Newsroom Hospital for Special Surgery

Celebrating Giselle Morales and RMH-NY Social Workers

Mon, 20 Apr 2026 11:29:33 -0400

Ronald McDonald House New York has published a feature highlighting the story of Giselle Morales, LCSW, social work program manager at HSS who focuses on patients living with lupus, an autoimmune disease that often hides in plain sight.

The piece focuses on Morales' dual perspective, both as a professional who regularly refers families to supportive services, and as a parent who unexpectedly needed those same resources during her daughter's NICU stay. Her personal experience as a parent of a premature infant has deepened her approach to patient care.

“I wanted to be in a position where I can help people… but also feel seen, supported, empowered,” said Morales. After her daughter was born at 32 weeks, she added, “I knew about the House…but I didn't think I qualified. I didn't want to take from someone else.”

Her month-long stay at Ronald McDonald House New York allowed her to remain close to her newborn, advocate during critical moments, and experience firsthand the stability the House provides. “Connection is healing,” she said. “Being able to be there… it's everything.”

This coverage originally appeared on rmh-newyork.org. The original article is no longer available online.

Early Autoimmune Signals: The Role of AIHA in Identifying SLE

Wed, 01 Apr 2026 17:56:00 -0400

Rare Disease Advisor reported on early autoimmune signals featuring insight from Romy Kallas, MD, rheumatologist at HSS.

Autoimmune hemolytic anemia (AIHA) is highly prevalent in patients with systemic lupus erythematosus (SLE), and some studies report poorer outcomes in patients with both conditions. Taken together, these findings underscore the importance of early detection of SLE-associated AIHA.

“Although less frequent than thrombocytopenia or leukopenia, AIHA remains one of the most common hematologic manifestations of SLE,” said Dr. Kallas.

In many cases, AIHA presents early in the SLE disease course and represents the first sign of that disorder. Dr. Kallas cited a study published in 2000 showing that AIHA was the initial disease manifestation in 66% of participants with SLE.

Read the full article at rarediseaseadvisor.com.

Why Are My Hands and Feet So Cold?

Tue, 02 Dec 2025 12:22:00 -0500

Jessica K. Gordon, MD, rheumatologist at HSS, shares insights with The New York Times on cold hands and feet and when this may indicate a more serious underlying issue.

About 5 percent of Americans have Raynaud’s syndrome, in which spasms of the arteries in the hands and feet, usually caused by cold or stress, temporarily cut off blood flow. This can cause the fingers and toes to change color, said Dr. Gordon — white and blue in lighter skin, or more yellow and purple in darker skin. While Raynaud’s is generally harmless, it can occasionally be caused by serious autoimmune diseases like lupus or scleroderma, she added.

Read the full article at nytimes.com. A subscription is required to access.

New SLE Guidelines Endorse Expanding HCQ, Restricting Glucocorticoids

Mon, 10 Nov 2025 13:24:00 -0500

Med Central reports that The American College of Rheumatology has updated its recommendations for the treatment of systemic lupus erythematosus (SLE) with key changes in the areas of screening, treatment, and monitoring. The guideline was recently published in Arthritis Care & Research.

The goal of the new guideline is to provide evidence-based expert guidance on treatment and management of non-renal SLE. The update emphasizes glucocorticoid tapering and discontinuation when possible, and acknowledges the persistent impact of health care disparity as a barrier to accessing care. A separate ACR guideline on lupus nephritis is awaiting publication.

Lisa R. Sammaritano, MD, rheumatologist at HSS served as lead author of the new guideline and presented the update at the annual meeting of the American College of Rheumatology (ACR Convergence 2025).

Read the full article at medcentral.com.

ACR Issues First Update to Lupus Guideline Since 1999

Fri, 07 Nov 2025 13:21:00 -0500

Medpage Today reports that the long-awaited updates to the American College of Rheumatology's (ACR) guideline on systemic lupus erythematosus (SLE) management make clear that hydroxychloroquine (HCQ) should be the centerpiece of treatment for most patients, with other medication classes added as needed to reach low disease activity (LDA) or remission.

Written by Lisa R. Sammaritano, MD, rheumatologist at HSS, and a committee of nearly 50 other experts, the new guideline also stipulates that corticosteroids are OK for gaining symptom control in newly diagnosed patients and when flares erupt, but the duration should be kept as short as possible.

Read the full article at medpagetoday.com.

How Does Menopause Impact Your Autoimmune Disease?

Tue, 28 Oct 2025 15:57:00 -0400

Caroline H. Siegel, MD, MS, rheumatologist at HSS shares how menopause can impact your autoimmune disease in an interview with Health Central.

According to research in Frontiers in Endocrinology, every time a woman experiences a major hormonal transition or fluctuation—in puberty, pregnancy (when applicable), and menopause—the immune system is affected. More specifically, there seems to be a link between these transitional states and the development of autoimmune diseases such as MS, lupus, RA, type 1 diabetes, and psoriasis, and possibly the progression, as well.

This can ultimately lead to worsening of disease in some women. “Some studies have found that the menopausal transition may accelerate functional decline in women with rheumatoid arthritis,” said Dr. Siegel. The same is true for psoriasis and psoriatic arthritis, according to Italian research, which found that low levels of estrogen can also trigger or worsen skin symptoms in both illnesses.

Read the full article at healthcentral.com.

Lupus: 11 Things Doctors Want You to Know

Mon, 15 Sep 2025 16:50:12 -0400

According to Healthgrades, Lupus is a disease that can affect almost any part of the body and can be mistaken for conditions from arthritis to rosacea. Flu-like illness, joint pain and skin problems are only a few of the many symptoms of lupus, which can also lead to more serious complications like heart and kidney disease. Lupus is a complex but usually manageable illness, as experts including Jane E. Salmon, MD, rheumatologist at HSS explain.

There is a test that can help diagnose lupus, but it’s only part of the picture. “An ANA test is a blood test that’s positive in the overwhelming majority of people with lupus, but not everybody with a positive test has lupus,” Dr. Salmon explained.

Women of childbearing age are the most likely to develop lupus, so pregnancy must be carefully timed for women who have the disease. “If your disease is quiescent–not active–and you’re on low doses of steroids, you’re feeling good, all of your organs are working well, and you don't have active kidney disease, then your pregnancy is likely to be uncomplicated,” said Dr. Salmon, who studies lupus and pregnancy.

Read the full article at healthgrades.com.

Past ACR President Named a PANLAR Master

Tue, 08 Jul 2025 10:06:00 -0400

During the 2025 Congress of the Pan-American League of Rheumatology (PANLAR), held in Mexico City, Mary K. Crow, MD, rheumatologist at HSS, was designated a PANLAR Master of Rheumatology. This distinction is awarded to individuals whose scientific contribution and/or recognized academic work has contributed significantly to the development of rheumatology in their country.

Dr. Crow, a former ACR president and Henry Kunkel Society president, said she experienced a warm reception from PANLAR attendees, and that it was very gratifying to receive this honor—not just the award itself, “but what it means for other people having a relationship with you and your work.”

Read the full article at the-rheumatologist.org.

A Cutting-Edge Cancer Therapy Offers Hope for Patients With Lupus

Wed, 18 Jun 2025 13:24:17 -0400

The New York Times reports that CAR T-cell therapy, a kind of “living drug” that modifies patients’ immune cells to help them attack misbehaving ones, has been used with significant success to treat some cancers, particularly of the blood. A growing body of evidence has suggested that the therapy can also treat a severe form of lupus that, at best, can be managed as a lifelong condition and, at worst, resists treatment and can lead to organ failure and death.

“It’s really promising, and honestly the first therapy that we’ve talked about as a cure,” said Lisa R. Sammaritano, MD, rheumatologist at HSS, and the lead author on a set of recently updated guidelines for lupus treatment. Until now, she said, “we haven’t had a cure — we’ve had control.”

Read the full article at nytimes.com. A subscription is required to access.

HSS Study at EULAR 2025 Congress Uses an AI Model to Predict Readmissions of Pregnant Women with Lupus Based on Social Determinants of Health

Sat, 14 Jun 2025 08:00:00 -0400

Hospital for Special Surgery (HSS) presented a research study at the European Alliance of Associations for Rheumatology (EULAR) Annual Meeting showing that an artificial intelligence (AI)-based model can predict readmissions of pregnant women with lupus by looking at patients’ social factors and clinical comorbidities.

Systemic lupus erythematosus (SLE), commonly known as lupus, is a chronic autoimmune disease in which the immune system attacks the individual’s own healthy tissue, causing pain, inflammation, and eventually damage to various organs. It commonly affects young women, and pregnancy is a particularly vulnerable period for this high-risk population. Although lupus-related medical complications affect pregnancy outcomes, social determinants and economic conditions, known as social determinants of health (SDOH), may also be important in shaping maternal health outcomes.

“Pregnant women with lupus have five times higher maternal mortality compared to those without lupus,” said Sandhya Shri Kannayiram, MBBS, MD, rheumatology fellow at HSS and principal author of the study. “There is little data on how social factors, including Income, Insurance, housing stability, access to transportation, availability of utilities, and literacy, along with clinical comorbidities, affect pregnancy outcomes in individuals with lupus.”

To better understand how SDOH impact readmissions for pregnant patients with SLE, the team used ten-year data (from 2011 to 2021) from the National Readmissions Database of the US, encompassing approximately 66,000 hospitalizations in the United States, and counted the number of readmissions within 30 days of discharge during pregnancy and delivery. “We found that approximately 2,500 [pregnant women with lupus] were readmitted to the hospital within 30 days,” said Dr. Kannayiram.

“We used a supervised ‘glass box’ machine learning model called the Explainable Boosting Machine (EBM), which helped predict who is likely to return to the hospital within 30 days,” said Dr. Kannayiram. She explained that EBM is a form of machine learning with a type of AI that learns from data to make predictions. “It’s an AI model that can be trained on the dataset to predict outcomes with transparency and accuracy compared to traditional statistical models,” she added.

The team specifically examined the major social determinants from the database that may influence readmissions during pregnancy in SLE, including Income and insurance status (public, private, or self-pay). Dr. Kannayiram explained that the results obtained showed patients living in lower-income neighborhoods were nearly twice as likely to be readmitted compared to those from wealthier areas, and those with Medicaid or Medicare insurance were more likely to be readmitted within 30 days. Patients discharged to locations other than home, such as rehabilitation facilities or nursing homes, were also more likely to return. However, they also found unexpected correlations. “We found that the size of hospitals was highly related to readmissions, rather than the location, such as cities or rural areas,” said Dr. Kannayiram, with large hospitals being the ones with more readmissions. Additionally, unlike most pregnancy studies, where older mothers are usually at higher risk, this study found that younger women with lupus were more likely to be readmitted. Dr. Kannayiram said that this result may be related to severe lupus in younger individuals since about half of the readmitted patients had Medicare coverage, which may suggest a high prevalence of disability or kidney disease within that younger population.

By using the predictive AI model, the team also discovered that income and insurance status were among the top five predictors of 30-day readmission during pregnancy and delivery-related hospitalizations, explained Bella Mehta, MBBS, MS, MD, rheumatologist at HSS and lead author of the study. She noted that these results could inform targeted interventions, such as policy actions to advocate for improved Medicaid and Medicare coverage, as well as post-discharge care coordination. “Integrating SDOH screening into prenatal care for SLE patients, and incorporating a multidisciplinary team of social workers, could reduce preventable readmissions and improve maternal outcomes,” added Dr. Mehta.

According to Dr. Mehta, in future studies, the team plans to analyze in detail how individual-level social factors, such as housing instability, food insecurity, education, mental health, transportation access, and patient demographics, interact with clinical comorbidities to determine pregnancy outcomes for women with SLE. “This study underscores the vital intersection between clinical care and structural inequality,” said Dr. Mehta. “The lupus community and broader maternal health initiatives must not only consider disease management but also address the social factors that influence outcomes.”

Poster details

Title: Predictors of 30-Day Readmissions in Pregnant Patients with Systemic Lupus Erythematosus: The Role of Social Determinants of Health
Authors: Sandhya Shri Kannayiram, Yiyuan Wu, Lisa Sammaritano, Michael Lockshin, Rich Caruna, D. Ware Branch, Jane E. Salmon, Bella Mehta.
Abstract n°: 2325
Presentation: June 14th, 2025. 10:00 AM CEST

My Lupus Symptoms Went Away During Pregnancy—but Returned With a Vengeance Postpartum

Mon, 09 Jun 2025 13:28:00 -0400

HSS patient, Kiana Cornejo, is featured in SELF magazine where she shares her personal experience living with lupus and navigating pregnancy with a chronic illness. Diagnosed at age 11, Kiana discusses the challenges she faced, the importance of a supportive care team, and how HSS helped her manage her health during pregnancy.

Read the full article at self.com.

