Perspectives of Rheumatologists on the Type 1 and 2 Systemic Lupus Erythematosus Model.
Date
2024-12
Journal Title
Journal ISSN
Volume Title
Repository Usage Stats
views
downloads
Citation Stats
Attention Stats
Abstract
Objective
The Type 1 and 2 systemic lupus erythematosus (SLE) Model was developed to encapsulate all signs and symptoms that patients with SLE experience. Our previous qualitative work demonstrated the model accurately reflects the lived experience of people living with SLE. The objective of this study was to present the Type 1 and 2 SLE Model to rheumatologists to understand how the model fits with their experiences treating patients with SLE.Methods
We conducted a qualitative descriptive study using semistructured interviews with rheumatologists. Rheumatologists were asked about their general impression of the Type 1 and 2 SLE Model, how the model does or does not fit within their approach to treating patients with SLE, the utility of the model in clinical practice, and any suggested changes. Applied thematic analysis identified salient themes.Results
We interviewed 13 rheumatologists. The majority of rheumatologists approved of the model and found it useful to guide therapy and clinical decision-making. Several rheumatologists thought the model was helpful for patient education to manage expectations about differences between Type 1 and Type 2 symptoms and treatments. A few rheumatologists expressed concern that the model could lead to an overdiagnosis of SLE.Conclusion
The Type 1 and 2 SLE Model was accepted by most rheumatologists interviewed and welcomed as a useful approach to identifying and treating symptoms in patients with SLE. Future studies will determine how implementing the Type 1 and 2 SLE Model affects patient understanding, the physician-patient relationship, and clinical outcomes.Type
Department
Description
Provenance
Subjects
Citation
Permalink
Published Version (Please cite this version)
Publication Info
Eudy, Amanda M, Megan EB Clowse, Amy Corneli, Summer Starling, Nneka Jebose Molokwu, Teresa Swezey, David S Pisetsky, Mithu Maheswaranathan, et al. (2024). Perspectives of Rheumatologists on the Type 1 and 2 Systemic Lupus Erythematosus Model. ACR open rheumatology, 6(12). pp. 865–870. 10.1002/acr2.11748 Retrieved from https://hdl.handle.net/10161/33269.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
Collections
Scholars@Duke
Amanda Marie Eudy
Megan Elizabeth Bowles Clowse
Dr. Megan Clowse is a Professor of Medicine and Chief of the Division of Rheumatology and Immunology; she also holds joint appointments in the Department of Obstetrics and Gynecology and Population Health Sciences. Her clinical research focuses on the management of rheumatic diseases in pregnancy. She has cared for over 1000 pregnancies in women with rheumatic disease, collecting information on these pregnancies initially in the Duke Autoimmunity in Pregnancy Registry and Repository, and the MADRA (Maternal Autoimmune Disease Research Alliance) registry and repository. She served on the Core Leadership Team for the inaugural American College of Rheumatology's Reproductive Health Guidelines, published January 2020. Dr. Clowse created www.LupusPregnancy.org and www.ReproRheum.Duke.edu, websites dedicated to improving pregnancy planning and management for patients and rheumatologists.
Dr. Clowse was the founding director of the Duke Lupus Clinic, where she continues to see patients each week and mentor junior faculty researchers. The team has developed a new approach to lupus classification and management and is currently collecting and analyzing patient- and physician-reported measures to better clarify this construct.
Amy Lynn Corneli
Dr. Amy Corneli, a social scientist by training, conducts qualitative, mixed-method, intervention, and implementation science research. Her work spans the U.S. and multiple countries in sub-Saharan Africa, the Middle East, and South and Southeast Asia. She has a history of collaborating with and learning from community organizations and representatives in conducting research with populations that face discrimination, bias, or unequal treatment within the healthcare system and society due to race, ethnicity, gender, sexual orientation, or socioeconomic status. Her collaborative research often focuses on generating synergies between the creativity of art and the analytical thinking of science. The findings from her research inform clinical trials and practice, socio-behavioral interventions, guideline development, and the practical dissemination of proven interventions.
Dr. Corneli's current research portfolio encompasses three areas:
- Leading, co-leading, mentoring, and supporting qualitative, mixed-methods, and implementation science research in HIV prevention.
- Serving as a methodological investigative partner on qualitative, mixed-methods, and intervention research on a variety of health conditions and topics with faculty in the School of Medicine at Duke University.
- Leading the social science team for the Clinical Trials Transformation Initiative, a public-private initiative between Duke University and the U.S. Food and Drug Administration.
Dr. Corneli is also the:
- Founder and Director of QualCore, a group of PhD- and master-level social scientists who partner with Duke faculty to provide scientific direction and interviewing and analysis expertise in qualitative research.
