The Improbable Journey of PsA Maestro Philip Mease

It was Aug. 14, 2003, and Philip Mease was on the brink of success. He was trying to do something that had never been done: launch a multi-disciplinary organization of scientists and clinicians with a strong interest in the field of psoriatic disease. After two years of discussions, Mease had 90 rheumatologists, dermatologists, epidemiologists and other specialists converging on a hotel in Manhattan for their first meeting.

There was just one obstacle: the Northeast blackout of 2003.

Due to the chaos over New York, Mease’s plane was diverted to Newark, New Jersey. The trains to the city weren’t running. He snagged a taxi at the airport, but the driver would only take him as far as the Jersey side of the Holland Tunnel. Mease remembers the driver “dumping me in 10 lanes of traffic,” which was not as dangerous as it sounds. With no power for traffic signals, all of those cars were, at best, crawling.

He hitchhiked into Manhattan, found his hotel, and, in the gloom inside the hotel, his suite. The researchers gathered in the conference hall without the benefit of slide decks, coffee, air conditioning or electricity, but in a mood Mease characterizes as “high camaraderie.” The next day they relocated to a hotel that had power and that was willing to host a conference of 90 people with no advance notice.

There’s a reason why Kristina Callis Duffin, M.D., M.S., co-chair of the department of dermatology at the University of Utah and an NPF medical board member, describes Mease as someone who is kind, humble and calm. “I’ve rarely seen him flustered,” she says.

Fifteen years later, the group that began in a room with people talking about skin, joints and treatments while waving flashlights is now the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis. Among the approximately 1,000 members of GRAPPA are researchers and thought leaders in psoriasis and psoriatic arthritis – and, since 2015, patients.

GRAPPA facilitates the sharing of information, promotes research, develops guidelines for treating PsA written in lay language, and nurtures early-career rheumatologists and dermatologists.

April Armstrong, M.D., MPH, associate dean of Clinical Research at the Keck School of Medicine at the University of Southern California, is one of many dermatologists who has worked closely with Mease.

“I met Philip at my first GRAPPA meeting about 10 years ago, but I’d known him from his reputation and research in the PsA world,” says Armstrong, a former NPF medical board member. Together, they formed a dermatologist-rheumatologist panel to help doctors learn how to evaluate psoriatic disease patients.

“He’s a very thoughtful person, very interested in developing the careers of young investigators dedicated to psoriasis and PsA research,” she says.

Duffin met Mease around 2001 when she was a research fellow working on genetics projects at the University of Utah. She got to know Mease better after 2007 when GRAPPA invited her to speak. She’s now the president of the organization.

“We have a common goal of video training for rheums and derms,” Duffin says. “He got me involved in this project, and it launched me as an end-point specialist.” She calls that an important moment in her career.

Colleagues describe Mease as someone they can – and do – turn to.

“I’m comfortable asking him questions about patient care and he’s generous with his clinical knowledge,” Armstrong says. “He’s very generous with his time and generous giving himself to the world around him.”

“I talk to Philip all the time,” Duffin says. “I wouldn’t hesitate to ask for his advice.”

Helping to create GRAPPA might be enough of an achievement for one person. That person is not Philip Mease.

Back When He Rode a Mule

Mease grew up in Kentucky. In school, he was a swimmer, a cellist and the student body vice president. His academic strengths were literature, history and philosophy. He had no thoughts about science or practicing medicine, and in his years at Phillips Exeter Academy in Exeter, New Hampshire, he took just one year each of biology and algebra.

It was, he says, “a happy life.”

In his freshman year at Stanford University, Mease continued his tour through the liberal arts, studying Dostoevsky and Mandarin. He experienced a “life-altering moment,” however, when the dean of Stanford introduced him to David Werner, author of Donde No Hay Doctor (Where There Is No Doctor: A Village Health Care Handbook). Werner described his work as a self-taught “doctor” in Ajoya, Sinaloa, Mexico, a small rural village in the foothills of the Sierra Madre Mountains, a settlement so isolated that you had to make the last leg of the journey aboard a mule. Werner suggested that Mease take his place.

“I got fired up,” Mease says. “I was going to be a barefoot doctor. I took Werner’s place during my sophomore year. I had no medical training, but I had Donde No Hay Doctor. And I had a library.” Mease turned 20 during the nine months he spent in Ajoya, where he was the only North American for miles. He extracted teeth, performed minor surgery and decided that medicine would be his life.

