- 555 University Avenue, Clinic 9, Main Floor, Burton Wing
The Paediatric Rheumatology program at SickKids and the University of Toronto is one of the largest Paediatric Rheumatic Disease Units in North America, and one of the world's leading centres for patient care, research and training in paediatric rheumatic diseases.
The Division of Rheumatology offers a comprehensive range of services for the evaluation and treatment of children with arthritis and paediatric rheumatic diseases; we have specialized disease clinics for the following conditions:
- Autoinflammatory Syndromes
- Juvenile Dermatomyositis
- Juvenile Spondyloarthritis
- Kawasaki Disease
- Neonatal Lupus
- Systemic Juvenile Idiopathic Arthritis
- Systemic Lupus Erythematosus
- Systemic Vasculitis
Our mandate is to provide and foster excellence in scholarly clinical care for children with rheumatic disease.
The Rheumatology Division at SickKids works with well-defined clinical populations, collaborating closely with other divisions to lay ground work for well-funded and productive research programs. The clinical research program includes studies of the major paediatric rheumatic diseases focusing on outcomes, prognosis and treatment. The Division has become the lead centre for a number of international treatment trials for new therapeutic agents in juvenile idiopathic arthritis
The Division of Rheumatology Medical Training Program offers training at the medical undergraduate and postgraduate levels. As detailed in our Education section, trainees and electives are appointed through the Department of Paediatrics, University of Toronto and Medical Affairs at The Hospital for Sick Children (SickKids).
What we do
Clinical and patient care
The SickKids Division of Rheumatology offers 11 ambulatory specialized disease clinics in addition to general childhood arthritis clinics and telemedicine clinics.
The general Rheumatology Clinic is found in Clinic 9, which is located on the main floor (M) in the Black Wing at the southwest corner of the hospital. Walk down SickKids’ Main Street and turn left at the Family Center. You will see the pink Clinic 9 sign.
The information below details each specialized disease clinic, their leadership, and accomplishments, as well as instructions if you’re preparing for an appointment at SickKids Rheumatology.
Physicians: Dr. Deb Levy, Dr. Earl Silverman, Dr. Linda Hiraki, Dr. Andrea Knight
The pediatric SLE clinic at SickKids is the largest clinic of its kind in North America. Since 1984 children have been prospectively evaluated using a standardized assessment protocol. Four rheumatologists, Drs. Deborah Levy, Earl Silverman, Linda Hiraki and Andrea Knight, regularly attend the SLE clinics and are able to integrate clinical research projects into the clinical care that we provide.
The divisions of Rheumatology, Nephrology and Adolescent Medicine come together in one location to provide a comprehensive care clinic for our children and families. This comprehensive model has become the standard for both paediatric and adult lupus clinics around North America.
Physician: Dr. Brian Feldman
The JDM clinic was started in 1991 as one of the first comprehensive care clinics for childhood myositis in the world. Clinic protocols have been developed and a rigorous, standardized assessment process occurs at each clinic visit. An average of 60+ individual patients are followed in this clinic each year. Each patient is seen by the clinic nurse and the medical team at each visit. In addition, each patient has formal nailfold capillaroscopy measured, and a comprehensive physiotherapy assessment performed.
Additional team members (physiotherapy practitioner and physiotherapist) are involved in the care of JDM patients. The JDM clinic provides a thorough training environment for clinical fellows, elective residents, medical students, nursing trainees, therapy trainees, etc. There are a number of ongoing local research projects in the JDM clinic; the clinic also contributes data to a number of North American and International collaborative projects.
Physician: Dr. Ronald Laxer
The Morphea clinic is a combined subspeciality clinic serviced by Dermatology and Rheumatology at SickKids. Morphea, a rare condition with an estimated incidence of 2.7 cases per 100,000, refers to a group of skin conditions consisting of an excessive accumulation of collagen in the skin and subdermal tissues. Patients with Morphea benefit from the combined Dermatology and Rheumatology expertise in diagnosis and treatment of this rare condition.
Please visit the Morphea Clinic Directory listing for contact details.
Physician: Dr. Rayfel Schneider
The sJIA clinic is a unique clinic worldwide which treats patients from across the province in a multidisciplinary setting. Patients with sJIA are generally quite ill and frequently require hospitalization to establish the diagnosis and initiate treatment. These children have multisystem involvement and therefore have the most severe and complex disease of all patients with JIA.
Please visit the sJIA Clinic Directory listing for contact details.