Pregnant mothers with lupus face risks but have better outlooks than ever before, doctor says

Tue, 27 May 2025 15:15:06 -0400

CBS News featured Lisa R. Sammaritano, MD, rheumatologist at HSS, in a story highlighting the improved outlook for pregnant women living with lupus. The segment follows HSS patient Kiana Cornejo, who was diagnosed with lupus at age 11 and navigated a high-risk pregnancy with careful planning and medical guidance. Dr. Sammaritano emphasized that with proactive disease management and appropriate medication adjustments, women with lupus can achieve healthy pregnancies.

Watch the story at cbsnews.com.

Social Isolation a Common Theme Among Older People With SLE

Tue, 27 May 2025 13:06:00 -0400

Med Page Today reports that in a study published in ACR Open Rheumatology, 30 older adults with systemic lupus erythematosus (SLE) with a mean age of 71.3 years reported a sense of social isolation and a reluctance to burden loved ones -- realities that could justify an uptick in screening for isolation, investigators concluded.

First author Sarah Lieber, MD, MS, a rheumatologist at HSS, explained that screening for isolation could help improve care. Once this information is obtained, it is important for the clinician to be able to point to tangible resources. Resources may include local lupus support groups or an individualized referral to another member of the care team such as a social worker. It is also valuable to consider the extent to which social isolation reflects a response to lupus symptoms that can be addressed through further treatments.

Read the full article at medpagetoday.com.

Need Help With Lupus Nephritis Management? ACR Has Your Back

Thu, 08 May 2025 16:48:00 -0400

Med Page Today reports that over the past dozen years, treatment approaches in lupus nephritis (LN) have changed substantially, and this is reflected in a long-awaited update to the American College of Rheumatology's (ACR) official guideline on the topic.

Whereas a two-step plan -- induction followed by maintenance therapy -- was called for in the ACR's last LN guideline, issued in 2012, medications introduced since then have prompted a "conceptual shift" in LN management, according to Lisa R. Sammaritano, MD, rheumatologist at HSS, and co-author of the new update.

With targeted drugs including the biologic agent belimumab (Benlysta) and the calcineurin inhibitor voclosporin (Lupkynis) now available, management now centers on early and continued use of combination treatment "targeting different arms of the immune system," the group explained.

Read the full article at medpagetoday.com.

2024 Lupus Guideline

Wed, 07 May 2025 11:35:00 -0400

HSS rheumatologists Lisa R. Sammaritano, MD, and Kyriakos A. Kirou, MD, DSc, FACP, and clinical research coordinator Christele Felix contributed to the latest American College of Rheumatology (ACR) Clinical Practice Guideline. The manuscript provides recommendations regarding screening, treatment, and management of lupus nephritis (LN) in both adults and children.

Read the full article at rheumatology.org.

Lupus Research Alliance Grants Lupus Innovation Awards to Eleven Talented Researchers to Accelerate Pace of Discovery in Lupus Research

Tue, 15 Apr 2025 10:27:00 -0400

The Lupus Research Alliance is proud to announce the recipients of this year’s Lupus Innovation Award including Franck Barrat, PhD, the Michael R. Bloomberg Chair in Autoimmune Diseases at HSS and Theresa T. Lu, MD, PhD, the St. Giles Chair for Research in the HSS Research Institute, and pediatric rheumatologist at HSS.

This award addresses many critical themes in lupus research including novel therapeutic strategies, the impact of chronic inflammation, and the identification of biomarkers for improved diagnosis and monitoring. These prestigious grants provide investigators from around the world with up to $150,000 per year for two years to accelerate the pace of discovery in lupus research, empowering scientists to tackle high-risk, high-reward projects that could transform how lupus is understood and treated. Together, these projects highlight the breadth and creativity of approaches needed to solve the complex puzzle of lupus.

Read the full article at lupusresearch.org.

9 Essential Questions to Ask About Managing Lupus

Tue, 01 Apr 2025 12:22:00 -0400

Lisa R. Sammaritano, MD, rheumatologist at HSS and Director of the Rheumatology Reproductive Health Program of the Barbara Volcker Center for Women and Rheumatic Diseases speaks to Health Central about pregnancy and reproductive health considerations for women living with lupus.

Lupus, also known as systemic lupus erythematosus, is a chronic disease that causes the immune system to attack its own tissues. Anyone can get lupus, but mostly women develop the autoimmune condition. The inflammation that goes along with lupus can cause a variety of issues including arthritis, fevers, rashes, and fatigue.

Many women with lupus have concerns about whether they can safely become pregnant.

“Most women living with lupus can have successful pregnancies. The key to pregnancy success lies in planning. The presence of quiet or low-level disease activity improves outcomes for both mother and baby,” explained Dr. Sammaritano. Dr. Sammaritano says that six months of low disease activity before conception can reduce the risk of lupus flare during pregnancy and improve pregnancy outcomes.

Read the full article at healthcentral.com.

HSS Participates in Promising Phase 3 Lupus Trial of Investigational Therapy DZP

Tue, 19 Nov 2024 13:26:00 -0500

HSS rheumatologists Kyriakos A. Kirou, MD, DSc, FACP and David R. Fernandez, MD, PhD, participated in the multicenter Phase 3 clinical trial PHOENYCS GO, which evaluated dapirolizumab pegol (DZP) as a treatment for people with moderate-to-severe systemic lupus erythematosus (SLE). In fall 2024, UCB and Biogen announced positive results, presented at the American College of Rheumatology conference in Washington, D.C.

The study found that adding DZP to standard care led to greater improvements in disease activity, fewer severe flare-ups, and reduced corticosteroid use compared to placebo. The treatment was generally well tolerated, with mostly mild side effects.

For patients with SLE, this study suggests that DZP could be a promising new treatment option that helps better control lupus symptoms, potentially reducing flare-ups and the need for high doses of steroids.

For healthcare providers, this could mean having a new tool to offer patients who are not responding well to current treatments, helping to improve their disease management and quality of life.

Building on these findings, a second Phase 3 trial, PHOENYCS FLY, launched in 2025, with HSS again participating as a study site.

To view the full abstract, please visit: acrabstracts.org.

HSS Presents New Research at the ACR Convergence 2024

Sat, 16 Nov 2024 10:30:00 -0500

At this year’s American College of Rheumatology (ACR) annual meeting, HSS presented exciting research related to rheumatology and orthopedics.

Research highlights include a study showing that online search trends can lead to more personalized rheumatic disease care, and blood changes in people at risk for rheumatoid arthritis, a study revealing that having rheumatoid arthritis was not a risk factor for needing a blood transfusion during or after total knee replacement, new discoveries in antiphospholipid syndrome, the effectiveness of avacopan for severe vasculitis, new insights on rheumatic diseases and reproductive health and a study that shows knee osteoarthritis causes more pain and inflammation in women.

New Study Signals How Online Search Trends Could Lead to More Personalized Rheumatic Disease Care

Physicians are learning how to better support the needs of people with rheumatoid arthritis from online search trends, according to a new study from researchers at HSS and colleagues at Columbia University Vagelos College of Physicians & Surgeons.

New Research Reveals Alterations in Blood of People at Risk of Developing Rheumatoid Arthritis

A new study by HSS and collaborating centers identified distinct immune cell patterns in the blood that signal an increased risk of developing rheumatoid arthritis before symptoms occur.

Surprising Study Finds No Link Between Rheumatoid Arthritis and Transfusion Risk After Knee Replacement

Having rheumatoid arthritis was not a risk factor for needing a blood transfusion during or after total knee replacement, according to a new study by HSS researchers.

New Antiphospholipid Syndrome Research Findings Presented at ACR Convergence 2024

Investigators from the Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) presented new research findings in antiphospholipid syndrome (APS). These studies explore differences in clinical manifestations of APS in children versus adults, identify key risk factors for thrombosis in persistently antiphospholipid antibody-positive patients, and investigate the prevalence and implications of lupus-related autoantibodies in patients without lupus.

Study Shows Avacopan Effective for Most Serious Vasculitis Cases

New multicenter study by HSS and others by HSS shows avacopan is effective in achieving disease control with less steroid exposure in patients with ear, nose and throat manifestations of ANCA associated vasculitis.

HSS Presents Cutting-Edge Discoveries in Rheumatic Disease and Reproductive Health at ACR Convergence 2024

HSS presented a number of studies focused on reproductive health for patients with rheumatic diseases including factors influencing infant feeding, predicting pregnancy outcomes in lupus, and improving contraception screening for women on teratogenic medications in rheumatology.

Study Shows Knee Osteoarthritis Causes More Pain and Inflammation in Women

Women with knee osteoarthritis experience more pain and inflammation than men, according to a new study led by researchers at HSS and The Rockefeller University.

What to Know About How Lupus Affects Weight

Thu, 14 Nov 2024 21:46:30 -0500

TIME Magazine reports that 1.5 million Americans are estimated to have the autoimmune disease lupus and have plenty to manage with the pain, fatigue, hair loss, and heart problems the condition can cause. So, the last thing they need is to feel stigmatized or shamed because of their weight. But that’s exactly what has happened to celebrities with lupus like Selena Gomez.

In February 2023, the actor and singer shared with her social media followers that she tends to gain weight while taking certain medications to manage her condition and lose weight when she can stop taking those meds.

This side effect is just one of several ways lupus (also called systemic lupus erythematosus) is linked to changes in weight.

Sometimes, it’s fluid retention. “Fluid can accumulate in people with lupus if they have, for example, renal failure from lupus nephritis or heart failure,” said Kyriakos A. Kirou, MD, DSc, FACP, rheumatologist at HSS.

If that’s the case, diuretics and other treatments for the underlying disorder usually resolve the fluid retention too, he explained.

Read the full article at time.com.

Lupus Research Alliance Announces Inaugural Recipients of Translational Bridge Award

Thu, 07 Nov 2024 17:18:52 -0500

The Lupus Research Alliance (LRA) announced the first-ever recipients of the Translational Bridge Award (TBA), established this year to accelerate the translation of groundbreaking research into potential treatments and diagnostics for lupus. The award aims to propel high-potential projects from LRA-funded foundational discoveries with strong commercialization potential or an opportunity for clinical evaluation. Five exceptional researchers have been awarded the 2024 Translational Bridge Award to tackle pressing issues, from managing pain and fatigue to developing an alternative to the widely used glucocorticoids.

Providing up to $450,000 over two years, the TBA emerged as a key initiative of LRA’s newly developed Research Roadmap, an ambitious research strategy designed to integrate LRA’s efforts across all stages of lupus research, from early discovery through clinical application. By funding innovative, milestone-driven projects with strong commercial or clinical potential, the TBA is driving scientific advances that can be quickly moved from the lab to the clinic, benefiting those with this complex disease.

Among the recipients is Timothy B. Niewold, MD, FACR, rheumatologist at HSS who is advancing novel therapies for lupus. While lupus treatments have advanced, there remains an urgent need for safer, more effective therapies. Dr. Niewold and his collaborator Vineet Gupta at UTMB have developed a first-of-its-kind drug called ONT01, which targets a molecule called ITGAM. He will test ONT01, which has shown promising results in mouse models, in a phase 1b trial to assess its safety in people with lupus. This trial could open the door to a new class of treatments that target lupus at the molecular level.

Read the full article at lupusresearch.org.

Lupus research focusing on earlier diagnoses, HSS chief doctor says

Mon, 21 Oct 2024 16:05:18 -0400

S. Louis Bridges, Jr., MD, PhD, rheumatologist and physician-in-chief and chair of the department of medicine at HSS, speaks with CBS News New York's Tony Sadiku at the Walk to End Lupus in Manhattan on new treatment approaches for lupus and the importance of research.

Watch the video at cbsnews.com.

Direct-to-Consumer Rheumatologic Tests Carry Some Benefit but Plenty of Potential Risk

Fri, 27 Sep 2024 17:48:00 -0400

According to Medscape, a growing number of patients who are ordering direct-to-consumer (DTC) lab tests without the recommendation or guidance of a doctor. They're offered online by labs ranging from well-established giants to smaller, potentially less vetted companies, although.

"Among the possible reasons people might order these tests are the delay in diagnosis that can often occur with a lot of rheumatologic conditions and that it can take a while to see a rheumatologist, depending on what part of the country you're in and what the availability is," said Timothy B. Niewold, MD, FACR, Vice Chair for Research in the HSS Department of Medicine. He's not surprised to see tests for Sjögren disease among the offerings, for example, because it's a condition that's difficult to diagnose but reasonably common within autoimmune diseases.

Read the full article at Medscape.com.

Making Sense of the Connection Between Vaccines and Lupus Flares

Thu, 08 Aug 2024 11:00:00 -0400

TIME reports on the connection between vaccines and lupus flares according to experts including HSS rheumatologists Medha Barbhaiya, MD, MPH, and Lisa A. Mandl, MD, MPH.

In 1978, a team of Harvard Medical School researchers examined whether people with lupus responded to the influenza vaccine differently from the way a group of “normal” control subjects did. They looked at vaccine side effects, as well as post-vaccination lupus symptoms and autoantibody activity.

“Symptoms after vaccination were somewhat more frequent in the lupus patients than in the normal subjects,” they reported. “However, all symptoms were minor and no major flare of illness occurred. No significant induction or increase of pre-existing autoantibodies among the patients was detected after vaccination.”