Mease returned to Stanford as a medical student and made up his academic gaps. He settled on a specialty. “Internal medicine is the thinking person’s specialty,” he says. “It’s more scholastic.”

In 1976, he traveled to Seattle for a tour of the University of Washington under the care of the chief resident of Harborview Medical Center (the university’s affiliated hospital). Mease chose to stay for a rheumatology fellowship. The Harborview resident, whom Mease describes as “a generous, civil person,” set the tone for Mease’s stay there.

“The rheumatology department back then was tiny, only three full-time faculty, all molecular bench workers,” he says. “But I had wonderful mentors.” He calls out the late Bruce Gilliland, M.D., who moved to Seattle in 1960 to begin his medical career and spent 45 years with the University of Washington School of Medicine as an intern, resident, fellow, physician, administrator and professor.

Mease wrote his first paper during his third year of residency, when he had a patient with a rare disease – the man couldn’t produce his own globulin (a protein found in the blood). “Twenty-six drafts later, I had a paper,” he says. He has since published more than 450 papers, and was the lead author or co-author of most of the papers the American College of Rheumatology and NPF used to develop the 2018 Guideline for the Treatment of Psoriatic Arthritis.

That case and his mentors led him to declare rheumatology as his second specialty.

First Brush with Biologics

Mease began his private practice in Seattle in 1982. He became “heavily involved” in treating PsA patients in the early 1990s. “I was a clinician then, not an investigator,” he says. “I got to spend all of those years with my family without having to travel. But I was afraid of burning out just seeing patients, and when my children were older my academic ambition got revved up.”

His revving began in 1999 when a Seattle-based pharmaceutical company approached him about a new type of drug. This drug was designed to fight inflammation by interfering with or inhibiting a cytokine called tumor necrosis factor. Cytokines are proteins that can cause abnormal activity in the body’s immune system.

The drugmaker wanted Mease to design and conduct a trial for this drug with his rheumatoid arthritis patients, but Mease suggested his PsA patients instead. The company agreed. The study of this trial and the drug’s effect on psoriatic arthritis was eventually published in The Lancet. “After that, my life changed again. I got much more involved in PsA as a disease.” He designed more trials for these early biologics including all the interleukin-17s (another pro-inflammatory protein).

Mease’s altered career path led him to work with established figures in the field. In 2001, he put on a webinar about PsA with Dafna Gladman, M.D., a professor of medicine at Toronto Western Hospital in Ontario, Canada. (She also has a long history with NPF as a former medical board member, a current board of directors member and a 2013 research grant recipient.) “She’d written everything on the topic. She was a goddess to me,” he says. “I was very honored to work with her. We’ve since become solid friends and colleagues.”

Mease’s success in his field hasn’t changed his basic personality. Duffin recalls a presentation Mease made at the University of Utah when she was a research fellow. “One thing that impressed me,” she says, “is that Philip had a slide with an error on it regarding a particular chromosome. It wasn’t exactly wrong, but it wasn’t exactly right.

“The department chair said, ‘Excuse me, Philip,’ and pointed out the error. Philip listened, said, ‘Oh, OK,’ stopped the PowerPoint, corrected the slide right there at the podium, and went on with his presentation.”

Off the Clock

“Philip is not your typical rheumatologist,” Armstrong says. “He has a variety of different interests outside of medicine. He has many different dimensions.”

Mease unwinds by hanging with his wife, Laura Kastner, a clinical psychologist and author of books on parenting adolescents, “she on the sofa, me on a chair, both with our laptops.” They have two grown children and two dogs. But while Mease appears to be relaxing, he does not appear to be putting on the brakes.

“People are surprised to learn I’m still in private practice. I still see 70 to 80 patients per week,” Mease says. “That’s precious. You don’t want to give that up. At heart, I’m more of a clinician. My nurse practitioners do all the heavy lifting, though.”

When he’s not seeing patients or conducting trials, Mease has returned to his childhood interest in the cello. He’s a member of the Seattle Rock Orchestra Social Club, which forms flash mobs and covers Radiohead. “I’d like to get into social justice stuff if my current life ever slows down,” he says.

Photo: Daniel Berman