Physician: Dr. Shirley Tse
In 2009, the JSpA clinic at SickKids was the first clinic for prospectively evaluating JSpA patients according to a standardized protocol with the goal of early identification and treatment in preventing the onset of permanent damage.
Juvenile Spondyloarthritis (JSpA), also referred to as Enthesitis-Related Arthritis, is comprised of a group of HLA-B27 associated disorders characterized by joint and entheseal inflammation of the lower limbs, sacroiliac and spinal joints. Uncontrolled disease activity may lead to permanent impairments in spinal mobility and gait translating to severe functional disability akin to the adult-onset form of ankylosing spondylitis. The clinic is a joint effort with Diagnostic Imaging, Rehabilitation Sciences, Gastroenterology and Rheumatology.
Physicians: Dr. Rae Yeung, Dr. Dilan Dissanayake
Childhood systemic vasculitis is a heterogeneous group of diseases having blood vessel inflammation as a common feature. Affected children have multi-system involvement and often present with organ and/or life-threatening illness requiring aggressive management in the intensive care unit or complex care as hospital in-patients. To improve care for this family of diseases, decrease variation in care, enhance patient and family engagement, and advance research and training, a Multi-disciplinary Childhood Systemic Vasculitis clinic was established in June 2013.
Physicians: Dr. Ronald Laxer, Dr. Dilan Dissanayake
The Autoinflammatory Clinic at SickKids began in 2009 and provides patient consultation and follow-up, trainee teaching, and research opportunities. Autoinflammatory diseases consist of a group of disorders with activation of the early arm of the immune system. Although most of the individual disorders are rare, collectively they are relatively common resulting in a large referral load to the clinic.
Physician: Dr. Rae Yeung
Kawasaki disease is a multi-system vasculitis with a predilection for the coronary arteries that is cared for through many unique paediatric specialities. KD is now the leading cause of acquired heart disease in Canadian children. At SickKids, the rheumatology division consults on every child with suspected Kawasaki disease.
We have the largest KD program in the world outside of Asia, having cared for over 2,300 children with KD since 1999. In 2012, the multi-disciplinary KD clinic was launched to improve care for KD, and to directly address quality improvement and safety due to the alarming increase in incidence of IVIG associated hemolysis and revisits to the emergency department post hospital discharge after acute KD.
Please visit the KD Clinic Directory listing for contact details.
Physician: Dr. Deb Levy
Inflammation of the anterior or posterior (or both) chambers of the eye can be asymptomatic and sight threatening. A combined rheumatology/ophthalmology uveitis clinic was initiated in 2017 to provide coordinated care for children and adolescents with uveitis.
The quarterly clinic is co-led by Dr. Deborah Levy from Rheumatology and Dr. Nasrin Tehrani from Ophthalmology. Although these two divisions care for more than 200 children and adolescents with uveitis (either idiopathic, or as a manifestation of JIA or other rheumatic disease), the clinic was initiated to serve a select population of patients who would derive the greatest benefit from the combined clinic. This includes children and adolescents who have the most severe and difficult to treat uveitis, in addition to families who travel a significant distance for their appointments.
Physician: Dr. Deb Levy
The Division of Rheumatology provides care to patients in remote regions of Ontario as rheumatologists are not available locally. To improve access to care and to decrease travel for some families, a Northern Telemedicine clinic was established. Children and adolescents with arthritis require a physical examination, so traditional telemedicine with the patient at one end and physician at the other is not feasible.
In the current clinic, an Advanced Clinician Practitioner in Arthritis Care (ACPAC)-trained physiotherapist residing in Thunder Bay is able to see and examine patients locally, with a pediatric rheumatologist (Dr. Deborah Levy) at SickKids reviewing and discussing the management plan with the family and therapist via telemedicine (through the Ontario Telemedicine Network). This clinic was initiated in 2017 with pilot research funding, and through ongoing funding from the Ontario Rheumatology Association and more recently an “Improved Models of Care” grant, long term sustainable funding is being sought. Initial evaluations and satisfaction measures of the clinic have been presented at local and national rheumatology meetings and an upcoming publication is expected.
When possible, tests/infusion/procedures are done on an outpatient basis on 4C. Referrals are made and joint injections are scheduled in Image Guided Therapy. A rheumatology fellow and a staff physician are assigned to perform the injections. The clinic nurse co-ordinates the booking including orders, and initiates phone contact with the family to review pre-operative procedures and then sends an information letter outlining specifics discussed during the phone call.
