It was 2013. Audra Horomanski was midway through an away rotation at Stanford as a medical student outside her home institution. That was when she encountered a young woman with newly diagnosed granulomatosis with polyangiitis, or GPA. The disease is one form of vasculitis, a rare condition characterized by inflammation of the blood vessels.

“The woman had a severe life-threatening ailment and made a quite significant recovery. That case really changed my whole trajectory and led to a growing interest in vasculitis during my internal medicine training and rheumatology fellowship,” says Horomanski, who earned her MD at Wright State University Boonshoft School of Medicine before completing postgraduate training at Stanford. Today, as a clinical assistant professor of immunology and rheumatology, she directs the Stanford Vasculitis Clinic.

A career in medicine, and rheumatology in particular, was a lifelong ambition for Horomanski.

“I’ve been interested in rheumatology since I was a kid. My sister, who’s three and a half years younger, has an autoimmune rheumatic disorder called juvenile idiopathic arthritis, or JIA. It went into remission when she was a teenager, but I spent a lot of my childhood going to pediatric rheumatology appointments with her and my mom. In fact, I recently came across a school project from first grade in which I answered the question, ‘What do you want to be when you grow up?’ My answer was, ‘I want to be a rheumatologist.’ It was spelled correctly, too! So, I’ve actually wanted to do this for as long as I can remember,” she says.

Crossing organ systems

Rheumatology requires close collegial relations with other medical subspecialties, and Horomanski’s vasculitis work exemplifies that.

“Because blood vessels run throughout the body, these diseases can affect virtually every organ system. During the past two years, I’ve been able to create a network with colleagues in other subspecialties who can help with different manifestations of vasculitis. Whether it’s cardiology, nephrology, neuromuscular neurology, ophthalmology, neuro-ophthalmology, ENT, or pulmonology, I work with an expert in that specialty to treat patients. It’s been a big help to identify the providers in those divisions and departments who have an interest in vasculitis and who work well collaboratively,” she says.

Paying it back

Given that it was her own medical education that exposed her to vasculitis, it’s fitting that Horomanski would be passionate about an additional role as the Immunology and Rheumatology Fellowship associate program director.

“Part of the reason that I like this clinic so much is because it’s a teaching clinic. In addition to teaching courses at the medical school, we can expose all of our trainees to these extremely rare disorders in clinic and give them tools to treat these patients when they encounter them,” she says.

Working with severely ill patients is extremely stressful, so how does Horomanski deal with that?

At the start of the COVID-19 pandemic, she and her husband were searching for an activity that was safe, could be done outdoors, and allowed for social distancing. That led them to take up ceramics.

“I mostly do wheel throwing, which is super-therapeutic. You can completely zone out, and the clay feels really nice. You don’t have to think about anything. It’s great,” she says.

Patient Volume Increases at the Stanford Rheumatology Vasculitis Clinic

Since 2020, the number of vasculitis patients seen at the Stanford Rheumatology Vasculitis Clinic has doubled. As of July 2022, the clinic had close to 150 unique vasculitis patients who were being seen regularly. On average, Horomanski sees about three new vasculitis consults a week.