Increasing contraception use among women receiving teratogenic medications in a rheumatology clinic.

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.

I am an Adult and Pediatric Rheumatologist and care for patients with a wide variety of autoimmune and rheumatic diseases, including: systemic lupus, rheumatoid arthritis, juvenile arthritis, vasculitis, and sarcoidosis, among others. I have a special interest in using musculoskeletal ultrasound to optimize diagnosis and treatment decisions at the bedside.

I am also a clinical researcher at the Duke Clinical Research Institute (DCRI). My research interests are in clinical trials and precision medicine through population pharmacokinetic/pharmacodynamic modeling. I obtained my PhD in Pharmaceutical Sciences from the UNC Eshelman School of Pharmacy. I serve as the principal investigator on several grants studying hydroxychloroquine and azathioprine pharmacokinetics and exposure-response in lupus, as well as principal investigator or co-investigator for several clinical trials at the DCRI. Additionally, I am an Assistant Scientific Director for the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry- the largest registry of children with rheumatic diseases in North America.

My clinical interests include systemic lupus erythematosus (SLE) and inflammatory myopathies.  I also  maintain a general rheumatology continuity clinic for individuals with rheumatoid arthritis, vasculitis, and other forms of inflammatory arthritis and autoimmune diseases.  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. 

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. 

Dr. Megan Clowse is an Associate 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.