“This is a big concern we hear from patients—whether their rheumatic disease will flare after a vaccine,” said Dr. Barbhaiya. “What the data suggests is that most people do well, and severe flares are very uncommon.”

Intuitively, it makes sense that a vaccine—something that is designed to stimulate an immune response—may occasionally trigger a reaction in people who experience overactive or disordered immune activity, such as those with SLE.

People with lupus are at risk for these adverse events just like anyone else. Are they at greater risk? That doesn’t seem to be the case. “There is no substantial evidence that patients with lupus have adverse events beyond what’s reported in the general population,” Dr. Barbhaiya explained.

In 2021, Dr. Barbhaiya and colleagues, including Dr. Lisa Mandl, conducted a study of COVID-19 vaccination responses among people with SLE. “The COVID pandemic offered this unique opportunity where we could assess vaccine outcomes in real time on a very large scale,” Dr. Mandl said.

Their group’s study of 183 patients found that roughly 8% of SLE patients experienced a flare within two weeks of vaccination with one of the three available SARS-CoV-2 vaccines. “These results were very reassuring,” Dr. Mandl said. “Of the few who did report a flare, most were mild or moderate.” In fact, only one patient in the study experienced a severe flare following vaccination. Furthermore, most of the flares resolved themselves within seven days.

Read the full article at time.com.

Challenges of designing and conducting cohort studies and clinical trials in populations of pregnant people

Thu, 01 Aug 2024 10:26:00 -0400

In the Lancet, Jane E. Salmon, MD, rheumatologist and senior scientist at HSS and colleagues discuss the challenges of conducting studies on postmarketing approved medications, specifically assessing pregnancy outcomes in women with rheumatic and musculoskeletal diseases.

Despite the growing need to understand the use of drugs to treat these diseases during pregnancy, clinical trials involving pregnant patients are rare, and pregnant individuals are routinely excluded from premarketing trials. As a result, safety data on treatments like disease-modifying antirheumatic drugs rely heavily on post-marketing observational studies.

The article highlights the scarcity of observational and interventional studies on the relationship between rheumatic diseases and pregnancy and stresses the need for greater trust and engagement with patients in research, alongside measures to protect both the pregnant person and the fetus.

Read the full article at thelancet.com.

Understanding lupus processes helps identify ‘important targets’ for intervention

Wed, 31 Jul 2024 21:28:00 -0400

Healio Rheumatology reports that ongoing research into the disease processes of lupus has yielded an increased number of therapeutic targets, according to a presentation at the 2024 Association of Women in Rheumatology annual conference by Mary K. Crow, MD, physician-in-chief emerita and senior scientist at the HSS Research Institute.

“We think about lupus based on its many, many clinical manifestations,” Dr. Crow explained. “Heterogeneity comes up as a descriptor, but we have made quite a bit of progress about what underlies this disease.”

In addition to the interferon pathway, Dr. Crow mentioned anti-RNA autoantibodies like anti-Ro, anti-La, anti-SM and anti-RNP, along anti-dsDNA autoantibodies and toll-like receptors (TLR), as potential targets for intervention.

The anti-RNA autoantibodies are sustained in patients with lupus over time, according to Dr. Crow.

“Their regulatory capacity is important for us to recognize,” she said. “If we do not target these antibodies, they are going to continue to modulate disease.”

Conversely, anti-dsDNA antibodies are not sustained over time. “They fluctuate over many years,” she said.

A growing body of evidence suggests that targeting toll-like receptors may have a greater role in lupus treatment in the future, according to Dr. Crow.

Read the full article at healio.com.

Steroid Use Higher than Expected in Patients with Lupus

Tue, 21 May 2024 10:43:20 -0400

Med Central reports that just over 90% of people living with lupus are using oral steroids as treatment, according to a recent World Lupus Federation survey, however, 96% of respondents reported concerns about the long-term effects of steroid use. The survey included more than 7,700 people with lupus out of which the majority were women between 45-64 years of age from more than 100 countries.

“Steroids are unique in our armamentarium against lupus or other autoimmune diseases because they work promptly, and they are very powerful in suppressing inflammation and autoimmunity,” said Kyriakos A. Kirou, MD, DSc, FACP, rheumatologist at HSS.

However, added Dr. Kirou, “because they have significant adverse effects, we try to minimize their use.”

Potential side effects of steroids include weight gain, lipodystrophy, glucose intolerance (especially in diabetics), secondary adrenal insufficiency, increased risk for infections, osteoporosis, osteonecrosis, glaucoma, cataracts, high blood pressure, atherosclerosis, irritability, mood changes, or even psychosis, according to Dr. Kirou.

Read the full article at medcentral.com.

Interferons in Systemic Lupus Erythematosus

Thu, 21 Mar 2024 10:14:00 -0400

The Rheumatologist interviews Mary K. Crow, MD, physician-in-chief emerita and senior scientist at the HSS Research Institute about Interferons in Systemic Lupus Erythematosus.

“It can be difficult to predict the long-term impact of research at the time it is being performed, but over time, as knowledge of a field grows, that impact can be tremendous,” explained Dr. Crow.

Dr. Crow is the co-author of a review that is part of a series on immunology for rheumatologists launched recently in Arthritis & Rheumatology (A&R).¹ In this new installment, Dr. Crow, Mikhail Olferiev, MD, and Kyriakos Kirou, MD, DSc, review advances in interferon (IFN) research related to the pathogenesis and treatment of systemic lupus erythematous (SLE) and other systemic rheumatic diseases.²

“The review identifies many of the investigators who have been critical in defining type I interferon and the impact of interferon research on advances in science and medicine,” explained Dr. Crow. “We review how interferon is induced and regulated, and its impact on host defense against virus infection, as well as its role in the pathophysiology of autoimmune, rheumatic diseases, particularly SLE.

“Understanding the history and progress of science allows us to have a deeper understanding of the underlying mechanisms of the diseases that we treat,” said Dr. Crow. “In the case of interferon, it is remarkable how the study of this cytokine family has generated essential knowledge of the role cytokines play in host defense and disease, and the essential aspects of biology that have, over time, led to identification of the type 1 interferon receptor, the [Janus kinase (JAK) signal transducer and activator of transcription (STAT)] pathway, the interferon-stimulated genes, the interferon regulatory factors and the plasmacytoid dendritic cell as an important cellular source of interferon.

“In addition to describing the trajectory of interferon research and its broad impact on understanding cytokine biology, the review lists many of the therapeutic agents currently in development or approved for treatment of rheumatic diseases that derive from research on the interferon pathway,” Dr. Crow explained.

Read the full article at the-rheumatologist.org.

APOL1 High-Risk Genotype in SLE: A Genes in Context Story

Fri, 08 Dec 2023 09:29:57 -0500

At this year’s American College of Rheumatology (ACR) annual meeting, HSS rheumatologist Ashira D. Blazer, MD, MSCI, delivered the Edmond L. Dubois, MD Memorial Lectureship. This lectureship is presented annually at the ACR meeting and features an outstanding investigator in the area of lupus research.

Dr. Blazer specializes in the treatment of rheumatic diseases including undifferentiated connective tissue disease, Sjogren’s syndrome, inflammatory arthritis, and systemic lupus erythematous (SLE), particularly in patients of African ancestry. As a physician-scientist, she studies the interplay between genetic signatures commonly found in African ancestry backgrounds, environmental and social stressors, and SLE pathogenesis. Here, she talks about the subject of her lecture and her broader research.

In my experience, any rheumatologist who takes care of people with lupus has observed disparities in outcomes for African American patients compared to others. This is especially true when it comes to lupus nephritis, the type of kidney damage associated with lupus. The bulk of this disparity is related to access to care and the social determinants of health. For a subgroup of African Americans, however, aggressive kidney disease may be due to genetic risk.

Thanks to research looking at the connections between African American genomes and disease, we are beginning to answer some of those questions. Investigators have found that about 13% of people of recent African descent carry two copies of a particular version, or variant, of the gene Apolipoprotein L1, or APOL1. One copy of the variant protects against Trypanosoma brucei, the parasite that causes African sleeping sickness. This evolutionary advantage helps explain why the variant is so common. But having two copies is associated with a much higher risk of kidney disease, as well as cardiovascular disease.

Interestingly, about 80% of people with high-risk APOL1 genes don’t go on to develop end-stage kidney disease. It takes a “second hit,” usually chronic infection or chronic inflammation, to send people with this mutation down the path toward having these severe kidney problems. By studying the how the inflammation seen in lupus patients interacts with these APOL1 variants and leads to severe disease, we hope to develop ways to modify the factors that trigger that risk.

Part of my research is focused on clinical observations in patients who carry these APOL1 variants. When a lupus patient has protein in their urine, is it due only to lupus nephritis or is it a combination of autoimmune activity and the APOL1 phenotype? These differences could affect how patients are treated and which medications they are given, including the amount of steroids we use. By learning more about these clinical differences, we hope to ultimately reduce the number of lupus patients who end up on dialysis. And it’s very exciting to bring precision medicine to a patient population that is largely underserved.

The other part of my research is focused on understanding which immune pathways are active when the APOL1 variant is most highly expressed and whether the combination of APOL1 and immune activity is really producing these severe disease symptoms. We look at how the APOL1 gene is expressed in different cell types and how that affects the cell damage that we see. One thing I’ve been studying is how these variants affect mitochondria and their ability to produce energy for the cell. I’ve also been looking at how the variants affect autophagy, which is one way that cells recycle their damaged parts. Studying autophagy could explain not only the relationship between APOL1 and inflammation, but potentially how APOL1 causes cellular injury in people who carry the variants.

The field of rheumatology is in a golden age right now. We have all these new biologic drugs that can specifically modulate different pathways. It’s possible that by identifying the essential immune stimulus, we’ll be able to find ways to decrease the likelihood that someone with lupus suffers kidney injury — preventing the poor outcomes seen in so many of these patients. We may also be able to develop small molecules that could directly impact the protein product of APOL1.

I’m studying the connections between these gene variants and lupus outcomes not only in patients who are treated at HSS; but I’m also working with collaborators at two teaching hospitals in Africa, the University of Ghana and Lagos State University in Nigeria. These large patient populations help us to study the cellular damage caused by the APOL1 variant and why patients who have it are more likely to develop global damage to their kidneys. Studying patients who are being treated in resource-limited countries also helps us understand the interplay between lupus, social determinants of health, and genetic risk; and how these factors that contribute to poorer kidney outcomes

The findings about APO1 explain a reason why African American lupus patients with this particular genetic background don’t do as well, but we know there are many socioeconomic and societal factors that also influence the different in outcomes. Ultimately, we want to find ways to promote better health for all people with lupus, whether they carry these variants or not.

HSS Presents New Reproductive Health Research at the ACR Convergence 2023

Tue, 14 Nov 2023 12:05:00 -0500

At this year’s American College of Rheumatology (ACR) annual meeting, HSS presented a number of important studies focused on reproductive health for patients with systemic lupus erythematosus, rheumatoid arthritis, and other rheumatic diseases, including issues related to fertility, sexual function, use of contraception and HPV vaccination.

What follows are some highlights from the meeting:

Association of Menstrual Cycles and Disease Flare Activity in Women with Systemic Lupus Erythematosus and Rheumatoid Arthritis
In this study, researchers surveyed female rheumatology patients to determine whether the menstrual cycle affects the timing of disease flares. More than 300 patients responded to the survey, and the analysis reported at the meeting included data from 122 respondents with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) — 49 with SLE and 73 with RA.

Overall, 39% reported an association between their menstrual cycle and disease flares, with similar rates in both the SLE and RA groups. Those who experienced these flares usually had them within the week before or during their periods. The investigators say these findings could inform physician counseling and that closer monitoring of patients during vulnerable phases of the menstrual cycle could enable more timely intervention and better disease control. Additional research is planned to assess whether demographics, lifestyle and medical conditions may influence this potential association.

Authors: Lucy Masto, BS; Amaya Smole, BA, Caroline H. Siegel, MD, MS, Sarah B. Lieber, MD, MS, Sanjana Adurty (Weill Cornell Medical College), Jonah M. Levine, BA, Bessie Stamm, BA, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Lisa R. Sammaritano, MD, Medha Barbhaiya, MD, MPH.

Contraception Choices in Individuals with Inflammatory Arthritis and Lupus-like Disease Differ Based on Diagnosis and Teratogen Use
This study surveyed women of reproductive age with systemic rheumatic disease about their use of contraceptives. Certain drugs prescribed for rheumatic disease are teratogenic, or can damage a fetus. Data were collected on 249 women with reproductive capacity, including 147 with inflammatory arthritis and 102 with lupus-like disorders.

The 52 participants taking teratogenic medication were more likely to discuss contraception with their rheumatologist compared with those not taking teratogenic medication (44.2% vs. 21.8%), and more frequently reported using permanent contraception (8.0% vs. 1.1%). Those taking teratogenic medication were no more likely to use effective contraception than those who were not: 44.0% reported using less effective methods such as barrier methods and fertility awareness/withdrawal or using no contraception. Those with lupus were less likely to use more effective methods containing estrogen (31.5% vs. 14.7%), even though these methods are safe for some (but not all) lupus patients. The findings highlight the importance of using educational interventions to optimize safe and effective contraception use in patients with systemic rheumatic diseases, especially those taking teratogenic medications and those with lupus-like diseases.

