Mary K. Crow, MD, physician-in-chief and chair of the Department of Medicine at Hospital for Special Surgery and chief of the Division of Rheumatology at New York-Presbyterian/Weill Cornell Medical Center, spoke with Rheumatology Advisor to discuss upcoming presentations at the American College of Rheumatology annual conference to be held November 11 – 16 in Washington, DC.
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I am Dr Peggy Crow, physician in chief of the department of medicine, chief of the division ofrheumatology, and also an investigator at Hospital for Special Surgery (HSS). I have spent 35 to40 years studying systemic autoimmune disease the laboratory, and now I am very involved inadministration of the department at our institution.I am very much looking forward to the American College of Rheumatology (ACR) annual meeting.
Every year the ACR committee schedules a basic sciencemeeting, and this year the topic is particularly interesting. The meeting will be focused on whathas been termed “immunometabolism.” This means that we can study lymphocytes andimmune system cells not only with regard to their production of inflammatory mediators andcytokines, but also their metabolism—how they use energy and how the use of that energyaffects their function. There has been considerable interest in this area not only to understandthe mechanisms of disease but also to gain new insights into potential therapeutic targets.
There have also been some interesting data emerging on how some of the available therapiescould be used to impact the metabolism of immune system cells.Several colleagues from my laboratory have abstracts accepted for presentation at ACR. One Iparticularly want to highlight is led by Mikhail Olferiev, MD. Mike is a very talented physicianand immunologist who has gained great expertise over the past few years inbioinformatics—analysis of what we might call big data and, in this case, gene expression data.We have been able to isolate subpopulations of immune system cells from both patients withlupus as well as healthy control subjects. We have then looked at the whole range of geneproducts expressed by those different cell populations, thereby gaining insight into someimportant molecular pathways that are activated in lupus.
One of the most obvious is the type Iinterferon pathway, which is prominent among the pathways expressed in all of thesepopulations of cells from lupus patients. However, we are very excited to have also observedsome new pathways that we will be talking about at the meeting and studying in the lab overthe next year.One of my colleagues, David Fernandez, has recently joined the faculty at HSS. David receivedboth MD and PhD degrees a number of years ago at the SUNY Upstate Medical University inSyracuse, where he studied mitochondria in cells of lupus patients. He was also involved instudies of N-acetylcysteine and rapamycin as potential therapeutic agents in lupus. Now that heis here at HSS, David is continuing to study the role of mitochondria and most recentlymitochondrial DNA in lupus patients. He has data in which he measured the circulatingmitochondrial DNA in blood of lupus patients, and he will be presenting those data in anabstract.
Patient-reported outcomes have become a very important way to gain insight into outcomes ofdisease. What the patient experiences and is able to communicate to the physician issometimes at least as important as the data from the lab tests that we order.
One of our juniorfaculty members, Shanthini Kasturi, MD, has recently been awarded a Masters degree based ona project that she led studying the role of the PROMISSE (Predictors of Pregnancy Outcome:Biomarkers in Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus)outcome measure in lupus patients. PROMISSE is a way to gain insight into disease based onthe reports of patients. A series of questions are posed to patients and based on theirresponses, a computer then identifies the next most appropriate question to be asked.
Dr Shanthini will be presenting a poster that describes this work and the potential for patient-reported outcomes as an important tool for measuring outcomes in patients with rheumaticdisease.Research is extremely important in medicine. It is the way we gain insight into diseasemechanisms and gain new ideas for therapeutic targets. We can then use those ideas in newdrug development and new ways of managing patients. It is absolutely essential that cliniciansbecome involved in research studies, whether by describing ideas for research studies or, andperhaps most importantly, by informing patients about participating in research.
Patientssometimes need to understand the value of research and also how they can contribute. Theyare often very enthusiastic about contributing to research; therefore, I would encourage allrheumatologists to think about how their efforts can help advance research and work with theirpatients to participate.There is a clear trend toward identifying patients with rheumatic disease even before they fit allof the classification criteria or diagnostic criteria for those diseases. We are very attuned tothinking about identifying patients with early inflammatory arthritis who might develop intopatients with rheumatoid arthritis, as well as looking for those patients with manifestations oflupus that don’t fit the full criteria.
Therefore, it is important for rheumatologists to be alert tothe symptoms and complaints that could suggest early disease because we are learning that theearlier a disease is treated, the more likely it is to be successfully treated and even preventmore severe manifestations.At HSS, we specifically focus on rheumatology and orthopedics. We have worked collaborativelyfor many years, particularly in the context of what we call the Combined Arthritis Program,where rheumatologists and orthopedic surgeons get together to discuss the management ofvery complex patients. But what we have seen emerge over the last few years is more andmore collaboration in research studies between rheumatologists and orthopedic surgeons.Many of our fellows become involved in these research studies with a particular focus on howwe can gain insight into the risk factors for good outcomes or less good outcomes fororthopedic surgery—how we can prepare patients with rheumatoid arthritis or lupus, forexample, for the best outcomes of surgery.
So there has been a lot of interaction betweenthese two important groups here the hospital, and it is wonderful to see our trainees becomeinvolved in some of the research studies that will be presented at the ACR meeting.We are all looking forward to the ACR annual meeting in Washington. It is always a lot of fun toget together with our colleagues, the alumni of HSS, and of course to see the importantpresentations and posters that describe exciting research studies.