- Co-founder and Director of The BASE (Bioethics and Stakeholder Engagement) Lab, a group of faculty and staff that partner with clinical investigators at Duke to conduct research with key contributors to inform the planning, conduct, interpretation, and reporting of clinical research.
- Director of the Duke CFAR Social and Behavioral Sciences Core.
QualCore | https://populationhealth.duke.edu/research/qualcore
The BASE Lab | https://populationhealth.duke.edu/research/base-lab
Duke CFAR Social and Behavioral Sciences Core | https://cfar.duke.edu
Clinical Trials Transformation Initiative | https://www.ctti-clinicaltrials.org
Prior to joining Duke University, Dr. Corneli was engaged in biomedical HIV prevention research at FHI 360 for 10 years.
David Stephen Pisetsky
Studies in my laboratory concern the immunological properties of DNA as related to two main topics: 1) the induction of anti-DNA responses in systemic lupus erythematosus; and 2) the stimulation of innate immunity by bacterial DNA. These topics are closely linked since we have established novel disease models in which lupus-like illness can be induced in normal mice by bacterial DNA under conditions in which mammalian DNA is inactive. This model has been useful in elucidating mechanisms of DNA antigen drive in autoimmunity.
To pursue these studies, our laboratory conducts investigations in the following areas: 1) specificity of anti-DNA for epitopes on mammalian and bacterial DNA; 2) molecular analysis of murine monoclonal anti-DNA antibodies; 3) histopathological analyses of DNA-immunized mice; 4) in vitro analysis of proliferation, antibody production and cytokine expression in human and murine immune cells; and 5) analysis of DNA binding to cell surface molecules on B cells, T cells and macrophages. Results of these studies have allowed identification of at least two structural motifs that are immunoactive. We are also exploring the impact of chemical modifications of the DNA backbone.
In addition to work on the immunology of DNA, I am also involved in clinical trials related to new immunomodulatory agents in the treatment of rheumatoid arthritis as well as serological markers of disease activity.
The areas of research for which I am known nationally are anti-DNA antibodies, systemic lupus erythematosus and immunological properties of DNA. I have written textbook chapters and reviews on all these subjects.
Mithunan Maheswaranathan
Kai Sun
My clinical interests are in general rheumatology, lupus, and musculoskeletal ultrasound. My research interest is in healthcare disparities and medication adherence in rheumatology.
Rebecca Eli Sadun
I am an adult and pediatric rheumatologist with clinical and research interests in the areas of lupus and transition to adult care. My time is split between the departments of Medicine and Pediatrics. In addition to seeing patients in both environments, I run a dedicated Young Adult Rheumatology Clinic in collaboration with Duke Family Medicine.
Lisa Giorgina Criscione-Schreiber
My clinical interests include systemic lupus erythematosus (SLE) and inflammatory myopathies. In 2007, I co-founded the Duke Lupus Clinic with Dr. Megan Clowse. We have continued this clinic with the aim to improve the health and quality of life for individuals living with lupus. In 2024, I co-founded the Duke Myositis Clinic with Dr. Nathaniel Harris. Similarly, we aim to improve the health, function, and quality of life for individuals living with inflammatory myopathies.
My primary research interests are in education and in SLE. My particular interest within education is learner assessment. I was previously funded by a Clinician Scholar Educator Award through the Rheumatology Research Foundation of the American College of Rheumatology. My CSE project explored validation of a rheumatology objective structured clinical examination (ROSCE). I continue to collaborate with the Rheumatology Program Directors at UNC Chapel Hill, Wake Forest University, the Medical University of South Carolina and Massachusetts General Hospital through our Carolinas Fellows Collaborative. Members of this group composed the competency-based goals and objectives (CBGO) for all learning activities of rheumatology fellowship training programs, which were adopted by the American College of Rheumatology and are posted on their website. I have been very involved in rheumatology curricular efforts through the American College of Rheumatology. I served on the Milestones working group and am a past member and past Chair of the ACR Curriculum Subcommittee of the Committee on Training and Workforce. I previously participated on the ACR/NBME rheumatology in-training examination working group.
Clinical research in lupus has included the Duke Lupus Registry population. Our recent work focuses on creating and defining the type 1 and type 2 lupus paradigms for classifying lupus disease activity. Additional interests through the Duke Lupus Clinic include elucidating clinician-level factors that can influence medication adherence as well as determining how health literacy and numeracy impact adherence and patient level outcomes. I collaborate with Dr. Megan Clowse, who studies reproductive health in women with autoimmune diseases. We have combined her subject matter expertise with my educational skills to create HOP-STEP, a program to teach patients with lupus and their rheumatologists about pregnancy planning to improve health outcomes. We have created lupuspregnancy.org, which houses many resources and videos designed to teach rheumatologists to better partner with women with lupus to have open and honest discussions about pregnancy planning. Our ultimate aim is to improve the health outcomes for women with lupus and their offspring.
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.