Authors: Caroline H. Siegel, MD, MS, Medha Barbhaiya, MD, MPH, Lucy Masto, BS, Amaya Smole, BA, Bessie Stamm, BA, Jonah M. Levine, BA, Sarah B. Lieber, MD, MS; Lisa A. Mandl, MD, MPH; Michael D. Lockshin, MD; Lisa R. Sammaritano, MD.

Demographic and Clinical Factors Associated with HPV Vaccination in Young Adults with Rheumatic Disease
Although the HPV vaccine is known to be safe and effective in people with rheumatic disease (RD), many do not get vaccinated. This study used data from the electronic health record of patients diagnosed with a rheumatic disease in adolescence, seen at HSS, to look at factors associated with HPV vaccination. Overall, the investigators found that among 321 individuals with rheumatic disease between the ages of 16 and 22, half were not fully vaccinated against HPV (2 or more doses).

Those who were white and non-Hispanic/Latino and those who had commercial insurance were less likely to be fully vaccinated —factors that are associated with lower vaccination rates in the general population. Those who were unvaccinated were more likely to have inflammatory arthritis versus other connective tissue diseases. Those who were fully vaccinated were also more likely to have received flu and COVID-19 vaccines. Further research is needed to identify and mitigate barriers to HPV vaccination in this high-risk group.

Authors: Caroline H. Siegel, MD, MS, Lauren Robinson, MD, Deanna Jannat-Khah, DrPH, Avi Mikhaylov, Nancy Pan, MD, Lisa R. Sammaritano, MD.

Educational Intervention to Increase Contraception Screening and Documentation for Reproductive-Aged Women Seen in an Academic Rheumatology Clinic

Only one-third of reproductive-aged women with rheumatic disease are prescribed effective contraception, despite the widespread use of teratogenic medications which can harm a fetus. This initiative aimed to increase the rate of provider screening and documentation of contraception use in the electronic health record for female rheumatology patients ages 18 to 45.

Interventions from the research team included educational presentations and motivating reminders for clinical staff. Over the 24-week study period, the rate of contraception documentation for these patients increased from 11% to 54%. Future phases of this initiative will focus on encouraging rheumatologists to provide contraceptive counseling and referrals to women’s health providers for patients taking teratogenic medications.

Authors: Caroline H. Siegel, MD, MS, Deanna Jannat-Khah, DrPH, Avi Mikhaylov, Erika Abramson (Weill Cornell Medicine), Nancy Pan, MD; Lisa R. Sammaritano, MD.

Experiences and Attitudes Related to Assisted Reproductive Technologies Among Women with Systemic Rheumatic Disease
Because systemic rheumatic diseases may be associated with decreased fertility in women, those with such diseases may pursue assisted reproductive technologies such as oocyte cryopreservation (OOC, or egg freezing). This study evaluated how sociodemographic factors and medical history influence OOC experiences and overall attitudes toward reproductive technologies among women with these conditions.

Among the 265 surveyed patients of reproductive age, 21 had done OOC (most before 35 years of age) and 102 had considered OOC. The factors that increased openness to OOC included having no previous pregnancies, having greater infertility concerns, lacking a spouse or partner, having a bachelor’s degree or higher, and having a history of taking certain immunosuppressive drugs. Among those who did not already have fertility issues, 64% reported that, if necessary, they would consider using these technologies only if their rheumatologist advised it was safe. The investigators say this study highlights the importance of studying the use of assisted reproductive technologies in women with systemic rheumatic diseases, and counseling patients regarding these options.

Authors: Sanjana Adurty (Weill Cornell Medical College), Lucy Masto, BS, Amaya Smole, BA, Caroline H. Siegel, MD, MS, Sarah B. Lieber, MD, MS, Jonah M. Levine, BA, Bessie Stamm, BA, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Medha Barbhaiya, MD, MPH, Lisa R. Sammaritano, MD.

HPV Vaccination in Adolescent and Young Adult Patients Seen in an Academic Rheumatology Center
This study looked at rates of HPV vaccination in adolescents and young adults living in New York State who had received care from a rheumatologist. The investigators reviewed data from the electronic health record, including vaccination information from a New York State database, for 534 HSS patients ages 16 to 22. Less than half of patients had been vaccinated for HPV. The study found that HPV vaccination was more common in people with a rheumatic disease diagnosis compared to those who did not have a rheumatic disease, but not after accounting for demographic variables and receipt of other elective vaccines. Additionally, those who had received flu and COVID-19 vaccines were more likely to have been vaccinated for HPV.

The overall low rate of HPV vaccination was concerning because young people with rheumatic diseases may be at increased risk for HPV infection and HPV-associated cancers due to immune dysregulation, immunosuppression, and gaps in preventive healthcare delivery. The researchers note that interventions are needed to improve HPV vaccination rates in this population and that targeting elective vaccine uptake in general may be a useful approach.

Authors: Caroline H. Siegel, MD, MS, Lauren Robinson, MD, Deanna Jannat-Khah, DrPH, Avi Mikhaylov, Nancy Pan, MD, Lisa R. Sammaritano, MD.

Knowledge and Misconceptions about Contraception Among Individuals with Inflammatory Arthritis and Lupus-like Diseases
This study looked at what patients with systemic rheumatic disease know about the use of contraceptives, comparing the knowledge of women with inflammatory arthritis to those with lupus-like diseases. This analysis included female patients aged 18-49 years who were seen by a rheumatologist at HSS two or more times between 2020 and 2022, excluding those who reported menopause, oophorectomy, hysterectomy, or other causes of infertility.

The participants were surveyed about the effectiveness of various contraceptives and about misconceptions related to specific methods in the context of having a rheumatic disease. The researchers found that despite being highly educated (93.2% held a bachelor’s degree or higher), about half of all patients responded incorrectly to questions about the effectiveness of various contraceptive methods. Those with lupus-like diseases were more likely to report that certain hormone-based methods have contraindications, in response to both accurate and inaccurate statements. The researchers say the results reveal the need for better counseling of patients with systemic rheumatic disease.

Authors: Caroline H. Siegel, MD, MS, Medha Barbhaiya, MD, MPH, Lucy Masto, BS, Amaya Smole, BA, Bessie Stamm, BA, Jonah M. Levine, BA, Sarah B. Lieber, MD, MS, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Lisa R. Sammaritano, MD.

Knowledge Related to Fertility and Infertility Treatments Among Women with Systemic Rheumatic Disease
Systemic rheumatic diseases can be associated with decreased fertility, but patients are not always aware of this connection. This study looked at patients’ understanding of these issues, taking into consideration the patient’s race, ethnicity, and socioeconomic status.

In an interim analysis of 142 reproductive-aged women treated at HSS for rheumatic disease who completed the Fertility & Infertility Treatment Knowledge Score (FIT-KS) test, the investigators found that — compared with women in the general population previously administered the FIT-KS — women with rheumatic diseases were more likely to be non-White, Hispanic/Latina and highly educated, and less likely to have had successful pregnancies. This population was more aware of the risks of infertility due to smoking, sexually transmitted infections and being underweight. These women also had a better understanding of success rates for vitro fertilization in older women but were less knowledgeable about the effectiveness of oocyte cryopreservation (OOC, or egg freezing). Future work will focus on highlighting important knowledge gaps among women with these diseases, particularly related to options for fertility preservation.

Authors: Sanjana Adurty (Weill Cornell Medical College); Lucy Masto, BS, Amaya Smole, BA, Caroline H. Siegel, MD, MS, Sarah B. Lieber, MD, MS, Jonah M. Levine, BA, Bessie Stamm, BA, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Medha Barbhaiya, MD, MPH, Lisa R. Sammaritano, MD.

Reproductive History and HPV Vaccination Awareness Among Women with Systemic Lupus Erythematosus and Rheumatoid Arthritis
Women with systemic rheumatic diseases, particularly those with systemic lupus erythematosus (SLE), may be more vulnerable to HPV infection and HPV-related cervical cancer, but HPV testing and vaccination rates are low in these patients. This study compared HPV vaccination status and awareness in female patients with SLE to female patients with rheumatoid arthritis (RA).

The analysis included 295 participants with similar demographics; notably, those with SLE were slightly younger than those with RA. Both groups were similarly likely to be sexually active and had similar rates of having regular Pap smears; however, women with lupus were more likely to have persistent abnormal smears (13.3% vs. 1.7%). While not statistically significant, two women with lupus reported a cervical cancer diagnosis compared to none with rheumatoid arthritis. HPV vaccination rates were similar for the two groups, with 37% of 158 women eligible for the vaccine (including those made eligible given extended eligibility approved in 2019 for those aged ≤45 years if clinically appropriate) reporting having received full vaccination. Among the 79 women who had never received the vaccine yet were eligible, 90% reported that it had never been offered. These findings underscore the importance of increasing HPV vaccination rates and discussions about cervical cancer screening in women with SLE and RA.

Authors: Amaya Smole, BA, Lucy Masto, BS, Caroline H. Siegel, MD, MS, Sarah B. Lieber, MD, MS, Sanjana Adurty (Weill Cornell Medical College), Jonah M. Levine, BA, Bessie Stamm, BA, Lisa A. Mandl, MD, MPH, Michael D. Lockshin, MD, Lisa R. Sammaritano, MD, Medha Barbhaiya, MD, MPH.

Self-Reported Sexual Dysfunction and Perceptions of Rheumatologist Engagement on This Issue in Patients with Systemic Sclerosis
This study looked at the prevalence and risk factors of sexual dysfunction among people with systemic sclerosis (SSc). HSS researchers developed the Sexual Function in SSc Questionnaire (SFSScQ) to anonymously survey patients on whether they had problems with their sexual function and, if so, whether they had ever discussed it with their rheumatologist. Participants who completed the SFSScQ were also asked to complete the already-established Female Sexual Function Index or the International Index of Erectile Function Questionnaire.

More than half of those who completed both surveys (26 out of 41) reported that they had sexual problems. The researchers note that while the number of survey participants was small, age, sex, race, SSc subtype and time since SSc diagnosis did not appear to be predictors of sexual dysfunction. Importantly, although about half of participants agreed it was important to discuss problems of sexual function with their doctors, 64% of those who reported sexual problems had not done so.

Authors: Liza Morales, Robert F. Spiera, MD, Jessica K. Gordon, MD, Deanna Jannat-Khah, DrPH, Kimberly S. Lakin, MD, MS.

New Antiphospholipid Syndrome Research Findings Presented at ACR Convergence 2023

Mon, 13 Nov 2023 17:05:00 -0500

Investigators from the Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) presented new research findings in antiphospholipid syndrome (APS) at the American College of Rheumatology (ACR) Convergence 2023, the ACR’s annual meeting.

Hospital for Special Surgery (HSS), one of the leading centers in the United States providing care for adults and children with APS, is the lead coordinating center for APS ACTION, an international research network of 34 academic institutions dedicated to advancing the understanding and management of APS. APS ACTION conducts large, multicenter clinical studies and trials in patients with positive antiphospholipid antibodies (aPL).

APS is a systemic autoimmune disorder characterized by the production of aPL, which attack proteins binding the cell walls of blood cells located on the inner layer of veins and arteries. APS increases the risk of dangerous blood clots, strokes, heart attacks and pregnancy complications.

APS ACTION created the APS ACTION Clinical Database and Repository (APS ACTION Registry) to study the natural course of disease in patients with persistently positive aPL, with or without other systemic autoimmune diseases. Investigators worldwide collect blood samples and clinical data annually and follow patients for 10 years. As of November 2023, the registry included samples and data for about 1,200 patients.

“Since the registry began in 2010, APS ACTION investigators have published 28 studies in peer-reviewed journals and delivered 50 podium and poster presentations at international congresses,” said Doruk Erkan, MD, MPH, a physician-scientist at the Barbara Volker Center for Women and Rheumatic Diseases and rheumatologist at HSS. Dr. Erkan is also a founding member of APS ACTION and the current chair of its Executive Committee. “It’s exciting to see six new studies presented at ACR Convergence 2023 that advance our understanding of APS.”

These six studies were based on the analysis of registry clinical data alone, registry clinical data in combination with patient samples and efforts of APS ACTION International Core Laboratories to improve the reliability of aPL tests. Highlights are as follows:

Three Studies Based on APS ACTION Registry Clinical Data

First and Recurrent Thrombosis Risk after 4,454 Patient-Years of Follow-Up

The study updated the incident first and recurrent thrombosis risk, previously reported in 2021 as 1.02 and 2.09 per 100 patient-years, respectively. Based on 4,454 patient-years of follow-up, the risk of first and recurrent thrombosis events remained relatively low at 1.00 and 2.13 per 100 patient-years in aPL-positive patients with and without a history of thrombosis, respectively. A secondary analysis revealed potential differences in medications and cardiovascular risk factors at enrollment between patients with and without thrombosis at follow-up. The researchers concluded these findings should be interpreted cautiously, given the multifactorial nature of thrombosis and the relatively small number of new events during follow-up. New APS ACTION studies are already in progress to better define independent thrombosis risk and protective factors in this patient population.

