress the immune system, whereas in HIV an infectious disease doctor would give treatments to rid the body of the virus.

Interviewer: What are some examples of autoimmune disease that you would look at?

Dr. Tracy Frech: So examples of autoimmune disease can include Rheumatoid arthritis, that's 1% of the population, that's an inflammatory disease of the joint. Systemic lupus erythematosus or SLE, lupus can involve the kidneys and in that case a rheumatologist would work closely with a nephrologist, but also involves the skin, the joints, seizures can be seen, fluid around the heart and lungs, abnormal clotting and problems with the blood count. Systemic sclerosis or scleroderma is something that I myself specialize in and in this condition the immune system doesn't like the small blood vessels of the body and we work to improve both blood flow and modulation of the immune system's response to that poor blood flow.

Interviewer: So I might be a little bit behind here, but it sounds like you specialize in the immune system attacking the body.

Dr. Tracy Frech: Exactly.

Interviewer: How does the body get the point where it doesn't like itself? And it starts attacking itself? How does that happen?

Dr. Tracy Frech: So that's the million dollar question and there's a lot of interest. Is it because we're having more genetically modified foods, is it environmental pollution, why are we seeing more and more autoimmune disease nowadays then we did several years ago? And better understanding the immune system is actually a real interest in the University of Utah, better phenotyping or understanding that clinical presentation and how that ties into molecular medicine is really a push of our division and our interest of how we move forward in the future.

Interviewer: Is there a thought out there that's kind of the thought as of right now?

Dr. Tracy Frech: It's probably multifactorial, so you're born with genetics and how those interact with the environment is probably the critical question. It's a better understanding of the genetic background and those environmental triggers is really the forefront of how we're trying to understand these conditions.

Interviewer: Is it kind of comparable to a switch getting flipped?

Dr. Tracy Frech: So exactly. So why your immune system at one point in time does a really good job fighting off infections and then fights self is an important part of understanding these conditions. Lots of interest in molecular mimicry, meaning did a bug look a lot like self or modify self and so now after you clear the infection, is your immune system now recognizing self as foreign, there's interest in that. Lots of cool theories, particular interest in things like microcrymerism, is the mother pregnant with a child, her subsequent child cells from the first sibling somehow cross the placenta, get into the other child and now that's a little bit like self but not quite, and your immune system is triggered.
Lots of different theories on why your immune system suddenly decides not to act right and lots of really active interest in trying to understand, how as rheumatologists we can better understand these conditions. Whether it's not the same trigger in all individuals, yet all individuals look the same when they present with the disease, is one of the pushes for sort of better defining the molecular basis to disease and again, an interest of the University of Utah.

Interviewer: So it sounds like the immune system goes out and it goes, oh, this is bad, now I'm going to make a little note of what this looks like so if I ever see it again, so it's constantly being programmed.

Dr. Tracy Frech: Exactly, it's constantly being programmed and it has a great ability to diversify and be able to recognize similarities between viruses and bacteria and whether ourselves get in the middle of that, that's a lot of active interest in trying to better understand that.

Interviewer: Is there a, kind of a generalized symptom somebody might have if their immune system is starting to attack themselves?

Dr. Tracy Frech: So what we generally as rheumatologists take great interest in is inflammatory joint disease, so a joint that's red hot and swollen, that is not normal.

Interviewer: Okay.

Dr. Tracy Frech: So you know lot of people ache and a lot of people are fatigued and that can be a symptom of rheumatic disease, the important one is that red hot swollen joint and that's not something that rheumatologists really like to see because, again, not only define our profession early on but allows us to engage in a cost effective workup.

Interviewer: Does a patient need to go to their primary care physician before they can see you, or if they feel that something is very familiar in this conversation that we had, can they come straight to you?

Dr. Tracy Frech: So unfortunately we actually do require referrals from primary care physicians and the main reason being is fatigue and achiness is so common in the community and rheumatologists are so few that we actually do like the primary care provider to say, oh yes that is a red hot swollen joint and then they would call and get the patient right in, if the wait list was long they would call the fellow on call to get any patient with a red hot swollen joint in expeditiously so we could move forward.

Interviewer: What's the thing that really excites you about what you do? What do you love about it so much?

Dr. Tracy Frech: We make people feel better, so there's nothing better than to have someone come in and be able to really affect their quality of life by getting inflammation under control.

Interviewer: Is there something that you would like a listener to know or take away from this discussion.

Dr. Tracy Frech: Again, rheumatoid arthritis is 1% of the population and young, female, we like to catch early and make sure we prevent joint destruction or disease progression.

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