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Elizabeth W. Karlson, MD
Senior Physician, Brigham and Women's Hospital
Professor of Medicine, Harvard Medical School

Brigham and Women's Hospital
Department of Medicine
Rheumatology, Immunology
75 Francis Street
Boston, MA 02115

Research Location: Boston Lying-In

Research Narrative:

The Rheumatic Disease Epidemiology Group, led by Dr. Karlson, is in the Section of Clinical Sciences, Division of Rheumatology, Immunology, and Allergy at Brigham and Women’s Hospital, and is affiliated with Harvard Medical School.  The group is located at 221 Longwood Avenue, Boston, MA, adjacent to Brigham and Women’s Hospital and Harvard Medical School. 

Dr. Karlson is a population scientist focusing on the epidemiology and outcomes of rheumatic disease.  Her research is focused on epidemiology and outcomes of rheumatic diseases, in particular Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE).  The group has developed innovative epidemiologic tools for testing hypotheses in populations, investigated the epidemiology of rheumatic diseases in large cohorts of female health professionals, studied predictors of outcome in RA and SLE and established a large SLE Registry.  

The BWH Rheumatic Disease Epidemiology Group has developed epidemiologic tools for rheumatic disease studies such as the Connective Tissue Disease Screening Questionnaire (CSQ) and demonstrated the validity of a new criteria system for defining SLE cases in research studies.  In addition the group developed and validated the Systemic Lupus Activity Questionnaire (SLAQ).  This is a tool used to follow SLE patients in outcome studies.
Dr. Karlson and colleagues have studied the epidemiology of rheumatic diseases in prospective cohorts.  The investigators demonstrated that postmenopausal hormones and prior oral contraceptive use increased a woman’s risk of SLE, while hair dye use did not increase risk.  They also demonstrated through both the Nurses’ Health Study and Women’s Health Cohort Study that breast implants were not associated with clinically significant immunologic abnormalities. They demonstrated that obesity early in life is an important risk factor for osteoarthritis of the hip and that breastfeeding may protect against RA but that coffee, decaffeinated coffee and tea intake were not associated with RA.  In recent work, the group has demonstrated associations between cigarette smoking and RA and SLE, occupational silica exposure and SLE, reproductive factors and SLE, antioxidants and RA and gene-environment interactions between GST genes and residential exposure to toxic waste sites and SLE. Additionally, the group showed that RA patients are at increased risk for cardiovascular disease (CVD), have higher inflammatory markers associated with CVD, but receive less cardiovascular preventive care than women without RA.  Recent studies include hormonal, cytokine and genetic biomarkers, perinatal risk factors, dietary factors and RA risk; and reproductive factors, silica, and solvents in SLE. I studied gene-environment interactions in SLE and in RA. Current studies include a NIAMS Center project on air pollution and gene-environment interactions in RA risk and an NIH-R01 grant on predictive modeling in RA using genetic and environmental risk factors. 

The group has studied a series of predictors of outcome in SLE.  They studied the relationship between socioeconomic status, race and outcome in SLE, and demonstrated that lower education status, but not race, was associated with worse disease activity.  They also demonstrated that self-efficacy for disease management and social support were most strongly associated with disease activity and health status outcomes in SLE, which led to a clinical trial of a psychoeducational intervention that demonstrated improved health status.  The group has also studied outcomes such as cardiovascular disease and lymphoma in SLE. In addition, the group established a multicenter SLE registry, that includes >1000 SLE patients from BWH, as well as 400 SLE patients from collaborating Boston hospitals.

