Our primary training site is in the Texas Medical Center (largest medical center in the world) which lends to seeing rare presentations of autoimmune diseases. Fellows also spend considerable time at the county hospital which cares for our indigent population We have world experts in both scleroderma and spondyloarthritis and our 2nd year fellows spend 4 months in both scleroderma and spondyloarthritis clinic. Additionally, 2nd year fellows spend 1 day/week in ultrasound clinic.