When rheumatologist Mary K. Crow, MD, became HSS physician-in-chief in 2010, she created a “Centers of Excellence” framework designed to improve coordination of patient care, education, and research around specific autoimmune diseases. This “bench to bedside” model has long been the philosophy of HSS, where research ideas are spurred by clinical experiences, and where findings translate into improved treatments and best practices.
Because HSS rheumatologists are renowned as specialists in rare and common autoimmune diseases, patients come to them from around the world for diagnosis and treatment. Centers of Excellence currently exist for inflammatory arthritis; lupus and antiphospholipid syndrome; and scleroderma, vasculitis, and myositis. Centers of Excellence for osteoarthritis; metabolic bone disease and bone health; and pediatric rheumatology are in development.
Dr. Crow, the Joseph P. Routh Professor of Rheumatic Diseases in Medicine, aims to give patients unsurpassed care while efficiently supporting research in these debilitating diseases: “I want to mobilize the faculty’s energy on what’s important to the patient – and that’s efficient care focusing on their particular diagnosis. We want patients to feel they are part of the Hospital.”
The Centers of Excellence model encourages clinicians and scientists to work together to prioritize and identify the most pressing research questions evolving from their clinical work.
“It’s helpful for laboratory scientists to bounce ideas off of people who work with patients, and it’s helpful for clinical researchers to discuss disease mechanisms with molecular biologists. We all work together to improve the way we care for patients,” says Dr. Crow.
The model also encourages patients to enroll in clinical registries and research studies. “When patients feel connected to the Center, they are enthusiastic about understanding their illnesses and participating in research endeavors,” says Sergio Schwartzman, MD, director of the Inflammatory Arthritis Center of Excellence, which focuses on rheumatoid arthritis (RA) and related diseases.
Under the direction of Jane Salmon, MD, the Center for Systemic Lupus Erythematosus (also known as SLE or lupus) and the related Antiphospholipid Syndrome (APS) is a model for successful translational research. The Mary Kirkland Center for Lupus Research at HSS just celebrated its 10th anniversary, making important contributions to understanding the molecular and cellular basis of SLE and the development of new lupus therapies.
Since its establishment in 2001 with support from Katherine and Arnold Snider of Rheuminations, Inc., the Kirkland Center has provided support to 19 HSS investigators who have collectively published 213 lupus-related articles and received more than $50 million in federal, foundation, and industry funding.
This year, Kirkland Center scientists have published several noteworthy findings that will ultimately help patients with these serious diseases live active, healthier lives.
New findings have emerged from PROMISSE (Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Study), which has received continuous funding from the NIH since 2003 to study pregnancy outcomes in women with lupus. Nearly 700 women are currently enrolled in this multi-center study, which requires monthly follow-ups from patients.
A new analysis of 333 pregnant women found that 4 out of 5 women who become pregnant when their lupus symptoms are quiescent and stable can have favorable pregnancy outcomes.
“There was a misconception that women with lupus should not have children,” says Dr. Salmon, the Collette Kean Research Chair, who leads the study. “Now that our treatments are more effective and we have a better understanding of the disease, we can identify a window when pregnancy is safe and outcomes are good for mothers and their babies.”
Dr. Salmon and colleagues have also uncovered genetic mutations that may predispose women to preeclampsia, a serious pregnancy complication that affects up to 10 percent of pregnancies in the U.S. and claims the lives of more than 60,000 women each year in developing countries. Because the cause of preeclampsia is unknown, there are no reliable means to predict its occurrence and no satisfactory prevention or treatment. When preeclampsia becomes life-threatening, the only option is to deliver the baby pre-term.
This study began as an offshoot of the PROMISSE study. Scientists analyzed DNA from 250 pregnant women with lupus and/or APS as well as 59 additional women without autoimmune disease who had had preeclampsia during a previous pregnancy. Although additional research is needed, the study suggests new targets for treating preeclampsia and the possibility for developing a test to determine women’s risk for the disease.
The Kirkland Center is committed to providing high quality medical care to all patients, regardless of their income. A new Lupus Center study of 143 low-income patients with lupus finds that they are often unable to attend scheduled physician appointments due to obstacles including late or unreliable transportation or insufficient childcare.
This study identified barriers to access to care that can be improved to help this population obtain adequate healthcare. “Improving transportation services or providing temporary childcare is potentially an important approach to ensure that this patient population receives the attentive care they need and deserve,” says Pretima Persad, MPH, lead author of the study and the manager of the Mary Kirkland Center for Lupus Care.
The goal of the Inflammatory Arthritis Center is to become a leader in patient care, education, and research of the inflammatory types of arthritis, including RA, psoriatic arthritis, ankylosing spondylitis, and autoimmune ophthalmic diseases.
Within the Inflammatory Arthritis Center, clinical and laboratory research create a cycle of discovery. Scientists discover a new disease mechanism in the lab that ultimately results in the development of new therapeutic interventions, which are finally studied in clinical trials with patients.
Lionel Ivashkiv, MD, associate chief scientific officer at HSS and physician in the Inflammatory Arthritis Center, and colleagues recently published a study demonstrating how a powerful pro-inflammatory protein, tumor necrosis factor (TNF), can also suppress inflammation by inducing a gene that has been previously linked to RA. The new understanding of how this mechanism works may lead to new therapeutic treatments for rheumatoid arthritis and other inflammatory diseases.
The Center has recently benefited from the recruitment of rheumatologist Vivian Bykerk, MD, a clinical researcher leading a long-term observational multicenter study of how to best treat patients with new onset inflammatory arthritis and ensure their early access to care. Dr. Bykerk is growing this study at HSS, which is now a sister site to Mount Sinai Hospital in Toronto, where Dr. Bykerk was previously director of its early arthritis program.
“As rheumatologists, we want to see patients with new onset rheumatoid arthritis as soon as possible,” says Dr. Bykerk. “The longer they wait, the higher the chance damage will occur.”
The Centers of Excellence aim to advance patient care, research, and education around specific disease groups. The model encourages collaboration between scientists and clinicians, who motivate each other to ask new questions, investigate treatment options and causes of disease, and improve care for patients.
Learn more in HSS's biannual publication, Discovery to Recovery.
Mary K. Crow, MD