HSS authors: Jonathan Thaler, MD (presenting), Doruk Erkan, MD, MPH (senior).
Complete author list: Refer to ACR Convergence 2023 Abstract 1604 (podium presentation).

Clinical Characteristics of Patients Presenting with Transient Ischemic Attack

Transient ischemic attack (TIA) can occur in aPL-positive patients. However, diagnosing TIA is challenging due to the need to rule out other conditions, such as complex migraine with aura or seizure. This study analyzed the clinical characteristics of persistently aPL-positive patients with reported TIA before enrolling in the registry and/or during follow-up. The investigators retrospectively compared patients’ baseline characteristics, including those with and without a history of thrombosis before they joined the registry. Next, the researchers prospectively assessed patients with new onset TIA. The study found that 8% of patients had a history of TIA at registry entry and the recurrence rate during follow-up was 8%. However, the new TIA rate was less than 1%. About two-thirds of TIA patients without a history of thrombosis were treated with anticoagulants, and all patients with new or recurrent TIA during follow-up were on anticoagulation. The researchers concluded the findings highlight the need for controlled studies of TIA in aPL-positive patients using strict TIA definitions.

Presenting author: Zeynep Belce Erton, MD (SUNY Downstate Medical Center).
HSS authors: Jonathan Thaler, MD, Doruk Erkan, MD, MPH (senior author).
Complete author list: Refer to ACR Convergence 2023 Abstract 0097 (poster presentation).

Predictors of Mortality

The study aimed to determine the mortality rate and the causes and predictors of mortality in aPL-positive patients. The researchers analyzed reported causes of death and compared the clinical and laboratory characteristics of patients who died with patients still living. The study found that the mortality rate among 963 patients was 5% after a median follow-up of five years. The five-year survival probability declined with age and was lowest for patients over 60 when they joined the registry. A history of arterial thrombosis, catastrophic APS, cardiovascular disease risk factors and co-existing systematic autoimmune diseases independently predicted future mortality. The investigators emphasized that a better understanding of the predictors of mortality is critical to help tailor treatment plans to improve patient outcomes.

Presenting author: Yasaman Ahmadzadeh, MD (Roger Williams Medical Center).
HSS author: Doruk Erkan, MD, MPH (senior author).
Complete author list: Refer to ACR Convergence 2023 Abstract 0098 (poster presentation).

Two Studies Based on APS ACTION Registry Clinical Data and Patient Samples

Complement Activation as a Marker of Thrombosis Risk

Recent studies suggest additional markers of thrombosis risk are present in patients with severe APS, such as catastrophic APS (CAPS), a life-threatening condition that involves the formation of multiple blood clots in a very short period. The study evaluated plasma levels of three complement activation markers—C5b-9, C4d and Bb fragment—using ELISA and the modified HAM assay that measures complement-dependent cell killing. The investigators compared results for patients who experienced thrombosis with those who did not over a median prospective follow-up time of 4.6 years. In general, the investigators found that elevated C4d levels and a positive modified HAM result were associated with a higher risk of new thrombosis. They concluded these complement markers might be useful tools for stratifying patients by risk.

Presenting author: Cecile Yelnik, PhD (Lille University).
HSS authors: Jane Salmon, MD, Doruk Erkan, MD, MPH (senior author).
Complete author list: Refer to ACR Convergence 2023 Abstract 1605 (podium presentation).

Plasma Proteomic Profiling of Different APS Phenotypes

APS is a heterogeneous autoimmune disease with complications arising from interaction between the innate immune system and coagulation. Patients may present with different phenotypes, such as thrombotic, obstetric or catastrophic/microvascular APS, while others may be aPL-positive without the presence of disease. To better understand the mechanisms driving immunothrombotic events, the investigators performed multiplex proteomic profiling of about 7,000 unique proteins found in plasma samples of 40 patients and compared results with 10 healthy controls. The plasma proteome of APS subtypes revealed alteration in several pathways, particularly receptor signaling, signal transduction, regulation of cellular differentiation, neutrophil, complement, coagulation and cytokine activation notable in all individuals with aPL-positivity. Several pathways, notably associated with immunothrombosis, revealed an escalating activation from the non-thrombotic aPL-positivity to the most thrombotic phenotype (catastrophic/microvascular APS).

Presenting author: Alexander Pine, MD, PhD (Yale University School of Medicine).
HSS authors: Doruk Erkan, MD, MPH.
Complete author list: Refer to ACR Convergence 2023 Abstract 1608 (podium presentation).

APS ACTION Core Laboratories Study to Improve aPL Test Reliability

An Assessment of Lupus Anticoagulant Tests Using Different Snake Venom Clotting Times

The lupus anticoagulant (LA) test is essential for diagnosing and managing patients with APS. However, variability in test results is challenging, especially in anticoagulated samples. The two commonly used tests as part of LA are the activated partial thromboplastin time and dilute Russell’s viper venom time (DRVVT). Based on a standardized protocol, four APS ACTION Core Laboratories assessed the performance of the LA test using the prothrombin-activating Taipan snake venom time (TVST) test and the Ecarin clotting time (ECT) confirmatory test, which are insensitive to vitamin K antagonists. The investigators compared the agreement in LA status between the DRVVT and the TVST/ECT. Preliminary study results suggested that the TVST/ECT could serve as an adjunct to DRVVT, providing high specificity without requiring mixing studies.

Presenting author: Maria Efthymiou, Phd, BSc, MSc (University College London).
HSS authors: Doruk Erkan, MD, MPH.
Complete author list: Refer to ACR Convergence 2023 Abstract 0096 (poster presentation).

Studying the ‘Dark Matter’ of the Genome May Reveal a Deeper Understanding of Lupus

Wed, 16 Aug 2023 11:42:03 -0400

The autoimmune disease systemic lupus erythematosus tends to run in families, suggesting it has a strong genetic component. But it’s typically not a condition in which one bad gene causes disease to develop: Most commonly, many different genetic changes have to come together to give rise to lupus. This is one of the big reasons why lupus is so challenging to study.

Physician-scientist Timothy B. Niewold, MD, FACR, Vice Chair for Research in the HSS Department of Medicine, recently received a nearly $4.2 million grant from the National Institutes of Health to learn more about the complex genetics that contribute to lupus. The ultimate goal of this research is to figure out how changes in certain regions of the genome affect the disease, with the hope of eventually understanding immune-related diseases more broadly.

Recently, Dr. Niewold spoke about his plans for this research project, including why he thinks probing the “dark matter” of the genome will lead to a better understanding of what causes lupus.

What have you already learned through your research?

Unfortunately, there are no simple answers to questions about which genes cause lupus and the ways in which they cause the disease to arise. We need to take a very broad look across the genome.

In recent years, the wider scientific community has developed more advanced and high-throughput ways to study people’s whole genomes. In the lupus research community, we’ve come together to use that genomic data to create large registries that can help to ask broad questions about the causes of the disease.

Thanks to those registries, we are able to compare the genomes of large numbers of people with lupus to large numbers of healthy controls — people who don’t have lupus. Then we can look at which areas of the genome are different between these two groups.

What we have been able to learn so far is that there are certain regions of the genome where changes are clearly associated with an increased risk of lupus. Notably, many of these changes are found in a region that is often called the “dark matter” of the genome.

What is the dark matter of the genome?

When we talk about “genes,” we mean sections of genetic material that contain instructions for making specific proteins. We have about 20,000 genes, which carry the code for all the proteins that are needed to build a whole human being.

But only about 1% of our genetic material contains genes that get directly made into proteins. The other 99% of our genetic material — the dark matter — has other functions. We are still learning what these are.

One of the functions of dark matter we have been studying in the context of lupus is the production of molecules called long noncoding RNAs (lncRNAs). These RNAs do not get translated into proteins, but they perform many other jobs that help regulate how genes get transcribed and how proteins get made. Some lncRNAs can affect the immune system.

What is the focus of your current project?

We decided to focus on a region of chromosome 12 where we know people with lupus have a lot of variations. There aren’t a lot of genes in this area. But despite that, we expect to find that the genetic variations in these regions are doing something important. It’s likely they are leading to changes that ultimately affect how the immune system is controlled and regulated, including carrying instructions for lncRNAs.

Although this project is focused on lupus, the big picture is also exciting. Studying how changes in the dark matter affect the immune system could apply to many other autoimmune diseases as well.

What kinds of studies do you have planned?

All of this research will be done in human cells. We will be using a registry created by the Feinstein Institutes for Medical Research, a research center on Long Island, as well as a registry at HSS. These registries contain samples from people with lupus and from healthy control subjects.

Much of the work of this project will focus on samples from the healthy controls. That’s because we need to look at the basic principles of how lncRNAs are supposed to regulate the immune system before we can understand how this process goes wrong in a disease like lupus.

We will also do work in cell lines. We plan to use CRISPR gene editing tools to study what happens to healthy cells when we remove sections of the dark matter that make lncRNAs. This work will be done with our collaborators at the University of Pittsburgh.

In particular, we’ll focus on how changes in the dark matter affect certain types of immune cells, especially those that are important for detecting and eliminating infections. We know that both B cells and monocytes in particular are strongly implicated in lupus.

This is a five-year grant. Where do you hope to be with this work in 2028?

I think we’ll have a much better understanding of how the genetic material contained within the dark matter can touch a number of different parts of the immune system.

I’m also excited that we’ll be able to begin to build a roadmap of how different regions of the genome come together in different ways to result in lupus. This will help to inform our understanding of disease and could suggest possible

What Drives Lupus and What are Potential Treatment Approaches?

Thu, 27 Jul 2023 12:30:00 -0400

Systemic lupus erythematosus (known as lupus) is a chronic disease in which the body generates an immune response to its own cells. This causes inflammation that can affect tissues such as the skin, the joints, and many different organs such as the kidneys, heart, and brain. In my recent review article in the Annals of the Rheumatic Diseases, called “Pathogenesis of Systemic Lupus Erythematosus: Risks, Mechanisms, and Therapeutic Targets,” I discuss recent insights into the causes and drivers of lupus as well as treatment approaches.

For roughly 50 years, lupus has been recognized as a disease that involves the immune system. In the 1960s, investigators made important discoveries about the autoantibodies that are hallmarks of the disease, how they function, and what they react to. Further studies of the immune system in general added understanding of changes in certain immune cells that contribute to lupus. For example, research on the function of immune cells such as T cells and B cells allowed for understanding how autoantibodies are produced and contribute to lupus.

Over the last several decades, researchers have discovered that cytokines, a type of protein, are key components in the body’s response to infection. They provide chemical signals to immune system cells that help them eliminate other cells infected with bacteria or viruses, but in rheumatic diseases, cytokines can play a role in inflammation. For example, in rheumatoid arthritis, cytokines were found to activate cells in the lining of joints, resulting in joint swelling and damage to healthy tissues like cartilage.

In the early 2000s, researchers including myself discovered that cytokines called interferons are significant players in lupus. Normally, interferons orchestrate a response to virus infection. But in people with lupus, interferon levels are elevated and cause inflammation in many parts of the body. In a healthy situation, a virus infection will stimulate rapid production of interferons, then go back to normal in several days; however, in most lupus patients, interferon levels remain elevated for months and years. Researchers have also identified many lupus-associated genetic changes that affect molecular pathways involved in the development of lupus, including the interferon pathway. Any one of these common genetic variants has a modest effect on risk of disease, but when multiple variants occur in an individual, risk of disease is significantly increased.

Based on what has been learned about the mechanisms involved in lupus over the last 20 years, researchers have made great efforts to develop new drugs to more effectively treat the disease. Roughly ten years ago, the FDA approved belimumab, which blocks the activity of a molecule called BAFF (B-cell activating factor) that drives B cells to become active and contributes to their ability to make damaging autoantibodies. A year and a half ago, the FDA approved anifrolumab, an antibody that blocks the cell surface receptor for the type I interferons that are particularly elevated in lupus patients.

Lupus research is conducted by investigators around the world, with many opportunities for progress being pursued. Sunlight, for example, can trigger flares of lupus, but we don’t really understand why. One possibility is that the ultraviolet rays of sunlight could damage DNA. Studies have supported an association between herpes virus, particularly Epstein-Barr virus, and lupus, and researchers have been working out the mechanisms. My laboratory has investigated the possibility that virus-like sequences in DNA, called genomic retroelements, can sometimes result in production of interferon in patients with lupus. There are currently many ongoing studies aimed at understanding why the interferon pathway is activated in lupus patients or why the body produces autoantibodies.

