Seeking Expert Guidance on Lupus Using a Physician Ranking Tool

Treating patients with lupus may present complex challenges. Although the autoimmune disease typically attacks the skin, joints, and internal organs, particularly the heart and kidneys, lupus can affect other parts of a patient’s body. As such, clinicians may be faced with rare presentations and require specialty consultation in order to provide appropriate care.

Complicating this matter is the fact that, when presentations are rare, finding treatment experts can be challenging. In recognition of such challenges, Expertscape is an online consultation and referral tool that seeks to fill this void.

Platform users have the option to search for professionals with knowledge in 29,000 different categories of clinical interest, in order to find the top experts for each search term. Expertscape then uses a formula designed to remove subjectivity from its ranking system. The tool begins with a search of the PubMed database, looking for all published medical journal articles in that category. To ensure currency, Expertscape limits its search to publications released in the past 10 years.

Each article then receives a score based on the type of article (studies receive more points than opinions) and the journal in which it appears. Once the points are tallied, Expertscape produces a ranked list of experts, which can also be narrowed based on regional considerations.

What It Means to Top the Expertscape List

As it turns out, the Expertscape list of ranked lupus experts yielded mixed results. In the top spot is George C. Tsokos, MD, chief of rheumatology at Beth Israel Medical Center in Boston, Massachusetts, a professor of medicine at Harvard University, and director of the Tsokos laboratory at Harvard University, which he says is “one of the largest lupus labs in the world.”

In his 30-plus years as a clinical researcher, Dr Tsokos explains that he and his team have learned that “lupus is not one disease, it’s many. Each lady [lupus primarily affects women] has her own disease.” As such, says Dr Tsokos, his research “is based on one simple assumption: whatever we see in terms of a clinical presentation must be underlined with abnormalities within the immune cells. That means that 2 ladies may have a skin rash, but they may have 2 different pathways to injure the skin, and if they have 2 different pathways, they need 2 different treatments.”

In order to facilitate that treatment, Dr Tsokos and his team focus on “identifying the underlying mechanism within the immune cells, so we could better categorize the disease presentations by chemical lines instead of clinical divisions.” To date, researchers at the Tsokos lab have identified abnormalities in the interleukin 17 (IL-17) and IL-23 immune cell lines. These discoveries have made inroads in the complexity of treating lupus. In fact, says Dr Tsokos, the latter discovery sparked the clinical trial of ustekinumab as an IL-23 blocker.

Given his impact on the field, Dr Tsokos wasn’t surprised by his Expertscape ranking — although he’d only recently become aware of the platform, thanks to an email from one of his residents. And, says Dr Tsokos, he is open to receiving queries because of his listing. “I get requests from all over the world,” he says, “and I’m always happy to spend some time and give them advice. If someone seeks my opinion, there’s always time to talk.”

The Downside of Ranked Expertise

Still, says Dr Tsokos, while Expertscape’s algorithm certainly yields a list of knowledgeable physicians, the mere fact of their listing doesn’t mean these experts are the best in the field. Says Dr Tsokos, “I have a physician in my division who is an absolutely fascinating lupus doctor, but she never publishes. But if I had a relative with lupus, I’d refer them to her.”

While we’ve addressed the challenge of identifying unpublished physicians in earlier posts, a new concern arose while exploring the Expertscape platform through the lens of lupus. In reaching out to top experts for potential interviews, one highly ranked physician expressed her displeasure with being ranked. Not only did she question the Expertscape algorithm, she also expressed, “I do not think I could handle any more referrals than I already get.” In other words, when using this tool, physicians can and should be prepared for mixed reactions when reaching out to listed experts.

The Top Experts in Lupus in the United States, According to Expertscape

With the understanding that not every ranked physician is open to connecting, these are some of the clinicians and researchers in the field of lupus rounding out the Expertscape top 5 list:

Michelle A. Petri, MD, MPH

Dr Petri is head of the Hopkins Lupus Center at Johns Hopkins Medicine in Baltimore, Maryland.  Her expertise lies in rheumatology and systemic lupus erythematosus, and she conducts research on lupus as well as antiphospholipid syndrome.

David Stephen Pisetsky, MD, PhD

Dr Pisetsky is a professor of medicine and immunology at the Veterans Affairs Medical Center at Duke University in Durham, North Carolina. He is also a member of the Duke Cancer Institute and the Duke Human Vaccine Institute. His research focuses on mechanisms of DNA antigen drive in autoimmunity. 

Timothy Niewold, MD

Dr Niewold is a Judith and Stewart Colton professor of medicine at the NYU Grossman School of Medicine in New York City. He is also a professor in the school’s department of pathology. Additionally, Dr Niewold heads the Colton Center for Autoimmunity at NYU Langone Health, where his research is focused on finding new treatment targets in autoimmune disease.