For quality assurance purposes, a follow-up call 48 hours post procedure is mandatory to review the patient’s status, address concerns and ensure appropriate follow-up. Medication infusions (IVIG, cyclophosphamide, infliximab, tocilizumab and rituximab) are administered on a weekly or monthly outpatient schedule according to specific patient protocols.
We aim to coordinate formal clinic visits with 4C admissions, in order to limit the burden on families. There are some patients receiving these infusions at designated external centres that require co-ordination and monitoring by rheumatology staff. In addition, occupational and physiotherapy practitioners provide interim follow up and pre-infusion assessment for patients on 4C.
In order to address an increase in patient consultations, a Triage Clinic was formed in 2016. The Triage Clinic allows our Allied Health Team (OT & PT) to review incoming consult requests and either direct them to a more appropriate service or provide an initial patient assessment.
In response to the lack of proper transition resources for our arthritis patients, we have recently started an Arthritis Transition Program with a paediatric and adult rheumatologist at Women’s College Hospital.
Preparing for your appointment
First-time visitors and parents may be confused about what to bring to their child’s appointment, where to park, and how much time they’ll need. Below we detail important information that will ensure your child’s appointment goes as scheduled.
Please allow enough time for:
- Completing the hospital infection screening questions
- Locating the clinic in the hospital
- Registering your child at the clinic
We suggest you leave at least 30 minutes to get to your appointment from the time you enter the hospital.
Please be prepared to be here for up to 3 hours for your first appointment. Your child will have a full assessment and may need x-rays, blood and urine tests. We suggest that you bring extra diapers, formula, snacks, and a favourite toy/book/device for your child.
It is very important to bring the following:
- Your appointment letter (or email-printed or mobile)
- Family/Referring doctor’s name and phone number
- Name/Address of family doctor/paediatrician where reports need to be sent
- Your child’s health card (OHIP card)
- Any medical test results done outside SickKids e.g. bloodwork reports, x-ray/MRI pictures on a CD
- List of any medication your child is taking (including dose and frequency)
- Shorts and t-shirt for child to wear during examination
- Remove any nail polish your child is wearing as rheumatologist may need to look at your child’s fingernails as part of the examination
- Immunization record
We're a teaching hospital
As SickKids is a teaching hospital, you may meet several people during your visit. We train doctors, nurses and other health care professionals in our Rheumatology Clinic.
We're a research hospital
As SickKids is a research hospital, you may be invited to take part in research studies.
Please see our introduction to research letter (PDF) from our team.
News Rheum is a newsletter created by the Rheumatology Family Advisory Council that contains Rheumatology Clinic articles, updates and events. You can read our latest edition or subscribe below!
Brian M. Feldman, MD, M.Sc, FRCPC
Head, Division of Rheumatology
Expand the sections below for full SickKids Rheumatology staff lists.
Dilan Dissanayake, MD, FRCPC
Linda Hiraki, MD, ScD, FRCPC
Andrea Knight, MD, MSCE
Ronald M. Laxer, MDCM, FRCPC
Deborah M. Levy, MD, MS, FRCPC
Elizaveta Limenis, MD, FRCPC
Rayfel Schneider, MBBCH, FRCPC
Earl D. Silverman, MD, FRCPC
Lynn Spiegel, MD, FRCPC
Shirley Tse, MD, FRCPC
Program Director & Staff Rheumatologist
Ruud Verstegen, MD, PhD
Rae S.M. Yeung, MD, PhD, FRCPC
Alisa C. Rachlis
Toronto Kindercare Pediatrics
Phone: (416) 848-7665
Fax: (416) 848-7664
Clare M. Hutchinson
North York General Hospital
Department of Pediatrics
Phone: (416) 756-6479
Fax: (416) 756-6152
Gordon S. Soon
St. Joseph's Health Centre Toronto
Department of Paediatrics
Phone: (416) 530-6625
St. Michael's Hospital
Department of Paediatrics
Phone: (416) 360-4000
Nicholas S. Blanchette
Mississauga Credit Valley Hospital
Department of Paediatrics
Phone: (905) 813-4120
Fax: (905) 813-4128
Karoon C. Danayan
Phone: (416) 466-1311
Fax: (416) 466-9629
- Audrey Bell-Peter, MN, BScN, RN
- Holly Convery, RN, BScN
- Ma’Anne Garawan, HBSc, BScN, RN
- Michelle Anderson, BScN, RN
- Christine O’Brien, OT Reg (Ont.), M.Sc., B.Sc.