Clinical drug development studies have exploded in recent years, with candidate drugs focused on many immune components involved in the disease. Rituximab, for example, which is approved for other uses, is sometimes used for lupus patients. Rituximab depletes B lymphocytes, which are the cells that make autoantibodies. Future drugs will aim to achieve optimal B cell depletion or reduce the function of interferon-producing cells. Other drugs that inhibit cellular signaling pathways involved in lupus are being developed, some of which may be administered as a pill rather than as an injection. I believe that multiple components of the immune response represent rational therapeutic targets for treatment of patients with lupus, and in the end, it may be necessary to target several parts of the immune system to achieve long-lasting responses or even cure. One approach of great current interest is administration of CD19-CAR T cells, a novel therapy that involves modification of a patient’s T cells followed by injection of those cells back into the body. A study of a small number of patients with lupus nephritis, a form of disease that involves the kidneys, has shown impressive responses that last as long as a year. Longer studies are necessary to fully assess the efficacy of the CAR T cell approach. Furthermore, some research is focused on why some patients develop disease of the vasculature, kidneys, heart, spleen, skin, and brain while others do not, drawing attention to alterations in cells outside of the immune system that impact the vulnerability of those organs for developing chronic damage.

Lupus is very variable in how an individual person will react to having the disease, even given the same degree of immune system activation. Though people do better with lupus now than they did 50 years ago, they can be quite damaged by the disease, and experience severe organ involvement, such as kidney failure or cardiovascular disease. Even those patients who do not experience organ damage can report life-altering symptoms such as fatigue and what they describe as “brain fog”.

Because so much of the immune system is involved in lupus, studying lupus patients has taught us a lot about the immune system that can be applicable to many other diseases that rheumatologists treat, as well as about how the immune system responds in the setting of infection or cancer. An example of that is COVID-19; there was a lot of study of the immune system in people who got sick with COVID. This created an opportunity to relate that data on how the immune system was behaving to what we have been studying in lupus.

My research efforts are focused on better understanding the underlying biology that results in the development of lupus and its complications. This includes the contributions of genetic risk factors, understanding what activates the immune system and results in the autoimmunity characteristic of lupus, and how patients can be characterized based on their unique immune response and disease symptoms. The overall objective is to gain enough new information that we can propose targets for more effective therapies, ultimately improving the lives of patients. More specifically, our current research is defining differences between those patients who maintain high levels of interferon chronically and those patients who only increase their interferon levels at times of disease flare. Other current projects include defining the immune mechanisms that are associated with different specificities of autoantibodies, understanding the molecular pathways that trigger flares of lupus nephritis, and understanding genetic risks for chronic inflammation in lupus.

Despite all we’ve learned, we still have a lot of work to do to understand what drives lupus, what activates the immune system, and what causes organ vulnerabilities. If we understand the mechanisms of the disease, the whys and what’s of the immune system becoming altered in its behavior, then we will have relevant ideas of what would be good approaches for development of novel therapies. There are many points of attack for this disease that are being considered and tested in clinical trials, so there is a lot of optimism that some of these will pan out as effective and relatively safe.

— Mary Crow, MD, physician-in-chief emerita and senior scientist at the HSS Research Institute

Lupus During Pregnancy Carries Higher Maternal, Fetal Morbidity Risks

Tue, 25 Apr 2023 17:27:00 -0400

Medscape reports that women with systemic lupus erythematosus (SLE) had higher risks for maternal and fetal morbidity compared to those without the chronic autoimmune disorder, according to a nationwide analysis of U.S. data.

The 10-year study showed that patients with SLE had higher intrauterine growth restriction versus people without SLE and more frequent preterm delivery, reported researchers led by Bella Mehta, MD, rheumatologist at HSS.

"I don't want people to look at this study and counsel patients against pregnancies," Dr. Mehta said. "This is only to spark a conversation, saying these risks exist, but we need to manage these patients better and work in a multidisciplinary fashion so that we can just mitigate this."

She said future research will look at the risk differences in patient subgroups and racial demographics, which were not assessed in the current study.

Read the full article at medscape.com.

How to Navigate Pregnancy With Lupus

Mon, 27 Mar 2023 16:54:00 -0400

Very Well Family reports on how to navigate pregnancy if you have lupus according to experts including HSS rheumatologist Jane E. Salmon, MD, and rheumatology fellow Caroline Siegel, MD.

People with lupus have a higher risk of pregnancy complications. But the good news is that when lupus is properly managed before conception and during pregnancy, it’s possible to have a healthy gestation.

“Having lupus does lead to an increased risk of certain pregnancy complications, including miscarriage, preeclampsia, fetal growth restriction due to placental dysfunction, and preterm delivery,” said Dr. Salmon. But not everyone with lupus will have the same risks. Your risk increases if you are having a lupus flare in early pregnancy, if you have lupus kidney disease, and if you are positive for antiphospholipid antibodies."

Lupus is not a contagious disease, but because lupus is likely an inherited condition, it’s possible that your child will develop lupus later in life, according to Caroline Siegel, MD, rheumatology fellow at HSS. “Because genetic factors contribute to the development of lupus, first-degree relatives of people with lupus are more likely to develop lupus themselves compared to people without affected family members,” Dr. Siegel said.

Read the full article at verywellfamily.com.

Nadler Announces Over $24 Million in Funding for Hospitals on Manhattan’s East Side

Thu, 23 Mar 2023 09:44:00 -0400

Congressman Jerrold Nadler announced over $24 million in combined grant funding from the US Department of Health and Human Services (HHS) to hospitals in New York’s 12th Congressional District, including HSS.

“The East Side is home to a number of the finest hospitals and medical universities in the world,” said Congressman Nadler. “I’m proud to announce this funding which will help these institutions continue their legacy of innovation in medical scientific research, particularly in the fields of cancer, diabetes, and mental health treatment. The grants HHS delivers today will fund the discoveries that will save lives tomorrow.”

Hospital for Special Surgery said, “HSS is proud to be home to the world’s leading and largest living laboratory for research into musculoskeletal conditions, which affect nearly half of all Americans each year. And we are especially grateful for two HHS grants totaling $1.4 million awarded already this year to that laboratory, the HSS Research Institute. The HHS grants support two HSS projects related to Allergy, Immunology, and Transplantation Research. One of those projects will study the ‘dark matter’ regions of the genome that are between genes, which are not well understood but are the source of most risk for common conditions including diabetes and heart disease. The other project will investigate why sunlight exposure causes both skin rashes and fatigue in the hundreds of thousands of people with the inflammatory disease known as lupus, which affects the joints, skin, kidneys, blood cells, brain and lungs.”

Read the full press release at nadler.house.gov.

Experts share real-world experience prescribing voclosporin, belimumab for lupus nephritis

Wed, 08 Mar 2023 13:41:00 -0500

MD Edge speaks to experts including Ashira D. Blazer, MD, MSCI, rheumatologist at HSS about two new treatment options for patients with lupus nephritis.

Although patients with lupus nephritis recently gained two new add-on treatment options in voclosporin and belimumab, there have been little data published with real-world experience in using these drugs.

Voclosporin, a calcineurin inhibitor, was approved by the Food and Drug Administration (FDA) in January 2021 to treat lupus nephritis in combination with immunosuppressive medication. Belimumab, a human monoclonal antibody and B-lymphocyte stimulator, was approved in December 2020 in the United States as an add-on treatment for lupus nephritis in adults and later in July 2022 for children who are already receiving standard therapy.

The lack of real-world data on either of these treatments can be attributed to lupus nephritis being a rare disease, and the approvals happening fairly recently, experts said.

Dr. Blazer explained that rheumatologists “are a little bit hesitant” to use newer agents rather than existing therapies, and have existing guidance from the American College of Rheumatology (ACR) on treating the condition.

“I think when someone has something like lupus nephritis that’s so serious, rheumatologists pull for the tried-and-true drugs that we know will affect the inflammation quickly and get that patient to remission,” she said.

Another issue Dr. Blazer encounters is cost. “I tend to treat patients who can have some socioeconomic challenges, and so I think very long and hard before prescribing either of them,” she explained. "Certainly in the case of voclosporin, when there are older, cheaper calcineurin inhibitors and I think I need one, I’m more likely to reach for one of the others,” she added.

Read the full article at MDedge.com.

HSS Research Institute and The University of Utah Receive NIH Grant to Continue Groundbreaking Study on Pregnant Patients with Antiphospholipid Syndrome Patients with or without Lupus

Thu, 26 Jan 2023 15:28:17 -0500

HSS Research Institute’s Jane E. Salmon, MD, is conducting a groundbreaking, interventional trial funded by the NIH and Lupus Foundation of America (LFA) to help patients with lupus and antiphospholipid syndrome (APS) (often seen in lupus patients) have successful pregnancies. Women with lupus and APS are at increased risk for preeclampsia and other serious pregnancy complications. The IMPACT clinical trial is the first trial to use a biologic therapy to prevent serious adverse outcomes in high-risk pregnancies.

Dr. Salmon and her team completed an observational study of 775 pregnancies to determine the strongest predictors of pregnancy complications in patients with lupus and/or APS. The presence of certain autoantibodies in women with APS with or without lupus is associated with a nearly 50% risk for serious adverse pregnancy outcomes. The IMPACT trial will determine whether treatment with Certolizumab, a monoclonal anti-TNF antibody that blocks inflammation, will prevent serious pregnancy complications. Studies in experimental animal models show that blocking this inflammatory mediator prevents preeclampsia, fetal death and fetal growth restriction – all problems seen in patients with lupus and with APS.

The grants from the NIH and Lupus Foundation of America come at a pivotal time in the study as they have recently enrolled 40 patients, and, so far, they are seeing promising results. The trial is spearheaded by the HSS Research Institute and University of Utah, where Dr. David Ware Branch serves study Co-Principal Investigator. Patients across the nation are eligible to enroll in the trial. To do so, they or their physicians can contact Drs. Salmon or Branch.

Dr. Salmon, Co-Principal Investigator of the trial, said, “In addition to helping lupus and APS patients carry babies to term – a feat once deemed near impossible—we hope to eventually apply the results of our study to non-autoimmune patients at risk for preeclampsia, a life-threatening and common condition with no treatment.”

Hospital for Special Surgery Research Institute Awarded Two New Grants to Study Potential Causes of Lupus Flares

Thu, 05 Jan 2023 10:05:00 -0500

A research team led by Hospital for Special Surgery (HSS) Research Institute, in collaboration with Weill Cornell Medicine, has been awarded two grants, one from the Department of Defense and one from the National Institutes of Health (NIH), to conduct groundbreaking research regarding lupus flares. Sun exposure can trigger skin lesions and worsening of kidneys or other internal organs affected by lupus, but how inflammation at the skin leads to internal organ effects is unknown. The hope is that this study will identify the molecular pathways that drive photosensitivity and lupus flares to determine better treatment options for this confounding and mysterious disease.

The Department of Defense has granted a three-year grant to study the proteins emitted from the skin that affect lymph nodes, the downstream immune tissues, while a two-year grant from the NIH will aid the investigation into non-protein molecules and changes of fibroblasts in lymph nodes. The team will do this by examining skin components including interstitial fluid.

“My lab is focused on understanding the pathogenesis of lupus. Lupus skin rashes affect the quality of life of patients and can be connected to systemic disease that can be life-threatening. Therapeutic options in lupus are limited, and it is important that we understand pathologic mechanisms so that we can develop better therapeutic options,” said lead investigator Theresa T. Lu, MD, PhD, from HSS Research Institute.

The grants and research will be executed at HSS Research Institute, the largest musculoskeletal research facility in the world.

About HSS Research Institute

HSS Research Institute is the largest musculoskeletal research facility in the world. With over 300 dedicated researchers and 20 laboratories, HSS Research Institute has been a leader in research aimed at improving the lives of patients suffering from debilitating orthopedic and rheumatic conditions such as arthritis, bone and soft tissue injuries, autoimmune diseases, and musculoskeletal pain and deformities.

Fall 2022’s Awards, Appointments & Announcements in Rheumatology

Fri, 09 Dec 2022 16:48:00 -0500

The Rheumatologist reports that The Lupus Research Alliance (LRA) inaugurated two new award mechanisms this past summer with the goal of alleviating the racial disparities prevalent in both autoimmune diseases and the biomedical research community.

Career Development Award recipient, Ashira Blazer, MD, MSCI, rheumatologist at HSS, says, “This award is very important for me and also for the field. One of the things that’s been a big issue in rheumatology, and in medicine as a whole is that we don’t have enough investigators of color. They are less likely to get quality mentorship and less likely to have the ability to stay in the pipeline.”

Postdoctoral award to promote diversity in lupus research recipient, Ruth Fernandez Ruiz, MD, MS, rheumatologist at HSS, is evaluating the impact of genetic variants in lupus progression. “I am thrilled and honored to be one of the inaugural recipients of the Diversity in Lupus Research Awards,” she says. This funding will be instrumental in continuing my contributions to SLE research and advancing my academic career. I believe that the Diversity in Lupus Research award program by the LRA is a great initiative to address the profound underrepresentation of minorities in biomedical research."

Read the full article: https://www.the-rheumatologist.org/

The impact of autoimmune disease on women

Tue, 29 Nov 2022 18:52:00 -0500

New research from HSS led by Lucy Masto, BS; Caroline Siegel, MD, MS; Sanjana Adurty, BA; and senior authors Medha Barbhaiya, MD, MPH, and Lisa Sammaritano, MD, highlights key reproductive health challenges for women with autoimmune rheumatic diseases, including menstrual‑cycle–related flares, low HPV vaccination rates, and misconceptions about contraception. The team also found that assisted reproductive technologies such as egg freezing and IVF can offer important options for patients facing fertility concerns.

