Clinician educator at Nationwide Children’s Hospital and an Assistant Professor of Pediatrics at The Ohio State University
Fatima Barbar-Smiley, MD, MPH, FAAP
“My goal is to help each and every patient achieve the best health outcomes. I partner with parents and guardians to assist our patients through their chronic illness journey”
Nationwide Children’s Hospital is one of the largest pediatric hospitals and research institutes in the United States. In recent years, it has consistently been ranked among America’s top 10 children’s hospitals by U.S. News & World Report, the recognized authority on hospital rankings. “Hospitals” magazine recently interviewed Fatima Barbar-Smiley, MD, MPH, FAAP, about her work in the Division of Rheumatology at Nationwide Children’s Hospital.
How and why did you come to join Nationwide Children’s Hospital as their clinician educator and a pediatric rheumatologist?
Originally from Lebanon, I obtained my medical degree at Beirut Arab University. I completed two pediatric residencies, the first in Lebanon at Hammoud Hospital University Medical Center, and the second at Nationwide Children’s Hospital. My Pediatric Rheumatology fellowship training was also at Nationwide Children’s Hospital, and I joined the pediatric rheumatology team here in 2016.
In addition to clinical practice, I’m actively engaged in clinical research with a focus on juvenile arthritis, uveitis and lupus. The research environment and technology systems at Nationwide Children’s Hospital are incredibly supportive and advanced, and the focus on outstanding patient care is second to none. My goal as a physician and researcher is to improve outcomes and access to healthcare for children with rheumatic diseases, and I felt Nationwide Children’s Hospital was the best place to do this. The hospital shares my goals.
The number of children with arthritis and other rheumatologic diseases is very low compared to adults. How do you conduct research?
I believe collaboration is key for high-quality clinical research to improve care and outcomes. It is critical to establish a broad research network and form a strong connection between the pediatric rheumatologist community and patients. Our team has built solid partnerships with the Childhood Arthritis and Rheumatology Research Alliance (CARRA), the Pediatric Rheumatology Collaborative Study Group (PRCSG) and the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN). Our efforts collectively focus on clinical research and improving the quality of medical care within the field.
What are some recent advancements in pediatric rheumatology that you feel are important?
Recent literature has described numerous advances in the field of pediatric and adolescent rheumatology. In 2019, the American College of Rheumatology/Arthritis Foundation (ACR/AF) published guidelines for the management of children with juvenile idiopathic arthritis (JIA), the most common rheumatic disease of childhood. The guidelines suggest treatment approaches for non-systemic polyarthritis, sacroiliitis and enthesitis.
They recommend a limited course of oral glucocorticoids (<3 months) may be used as bridging therapy for patients with significant disease activity, but not for those with low disease activity. However, regardless of disease activity, the ACR/AF strongly recommended against adding chronic low-dose glucocorticoids in this population, given the long-term adverse effects in children.
Another highlight pertains to treatment of JIA cases with sacroiliitis who fail non-steroidal anti-inflammatory medications (NSAIDs). They recommend against use of methotrexate monotherapy, and strongly suggest starting a biologic therapy such as a tumor necrosis factor alpha inhibitor (TNFi). The ACR expects to release additional JIA guidelines in 2021, which will be important to our patients’ medical treatment.
In the practice of pediatric rheumatology, what makes Nationwide Children’s Hospital different from others?
At Nationwide Children’s Hospital, we are committed to providing the best quality of medical care to children and adolescents with rheumatic diseases. We have a team of multidisciplinary providers, including seven pediatric rheumatologists, two nurse practitioners, three pediatric rheumatology fellows, a team of rheumatology nurses, a specialty pharmacist, a psychologist, a social worker, a quality improvement specialist, a dedicated research coordinator and registration staff. Together, we provide comprehensive care to our patients through inpatient, outpatient, infusion and even telehealth visits.
We work closely with other specialty centers at Nationwide Children’s Hospital, such as ophthalmology, gastroenterology and pain management. We also offer interdisciplinary diagnosis, treatment and management through specialty clinics for lupus, arthritis, hypermobility and other rheumatic conditions. Children with arthritis can benefit from our diagnostic and therapeutic musculoskeletal ultrasound clinic, for example. We treat the whole patient by ensuring that we are meeting all of their individualized medical and psychosocial needs.
How do you interact with parents and prepare them to take part in their children’s treatment journey?
My goal is to help each and every patient achieve the best health outcomes. As part of this goal, I partner with parents and guardians to assist our patients through their chronic illness journey. We describe the experience as a journey that starts with a shared understanding of the patient’s medical and psychosocial needs, and we look at it in the context of a family’s resources. We develop a personalized care plan that will best serve the patient. We then provide treatment recommendations based on the best available evidence and partner with the patient and family to facilitate truly shared decision-making.
As a team, we strive to simplify complex treatment regimens whenever possible to make it easy for the family and patient to be successful on therapy. We assist the family unit by providing needed education and psychosocial support throughout their journey, from pre-diagnosis through to follow-up care.
To learn more about Nationwide Children’s Hospital and Dr. Barbar-Smiley, visit NationwideChildrens.org/Specialties/Rheumatology.