- Jo-Anne Marcuz, MScPT
- Kristi Whitney MSc, BScPT, ACPAC (C)
- Neely Lerman, MSW, RSW
Recent staff awards & achievements
SickKids Rheumatology staff are recognized across North America for their outstanding contributions to the field, teaching and education.
Dr. Rayfel Schneider - 2021 Dr. Susan Tallet Award
The clinical research program includes studies of the major paediatric rheumatic diseases focusing on outcomes, prognosis and treatment.
The Division has become the lead centre for a number of international treatment trials for new therapeutic agents in childhood arthritis. Currently, the division has four established labs; fronted by Drs. Rae Yeung (recently Dr. Dilan Dissanayake has joined her lab), Brian Feldman, Linda Hiraki and Andrea Knight, with other faculty members also participating in clinical trials and ongoing research studies.
You can learn more about each doctor’s specific research activities by expanding their names below.
Dr. Dilan Dissanayake is a Transition Scientist, and newest addition to our faulty as well as the Research Institute. His research focus includes the UCAN CAN-DU international study and immunophenotyping of blood samples from patients with juvenile idiopathic arthritis at various stages of their disease course. Using both mass cytometry and single cell gene expression techniques, Dr. Dissanayake is using a 'multi-omic' approach to identify patterns that correlate with treatment response, with the hope of ultimately generating predictive indicators that can help guide management decisions.
Additionally, through this study, as well as through specialized disease clinics, Dr. Dissanayake is identifying patients who have an atypical or severe phenotype with a likely monogenic cause, in order to discover novel gene variants and their functional contribution to disease. By doing so, he aims to not only develop treatment options for these patients, who are often refractory to standard therapies, but also to shed light on the pathways that contribute to disease in the larger population.
Dr. Brian Feldman and his lab team work to develop, test, and/or refine study designs and outcome measures for use in clinical trials and outcome studies. Dr. Brian Feldman has made contributions to the understanding of the prognosis and treatment of juvenile dermatomyositis (JDM), the cost–effective prevention of arthropathy in severe hemophilia, the effectiveness of exercise as medicine, and other lifestyle changes in childhood chronic disease, and the course and outcome of systemic juvenile idiopathic arthritis (JIA) and juvenile systemic lupus erythematosus (SLE).
Dr. Linda Hiraki is a Clinician-Scientist in the Division of Rheumatology and Scientist-Track investigator in the Child Health Evaluative Sciences program at SickKids. Dr. Hiraki’s current research interests include examining the genetic contribution to complex, rheumatic diseases and their associated long-term outcomes. She is applying methods that take advantage of rich, longitudinally collected clinical data along with both common and low-frequency genetic variants to discover new genetic associations with manifestations and complications of the complex disease.
Dr. Hiraki is also employing novel methods to transethnic studies of admixed populations with complex diseases. Hiraki is also interested in using repeated measures to better characterize disease course, and identify both environmental and genetic risk factors for adverse outcomes in rheumatic disease.
Dr. Andrea Knight is a Clinician-Investigator in the Division of Rheumatology and Associate Scientist in the Neurosciences and Mental Health program at SickKids. She has investigated the burden of psychiatric morbidity as well as strategies to improve comprehensive care for youth with systemic lupus erythematosus, and other rheumatologic disease. She is also investigating the impact of inflammatory diseases such as lupus on brain structure, function and development. Dr. Knight’s clinical research program seeks to improve mental health and overall outcomes for pediatric patients with pediatric systemic lupus erythematosus (pSLE), and other rheumatologic disease.
She is utilizing cognitive and psychiatric measures along with advanced neuroimaging techniques, to examine the impact of pSLE on neurocognitive health and brain development, and to identify mechanisms of neuropsychiatric dysfunction in pSLE. Understanding the underlying mechanisms will enable development of approaches for early detection and targeted treatment of neuropsychiatric disorders in pSLE. She is using administrative data, survey and mixed methods approaches to understand the effect of psychiatric comorbidity on outcomes, and to develop and test mental health interventions for these patients.
Dr. Rae Yeung and her team work to understand the molecular and cellular mechanisms governing autoimmunity with a strong focus on Kawasaki disease, Systemic Vasculitis and JIA. Currently a large team has been focusing on the UCAN CAN-DU: Canada – Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases, which received a total of $18M in funding since 2017. The network brings together clinicians, researchers, consumers and health policy makers from across Canada and the Netherlands, to share knowledge, expertise, recourses, platforms and technologies, in order to enhance the efficiency of research and ensure rapid uptake of discoveries and tools into practice and policy.