Read the full article at contemporaryobgyn.com.

HSS Research Uncovers How UV Light Triggers Immune Activation and Disease Flares in Lupus

Sun, 13 Nov 2022 10:00:00 -0500

After sun exposure, people with systemic lupus erythematosus (SLE) frequently develop skin rashes, which often are accompanied by a flare of their overall disease. This connection between ultraviolet (UV) light and disease flares in lupus is well known, but the way in which UV exposure actually triggers the disease has been poorly understood.

In a new study being presented at ACR Convergence 2022, the annual meeting of the American College of Rheumatology, researchers from Hospital for Special Surgery (HSS) report that they have found an underlying mechanism that explains this association: decreased lymphatic drainage, which contributes to both photosensitivity and an immune response in the lymph nodes. The research also suggests that boosting lymphatic drainage may be an effective treatment for lupus photosensitivity and autoimmunity.

“When people with lupus have a systemic flare of their disease, it can affect any organ that is part of their disease,” says senior author Theresa T. Lu, MD, PhD, who holds the St. Giles Chair for Research in the HSS Research Institute, is a faculty member in Pediatric Rheumatology and in Rheumatology at HSS and is a professor of microbiology and immunology and of pediatrics at Weill Cornell Medicine. “We wanted to look at why sun exposure at the level of the skin affects internal organs like the kidneys, heart and lungs.”

“This study sheds some light on how sun exposure and UV light cause people with lupus to have more autoantibodies in their blood,” adds first author William Ambler, MD, a former fellow at HSS in Dr. Lu’s lab who is now Metzger Scholar in Translational Medicine at the National Institute of Arthritis and Musculoskeletal and Skin Diseases at the National Institutes of Health.

The skin communicates with the immune system by sending cells and molecular signals via the lymphatic vessels to the lymph nodes, where immune responses begin. The signals that the skin sends to the lymph nodes control the type of immune responses that occur. Lymphatic vessels also serve the function of removing fluid and cells from the skin. If lymphatic vessels do not work properly to bring signals from skin to lymph nodes, there can be delayed resolution of skin inflammation, leading to faulty signals being sent to the lymph nodes.

Research in the Lu lab suggests that lymphatic flow from the skin to the draining lymph nodes is reduced in people with lupus. The investigators hypothesize that this decreased flow alters lymph node immune responses, making them more pathogenic. They decided to look more closely at this communication and how it impacts immune function. The current research employed both patient samples and mouse models of SLE.

The investigators studied skin biopsies from lupus patients as well as from healthy volunteers who served as controls. When they looked at the samples from the lupus patients, they found these more dilated lymphatic vessels compared with the healthy controls. This provided evidence that people with lupus have poor lymphatic flow.

They then studied mouse models of SLE, using a dye injected into the skin to visualize the flow of lymphatic fluid. They found that when lupus mice were exposed to UV radiation, more dye remained in the skin. This provided evidence that the lymphatics were not clearing the fluid as well as they should.

Importantly, the researchers then looked to see if they could improve certain hallmarks of disease in the mice by using manual lymphatic drainage techniques to manipulate the flow of lymph fluid. This type of therapy is used in people with certain types of cancer, especially breast cancer, to prevent lymphedema (fluid accumulation and swelling) after the surgical removal of lymph nodes. They found that performing lymphatic drainage in the mice reduced the numbers of plasmablasts and germinal center B cells, types of cells that are known to be important players in lupus.

Drs. Ambler and Lu are optimistic that manual lymphatic drainage may benefit lupus patients but emphasize that clinical trials in patients are needed to confirm it would be safe and effective.

The investigators note that this research is also important because it advances the broader field of understanding how skin and organs communicate through the lymph nodes and the immune system.

Study Finds Chronic-Pain Management, Falls and Limited Access to Care Are Critical Issues Among Medically Underserved

Sun, 13 Nov 2022 09:00:00 -0500

To improve the health of a community, the first step is to identify its most pressing needs. To that end, in 2022 Hospital for Special Surgery (HSS) implemented a community-based participatory research (CBPR) approach to assess musculoskeletal health needs, identify health disparities and support the development of initiatives to address unmet needs.

Critical issues included a lack of health education and awareness in managing arthritis and other painful conditions; a high incidence of falls in the community; and limited access to care among underserved populations.

The study, “Assessing Musculoskeletal Health Needs of Underserved Patients & Community Members Using a Community Based Participatory Research Approach,” was presented virtually at ACR Convergence 2022, the annual meeting of the American College of Rheumatology in Philadelphia.

“Musculoskeletal disorders are the most prevalent health conditions in the United States, resulting in financial and social burdens, especially in underserved communities,” explained Titilayo Adeniran, MPH, director of outcomes & data analytics at the HSS Education Institute. “Studies show that musculoskeletal health disparities disproportionately affect women, older adults and racial/ethnic minorities.”

HSS researchers used a mixed-method approach to develop a Community Health Needs Assessment (CHNA). “For quantitative data, we distributed a community survey in four languages—English, Spanish, Chinese and Russian—to assess the socio-demographic characteristics of the populations we serve; health status and quality of life; health behavior and lifestyle; use of and access to care; and health education needs,” explained Adeniran. “For qualitative data, we conducted interviews with 22 community partners, including community-based organizations, city and state agencies and universities.”

The survey was distributed in various ways, including online, via email, using Alchemer panels, in person, and through the mail over a four-week period from January 15 to February 15, 2022. A total of 18,248 patients and community members completed the surveys, with 57% representing a diverse and underserved population.

In addition to the surveys, interviews with community partners provided valuable insights into unmet health needs, Adeniran noted. Community organizations represented all five boroughs of New York City, as well as surrounding areas serving racially/ethnically diverse populations. They represented all age, gender, and socioeconomic groups.

Key findings:

- Chronic pain, osteoarthritis or another form of arthritis were the most common musculoskeletal conditions reported in the survey.
- Among respondents with a musculoskeletal condition, a lack of confidence in managing symptoms emerged as a health need, particularly among medically underserved community members.
- Almost one-third of all respondents reported falling in the past year.
- Those with chronic pain, fibromyalgia or lupus were more likely to report two or more weeks of poor physical and mental health.
- Medically underserved respondents diagnosed with lupus, chronic pain or rheumatoid arthritis were more likely to have used a prescription opioid to manage pain.
- Health education emerged as a major need, with 70% of respondents reporting no participation in health education in the past 12 months. The top reasons were fear of COVID-19 and not knowing about educational programs.
- The top issues impacting respondents’ health and well-being were COVID-19 related issues, social isolation/loneliness, limited places to exercise, and limited access to healthy foods.
- The survey identified a need to address access to healthcare, with 42% of respondents reporting they could not access healthcare in the past 12 months, compared to 8% in a previous survey conducted in 2019. The top barriers were difficulty getting an appointment, lack of affordability or a service not covered by insurance. The need for transportation was also cited among the medically underserved.
- The most common type of discrimination reported in medical settings was that a doctor or nurse was not listening to the respondent. More than half of those taking the survey cited this issue.

“Broad community engagement is crucial to the success of any CBPR approach when assessing the health needs of the community and identifying health disparities,” said Sandra Goldsmith, MA, MS, RD, assistant vice president at the HSS Education Institute. “The results of our study will enable us to raise awareness about disparities that continue to affect our diverse and underserved populations and help us develop community-based initiatives to promote health equity.”

Authors: Titilayo Adeniran, Bertilia Trieu, Sandra Goldsmith and Laura Robbins, Hospital for Special Surgery, New York, NY

Cytokines and Rheumatic Diseases

Sat, 12 Nov 2022 14:00:00 -0500

In my talk at the American College of Rheumatology (ACR) Convergence 2022 titled “Cytokine regulation of inflammation in rheumatic diseases,” I discussed the role of immune molecules called cytokines in the pathogenesis of rheumatoid arthritis (RA) and other disease processes.

Cytokines are key actors in the body’s response to infection. They help white blood cells attack bacteria and other invaders by giving them chemical signals to eliminate their targets. For people with autoimmune disorders such as RA and lupus however, cytokines activate white cells in the joints, where they can destroy healthy tissues like cartilage.

In the 1980s and 1990s, researchers showed that patients with rheumatologic conditions could benefit from medications that suppress cytokines. Those discoveries led to the development of several effective drugs designed to block a range of cytokines, including tumor-necrosis factor, interleukin-6 and interleukin-1. My laboratory helped link RA with a cytokine communication system called the JAK-STAT pathway. Subsequently, drugs that inhibit the JAK pathway were developed and approved by the U.S. Food and Drug Administration (FDA) for the treatment of patients with RA and other inflammatory diseases.

We also learned that individual patients appeared to have different cytokine reactions, and that finding the most important cytokine for each patient was essential in maximizing the chances of successful treatment—in other words, personalized medicine.

But the last 30 years have not seen the story play out as many of us had hoped. Cytokine therapy, even when highly tailored to the individual, hasn’t worked as well as expected. For starters, clinicians have a hard time identifying which cytokine to target with medication. You can’t block them all because doing so would deprive the body of its ability to fight infections and cancer. And when they do find the right one, up to half of patients experience only a partial response and another third are resistant to treatment.

This unmet medical need has led us in new, very promising directions. Along with my colleagues Franck Barrat, PhD, and Mary “Peggy” Crow, MD, we are starting to make exciting advances in our understanding of how cytokines interact with the genes of cells. In particular, we have been looking at how certain cytokines affect proteins that instruct genes to become more or less active.

Our understanding of this process, called epigenetics, and how it relates to rheumatologic diseases is incomplete. But we believe that the interplay of cytokines and epigenetics may be a key step in autoimmunity. By interrupting these signals, we think we can short-circuit the immune system’s assault on joints and other parts of the body.

A focus of our work recently has been on a cytokine called interferon (IFN). This molecule has been approved by the FDA for treating a variety of diseases, including infection with the hepatitis C virus and blood cancer. In contrast, blocking the effects of IFN is effective in treating lupus.

COVID-19 has given us several new ideas about IFNs that might be helpful in achieving this goal. Early in the pandemic, researchers observed that patients with severe illness often generated massive amounts of inflammatory cytokines in response to the infection. This response, which is called a “cytokine storm,” seems to be an all-hands-on-deck call to the immune system to rally the defenses against the virus. This cytokine storm happened later in the course of the illness, and in collaboration with Dr. Barrat we implicated IFNs in the cytokine storm occurring via epigenetic mechanisms. In other words, some of the same immune issues we see with COVID-19 are also happening with autoimmune diseases like lupus and RA.

Intriguingly, this observation meshes with our studies of Janus kinases (JAKs). These molecules are known to be involved in a variety of autoimmune diseases, including ulcerative colitis (UC) and Crohn’s disease, as well as RA. Drugs that inhibit JAKs have been approved by the FDA for several indications, and researchers have found that the medications also appear to help patients with COVID-19.

Much of the scientific community believes that JAK inhibitors work by suppressing genes that are induced by interferon. Although this view is correct, our lab has shown that the JAK system also connects to many other cytokines linked to RA, including interleukin-6. We’ve also shown that we can use JAK inhibitors to regulate these pathogenic genes, likely through epigenetic mechanisms.

Scientists at HSS are excited about the future of cytokine research and the benefits this can bring to patients with rheumatic diseases. We believe that effective targeting of cytokine-related signaling pathways and epigenetic mechanisms can lead the way towards remissions and even cures.

- Lionel B. Ivashkiv, MD, chief scientific officer at HSS

Participation Doubles After Lupus Support Group at HSS Transitions to Virtual Format During Pandemic

Sat, 12 Nov 2022 13:00:00 -0500

A study at Hospital for Special Surgery (HSS) highlights the success of a lupus peer support and education group that transitioned to a virtual format during the pandemic. In addition to receiving high marks from group members, participation more than doubled after the meetings went remote.

“Studies have demonstrated the benefits of online peer support forums in meeting the mental health, disease self-management and coping needs of people living with a chronic illness,” explained Giselle Rodriguez, LCSW, social work program coordinator for Charla de Lupus (Lupus Chat)® at HSS. “Although in-person meetings were no longer viable during the pandemic, the virtual groups offered an effective platform for patients to continue to meet with their peers, reduce isolation and expand the reach to additional family members at home and across the country.”

Rodriguez presented the study, “Evaluating the Effectiveness & Impact of an In-Person Peer Support Group That Transitioned to a Virtual Platform During the COVID-19 Pandemic,” at ACR Convergence 2022, the annual meeting of the American College of Rheumatology, in Philadelphia on November 12.

At the monthly support group, which has been ongoing at HSS since 2001, social workers, rheumatologists and other health care professionals offer information on topics related to lupus, such as medications, nutrition, pain management and research. The bilingual social work team translates all presentations into Spanish to distribute to Spanish-speaking members prior to the Zoom meetings. In addition, all communications in the chat box are translated live during the sessions to encourage Spanish speakers to participate. In some groups, simultaneous translation is provided.