Investigative Interests: Epidemiology of Rheumatoid Arthritis, Gene-environment Interactions, Rheumatoid Arthritis and SLE Outcomes

Johns Hopkins School of Medicine, 1988, MD

Publications (Pulled from Harvard Catalyst Profiles):

1. Cui J, Diogo D, Stahl EA, Canhao H, Mariette X, Greenberg JD, Okada Y, Pappas DA, Fulton RS, Tak PP, Nurmohamed MT, Lee A, Larson DE, Kurreeman F, Deluca TL, O'Laughlin M, Fronick CC, Fulton LL, Mardis ER, van der Horst-Bruinsma IE, Wolbink GJ, Gregersen PK, Kremer JM, Crusius JB, de Vries N, Huizinga TW, Fonseca JE, Miceli-Richard C, Karlson EW, Coenen MJ, Barton A, Plenge RM, Raychaudhuri S. Brief Report: The Role of Rare Protein-Coding Variants in Anti-Tumor Necrosis Factor Treatment Response in Rheumatoid Arthritis. Arthritis Rheumatol. 2017 Apr; 69(4):735-741.

2. Barbhaiya M, Lu B, Sparks JA, Malspeis S, Chang SC, Karlson EW, Costenbader KH. Influence of Alcohol Consumption on the Risk of Systemic Lupus Erythematosus Among Women in the Nurses' Health Study Cohorts. Arthritis Care Res (Hoboken). 2017 Mar; 69(3):384-392.

3. Sparks JA, Barbhaiya M, Karlson EW, Ritter SY, Raychaudhuri S, Corrigan CC, Lu F, Selhub J, Chasman DI, Paynter NP, Ridker PM, Solomon DH. Investigating methotrexate toxicity within a randomized double-blinded, placebo-controlled trial: Rationale and design of the Cardiovascular Inflammation Reduction Trial-Adverse Events (CIRT-AE) Study. Semin Arthritis Rheum. 2017 Feb 10.

4. Majka DS, Vu TT, Pope RM, Teodorescu M, Karlson EW, Liu K, Chang RW. Association of Rheumatoid Factors With Subclinical and Clinical Atherosclerosis in African American Women: The Multiethnic Study of Atherosclerosis. Arthritis Care Res (Hoboken). 2017 Feb; 69(2):166-174.

5. Rao DA, Gurish MF, Marshall JL, Slowikowski K, Fonseka CY, Liu Y, Donlin LT, Henderson LA, Wei K, Mizoguchi F, Teslovich NC, Weinblatt ME, Massarotti EM, Coblyn JS, Helfgott SM, Lee YC, Todd DJ, Bykerk VP, Goodman SM, Pernis AB, Ivashkiv LB, Karlson EW, Nigrovic PA, Filer A, Buckley CD, Lederer JA, Raychaudhuri S, Brenner MB. Pathologically expanded peripheral T helper cell subset drives B cells in rheumatoid arthritis. Nature. 2017 02 01; 542(7639):110-114.

6. Hu Y, Sparks JA, Malspeis S, Costenbader KH, Hu FB, Karlson EW, Lu B. Long-term dietary quality and risk of developing rheumatoid arthritis in women. Ann Rheum Dis. 2017 Jan 30.

7. Bengtsson C, Malspeis S, Orellana C, Sparks JA, Costenbader KH, Karlson EW. Menopausal factors are associated with seronegative RA in large prospective cohorts: results from the Nurses' Health Studies. Arthritis Care Res (Hoboken). 2017 Jan 13.

8. Hu Y, Cui J, Sparks JA, Malspeis S, Costenbader KH, Karlson EW, Lu B. Circulating carotenoids and subsequent risk of rheumatoid arthritis in women. Clin Exp Rheumatol. 2017 Mar-Apr; 35(2):309-312.

9. Chang HH, Liu GY, Dwivedi N, Sun B, Okamoto Y, Kinslow JD, Deane KD, Demoruelle MK, Norris JM, Thompson PR, Sparks JA, Rao DA, Karlson EW, Hung HC, Holers VM, Ho IC. A molecular signature of preclinical rheumatoid arthritis triggered by dysregulated PTPN22. JCI Insight. 2016 Oct 20; 1(17):e90045.

10. Tedeschi SK, Cui J, Arkema EV, Robinson WH, Sokolove J, Lingampalli N, Sparks JA, Karlson EW, Costenbader KH. Elevated BMI and antibodies to citrullinated proteins interact to increase rheumatoid arthritis risk and shorten time to diagnosis: A nested case-control study of women in the Nurses' Health Studies. Semin Arthritis Rheum. 2016 Sep 13.