The Division of Rheumatology Medical Training Program offers training at the medical undergraduate and postgraduate levels. Trainees and electives are appointed through the Department of Paediatrics, University of Toronto and Medical Affairs at The Hospital for Sick Children (SickKids).
Expand each program below to read specific details, and for more information regarding our medical education programs, eligibility, and deadlines to apply, please contact firstname.lastname@example.org.
Students are integrated as a member of the Paediatric Rheumatology Program and participate in Ward Rounds, Consults and Ambulatory Clinics. They are given responsibility for history-taking, physical examination, investigation and management decisions under the supervision of the relevant medical staff. They also attend all academic sessions and rounds of the Division.
The Division of Rheumatology offers postgraduate elective rotations of two to four weeks in duration for trainees enrolled in the University of Toronto and other residency programs. During the elective period, the resident attends Rheumatology outpatient clinics and joins the staff, fellows and medical students on the inpatient and consultation service.
The fellowship program is a two-year clinical program and is accredited by the Royal College of Canada. The training program ensures graduates have all the required skills to function as academic paediatric rheumatologists. Our teaching faculty consists of 12 full-time and part-time rheumatologists (as well as our community rheumatology partners) with diverse clinical and research interests.
The clinical program is one of the largest in North America and provides trainees with the opportunity to assess and manage a full spectrum of paediatric rheumatic diseases. The trainees monitor patients from admission to discharge and follow-up in the ambulatory clinics, ensuring they are able to develop an understanding of the natural history and long-term treatment of rheumatic diseases.
The inpatient rotation includes the assessment and management of patients, as well as a consultation service which allows the trainees to see the many rheumatic manifestations of systemic disease.
Trainees also rotate through the medical day care unit (4C) where they supervise infusions and perform intra-articular corticosteroid injections. They are also responsible for emergency room consultations.
Trainees participate in four to six-month rotations within the general rheumatology clinic and in each of the specialized disease clinics: systemic lupus erythematosus, neonatal lupus, systemic juvenile idiopathic arthritis, juvenile spondyloarthritis, juvenile dermatomyositis, systemic vasculitis, Kawasaki disease, autoinflammatory syndromes and morphea. Trainees also participate in their own longitudinal continuity clinic during the course of their fellowship. There is exposure to community paediatric rheumatology clinics where trainees are able to learn a more community-based approach.
Residents and fellows are required to participate in a one-month adult rheumatology rotation.
Electives can be completed in a variety of disciplines including: paediatric immunology, orthopedics and radiology.
The residents and fellows have a close relationship with the teaching staff who ensure there is graded responsibility with greater independence of the residents and fellows expected as they gain experience.
There is a comprehensive academic program which has been consolidated into a weekly academic half day. This half day includes paediatric rheumatology teaching sessions (core curriculum and subspecialty rounds), research rounds (where division members and fellows present research projects or projects in evolution), journal club/clinical epidemiology rounds, pathology rounds, morbidity and mortality rounds, ethics seminars and a clinical research tools course.
The program has a strong focus on research that trainees are expected to initiate during the first year of their training. They are expected to complete a scholarly project in either basic science, clinical, translational, educational or quality research. Projects are presented at the Department of Paediatrics' Research Day and the Rheumatic Disease Unit Research Day (Ogryzlo Day). Abstracts are usually submitted for presentation at the American College of Rheumatology Annual Meeting.
Trainees who wish to pursue independent, investigative research careers are encouraged to complete an additional year(s) of training.
The program offers two (2) positions under the Canadian Rheumatology Association Summer Studentship Program. This program allows for medical students to garner experience in paediatric rheumatology. They have the opportunity to see a full spectrum of paediatric rheumatic diseases.
Applications for the 2021 summer program have closed.
We are recruiting for multi-talented individuals of various backgrounds (arts, education, communication, technology, science, etc.) to join the SPARRK Team. The team supports a variety of initiatives within the Division of Rheumatology. Volunteer opportunities occur during working hours on weekdays.
To apply for the 2021 SPARRK team, please submit the following items to email@example.com:
- Unofficial transcript/report card (if you are in school or have graduated within the last five years)
Applicants must submit all items in order to be considered.
A select number of candidates will be invited to an informational interview to learn about the various opportunities available within the SPARRK program.
Clinic #9, Main Floor Burton Wing
Division of Rheumatology
The Hospital for Sick Children (SickKids)
555 University Avenue
For medical emergencies only
Phone: 416-813-7500 and ask for the rheumatology fellow on-call.