To assess the effectiveness of the meetings, members received an online survey with multiple-choice and open-ended questions after nine virtual sessions from September 2020 to June 2021. Researchers conducted a comparison analysis with surveys completed by in-person groups held in 2018-2019 to assess reach, satisfaction, knowledge, coping and disease management.

Reach increased significantly after transitioning to a virtual group, with 373 participants versus 177 in 2018-2019. Responses highlighted the benefits of a virtual group, such as removing transportation barriers, the ability to join the meeting from anywhere and ease of participation by sharing a link. Limitations included inability to connect one on one, no internet access and challenges using Zoom.

Key findings:

- 99% of respondents reported satisfaction with the virtual groups
- 98% agreed that the groups increased their understanding of lupus-related issues
- 98% agreed the program met their expectations
- 97% agreed that they would recommend this group
- 95% agreed they could apply what they learned to manage lupus
- 93% agreed the groups helped them cope with lupus

No significant differences were observed when comparing most answers from in-person groups conducted in 2018-2019 to the virtual group. However, in the virtual group, there was an 8% increase in respondents indicating that the sessions helped them cope with lupus.

Survey comments from participants demonstrated that they appreciated the virtual format:

"It was an excellent idea to transition from in-person programming to virtual. Charla should keep it virtual or a mixture of programming and virtual to keep it easy to attend all the meetings without missing any."

"Charla has made great use of Zoom for each of their programs. Although the experience is not the same as in person, every program was just as informative."

"I love the Zoom meeting since it is a way for everyone to stay connected from home healthy and safe."

“I would not have been able to attend the meetings due to location.”

The monthly lupus support groups and special events continue to be hosted online through Zoom. Rodriguez and colleagues are assessing participants’ interest in a hybrid model utilizing both in-person and virtual groups going forward.

Authors: Giselle Rodriguez¹, Priscilla Calvache¹, Lillian Mendez¹, Kimberly Cabrera¹, Roberta Horton¹, Lisa Imundo² and Jillian Rose-Smith¹, ¹Hospital for Special Surgery, New York, NY, ²New York Presbyterian Hospital - Columbia Campus, New York, NY

HSS Presents New Research at the ACR Convergence 2022

Sat, 12 Nov 2022 08:17:40 -0500

At this year’s American College of Rheumatology (ACR) annual meeting, HSS presented exciting research related to rheumatology and orthopedic surgery. Additionally, the ACR and the Association of Rheumatology Professionals (ARP) honored two rheumatologists and a social worker with distinguished awards.

Research highlights include the success of a lupus peer support and education group that transitioned to a virtual format during the COVID-19 pandemic, a community-based participatory research approach to assess musculoskeletal health needs, the way in which ultraviolet (UV) exposure triggers immune activation and disease flares in lupus, trends in the use of total knee arthroplasty (TKA) in patients under the age of 21 in the United States (U.S.), and insights that may help future research explore why women with knee osteoarthritis report worse pain than men.

HSS Rheumatologists, Social Worker Honored by American College of Rheumatology
The ACR and ARP have honored HSS rheumatologists Michael D. Lockshin, MD, Melanie H. Smith, MD, PhD and social worker Adena Batterman, LCSW, MSW, with prestigious awards at the ACR Convergence meeting on November 12. Each year, the ACR and ARP recognize members who have made outstanding contributions to the field of rheumatology.

Participation Doubles After Lupus Support Group at HSS Transitions to Virtual Format During Pandemic
An HSS study presented by Giselle Rodriguez, LCSW, social work program coordinator for Charla de Lupus (Lupus Chat)®, highlighted the success of a lupus peer support and education group that transitioned to a virtual format during the COVID-19 pandemic. In addition to receiving high marks from group members, participation more than doubled after the meetings went remote.

Study Finds Chronic-Pain Management, Falls and Limited Access to Care Are Critical Issues Among Medically Underserved
Titilayo Adeniran, MPH, director of outcomes & data analytics at the HSS Education Institute and colleagues implemented a community-based participatory research approach to assess musculoskeletal health needs, identify health disparities and support the development of initiatives to address unmet needs. Critical issues included a lack of health education and awareness in managing arthritis and other painful conditions; a high incidence of falls in the community; and limited access to care among underserved populations. Findings will help to raise awareness about disparities that continue to affect diverse and underserved populations and the development of community-based initiatives to promote health equity.

HSS Research Uncovers How UV Light Triggers Immune Activation and Disease Flares in Lupus
A study by HSS scientist Theresa T. Lu, MD, PhD and former fellow William Ambler, MD, examined the way in which UV exposure triggers immune activation and disease flares in lupus. Results found an underlying mechanism that explains this association: decreased lymphatic drainage, which contributes to both photosensitivity and an immune response in the lymph nodes. The research also suggests that boosting lymphatic drainage may be an effective treatment for lupus photosensitivity and autoimmunity.

Study Examines Total Knee Replacement in Patients Under 21
HSS rheumatologist Bella Mehta, MBBS, MS, hip and knee surgeon Cynthia A. Kahlenberg, MD, MPH, and colleagues evaluated trends in the use of TKA in patients under 21 years old in the U.S. The researchers retrospectively analyzed the Kids’ Inpatient Database (KID), a national weighted sample of all inpatient hospital admissions of patients under 21 years of age in approximately 4,200 hospitals in 46 states. They also used International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes to identify patients undergoing TKA from 2000-2016 and determine primary diagnosis. 70.3% of TKAs were performed for a primary diagnosis of a tumor; and the number of TKAs for malignant tumors increased slightly over the study period. In contrast, use of TKA for inflammatory arthritis / juvenile idiopathic arthritis (JIA) decreased by more than 70% over the study period, likely due to improvements in medical management of inflammatory arthritis /JIA patients.

Mast Cell Levels May Explain Sex Differences in Osteoarthritis Pain
A study by HSS rheumatologists Dana Orange, MD, MS, Bella Mehta, MBBS, MS, and colleagues discovered that at the time of total knee replacement, women have significantly increased levels of immune cells called mast cells in synovial tissue surrounding the knee joint than men. The findings may help future research explore why women with knee osteoarthritis report worse pain than men.

HSS Rheumatologists, Social Worker Honored by American College of Rheumatology

Sat, 12 Nov 2022 08:00:00 -0500

The American College of Rheumatology (ACR) and the Association of Rheumatology Professionals (ARP) have honored two rheumatologists and a social worker at Hospital for Special Surgery (HSS) with prestigious awards. Each year, the ACR and ARP recognize members who have made outstanding contributions to the field of rheumatology. The ceremony took place at the ACR Convergence meeting in Philadelphia on November 12.

Michael Lockshin, MD, received the ACR Distinguished Clinician Scholar Award, which honors a rheumatologist who has made outstanding contributions in clinical medicine, clinical scholarship or education.

Melanie Smith, MD, PhD, received the ACR Distinguished Fellow Award, which recognizes clinical and research fellows who are in a rheumatology fellowship training program and have performed meritoriously.

Adena Batterman, LCSW, MSW, received the ARP Distinguished Clinician Award. It is presented to an ARP member who is engaged in clinical practice and demonstrates outstanding clinical expertise in arthritis and the rheumatic diseases.

"HSS is extremely proud of our team members who have been honored with these notable awards,” said Louis A. Shapiro, president and CEO of HSS. “We warmly congratulate them for their contributions and achievements in patient care, research, support and education.”

Michael Lockshin, MD

Dr. Lockshin’s award follows a career spanning more than four decades at HSS. When asked about receiving the honor, he said, “I think it honors those who surrounded and challenged me more than it does me—patients who asked hard questions; the team led by Charles Christian that trained me and with whom I was privileged to work; intellectually curious colleagues, students and fellows; Hospital for Special Surgery, which gave me freedom to pursue goals I thought were worthwhile; and my wonderful family.”

Director emeritus of the Barbara Volcker Center for Women and Rheumatic Disease at HSS, Dr. Lockshin is a preeminent expert in the long-term care of chronically ill patients. His research enabled him to develop special expertise in solving health-care issues associated with systemic lupus erythematosus, antiphospholipid antibody syndrome and other autoimmune diseases that predominantly affect women.

Dr. Lockshin continues to conduct research and engage in mentoring activities at HSS. His current work focuses on diagnostic uncertainty, the topic of an international conference he organized last year. He has also published a white paper and written a book on the subject.

Melanie Smith, MD, PhD

Dr. Smith describes her Distinguished Fellow award as an incredible honor. “It is a testament to the opportunities I have had during my fellowship training and the amazing group of mentors that have supported my development as both a physician and a scientist,” she said. “I am excited to embark on a career dedicated to understanding mechanisms of disease with the goal of improving care for our patients.”

Dr. Smith, now a staff rheumatologist at HSS, specializes in treating inflammatory arthritic conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Sjogren's syndrome and gout/pseudogout. She also treats patients with osteoarthritis. Her research focuses on how cells that make up the healthy joint lining change when an individual develops rheumatoid arthritis.

Adena Batterman, LCSW, MSW

Adena Batterman, recognized with the ARP Distinguished Clinician Award, is senior manager of the Inflammatory Arthritis Support and Education Programs at HSS. “I feel honored and grateful to be recognized for clinical work and research that enhances the lives, and elevates the voices, of patients,” she said. “I’m grateful to be engaged in work made possible by colleagues and mentors that continues to have deep personal and professional meaning to me.”

Ms. Batterman develops and oversees support and education programs designed to address the multifaceted needs of patients with inflammatory arthritis during the many stages of their illness. The programs provide essential information to help participants make informed decisions about management and treatment; offer peer support and coping strategies; and create a forum in which members can share their experiences and feelings.

“I commend our HSS colleagues who have been honored by two of the foremost organizations advancing the field of rheumatology,” said S. Louis Bridges, Jr., MD, PhD, physician-in-chief and chief of the Division of Rheumatology at HSS. "Our colleagues’ hard work, skill and dedication have enabled them to excel in their respective specialties. Their contributions have helped HSS achieve a leadership role in rheumatology to improve the lives of patients with exceptional care and vital research.”

Lupus, coronary artery disease share genetic risk factors; data may lead to early testing

Fri, 04 Nov 2022 15:19:00 -0400

Healio Rheumatology reports that researchers have identified shared genetic risk factors for systemic lupus erythematosus and coronary artery disease, according to data published in Cell Reports Medicine.

According to Jane E. Salmon, MD, rheumatologist at HSS, who was not involved in the study, the findings offer an opportunity for new treatment strategies to both prevent and treat atherosclerotic CVD in SLE.

“For the first time, AMPEL’s elegant CardioGENE work elucidates the genetic risk factors shared between patients with coronary artery disease and those with lupus, providing a new opportunity to consider novel therapeutic approaches to prevent and treat atherosclerotic CVD in patients with lupus,” said Dr. Salmon.

Read the full article: https://www.healio.com.

CBS Saturday Morning

Sat, 22 Oct 2022 12:15:00 -0400

CBS Saturday Morning interviews S. Louis Bridges, Jr., MD, PhD, physician-in-chief and chair of the Department of Medicine at HSS, at the Lupus Research Alliance’s (LRA) Many One Can Walk to Cure Lupus in New York City on October 22, about the misconceptions of lupus.

Dr. Bridges noted “I think a lot of people think of lupus in the old days before we had good treatments - that it was life threatening and rarely do we see that anymore." He continued, “Even though it is a terrible disease, we are developing brand new treatments that can really impact patient’s lives. We encourage people to get diagnosed early. It’s a challenge for many people because lupus can look like other things. We encourage everyone who has lupus to ask their doctors ‘What can you do for me?’ as we have new medicines.”

Dr. Bridges added, “The symptoms [of lupus] when they start are vague, and so it’s difficult to diagnose sometimes. LRA is raising great money for research, and at HSS we have teams of rheumatologists, clinicians, and basic scientists who are developing new ways to treat lupus. It’s a very exciting time right now.”

This segment appeared on CBS Saturday Morning at 9am on October 22, 2022.

Additional coverage: CBS Radio

In Small Study, CAR-T Therapy Pushes Lupus Into Remission

Thu, 15 Sep 2022 18:32:00 -0400

HealthDay reports on study results published in Nature Medicine showing CAR-T therapy may kick hard-to-treat lupus into remission and includes commentary from HSS rheumatologist Ruth Fernandez Ruiz, MD, MS, who was not involved in the study.

The study included five people with severe lupus involving multiple organs — such as the kidneys, heart, lungs and joints — who hadn't responded to standard therapy.

According to Dr. Fernandez Ruiz, “[Lupus] patients had striking clinical improvement after CAR-T cell therapy and experienced clinical remission while off... [the] drugs for the duration of follow-up after CAR-T cell therapy. Despite the limited sample size, it is likely that there will be a role in implementing CAR-T cell therapy in [lupus], particularly for patients with severe disease that is refractory [resistant] to standard-of-care treatments.”

Read the full article at Healthday.com. Additional coverage: USnews.com.