Ongoing Clinical Studies

The Brigham and Women's Division of Rheumatology is currently recruiting patients with rheumatoid arthritis (RA), interstitial lung disease, lupus erythematosus (SLE), and pseudogout. Please see the links below for details on specific studies and whom to contact for more information.

The Nurses’ Health Study Rheumatic Disease Epidemiology Group

Led by Drs. Elizabeth Karlson and Karen Costenbader, this group have studied smoking, perinatal/reproductive factors, air pollution, geography, and metabolic/dietary risk factors for rheumatoid arthritis and systemic lupus erythematosus. Many other funded studies are underway.

Rheumatoid Arthritis (RA)

RA is a chronic autoimmune disease affecting more than 1.5 million Americans and millions more worldwide. The Nurses’ Health Studies are large scale prospective cohort studies of lifestyle, reproductive, and dietary risk factors.

Long-term exposure to lung irritants, with cigarette smoking as the dominant environmental risk factor, predisposes individuals to developing RA. Environmental toxins such as silica dust and cigarette smoke may trigger RA-related autoimmunity in the lung. NHS investigators reported higher relative risks of RA in the U.S. Northeast and Mid-West, regions with higher exposure to these environmental factors including air pollution. The NHS provided evidence for higher RA risk in U.S. women who lived closest to major roads (a proxy for traffic pollution).

Reproductive factors identified in RA include a protective effect of longer duration of breastfeeding and while irregular menstrual cycles and menopause increased the risk for future development of RA. Obesity is associated with higher RA risk, primarily for early onset RA at ≤ age 55. Adherence to healthy diet recommendations and moderate alcohol intake reduce risk of RA in the NHS cohorts. In nested case-control analyses, cytokine biomarkers and inflammatory factors were significantly elevated prior to RA onset, even after adjusting for environmental factors.

RA is also a systemic rheumatic disease with comorbidities such as coronary heart disease and respiratory disease outcomes occurring more frequently than in non-RA. Colleagues have established and excess risk of cardiovascular disease and excess respiratory mortality risk in RA in the NHS cohorts.

BWH SCS investigators have worked together on several funded studies spanning many years to build a comprehensive research strategy to:

  • Study the epidemiology and outcomes of RA
  • Identify the genetic determinants of RA
  • Identify gene-environment interactions in RA
  • Define key pathobiological mechanisms influencing RA susceptibility and heterogeneity

Systemic Lupus Erythematosus (SLE)

SLE is a related chronic, often severe multiorgan system autoimmune disease. It is rarer than RA, and affects primarily, but not exclusively, women. As for RA, the reasons that some people develop SLE are not completely understood, although there is ongoing research into the cause of SLE. Investigators in the BWH rheumatic disease epidemiology group have spent several years identifying all new onset cases of SLE in the Nurses’ Health Study cohorts, to delve into the study of exposures and risk factors that might influence the risk of developing this complex disease within this large population of women living all over the U.S. They have reported that current cigarette smoking also increases the risk of developing SLE characterized by autoantibodies, while oral contraceptive use may trigger the onset of the disease among women who are genetically predisposed. Endometriosis, a pelvic inflammatory condition, has been shown to increase the risk of developing SLE and obesity may also be related to increased risk of developing SLE. Several NIH-funded studies are ongoing to investigate other risk factors and how they interact with each other in influencing SLE risk.

Training

The BWH SCS rheumatic disease epidemiology team has an unparalleled track record in training investigators in developing an interdisciplinary understanding to work on autoimmune diseases, including RA and SLE, under our long-standing T32 training program in rheumatology.

Faculty

  • Elizabeth W. Karlson
  • Karen H. Costenbader
  • Bing Lu
  • Jeffrey Sparks