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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


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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


Education:
Johns Hopkins School of Medicine, 1988, MD

Publications (Pulled from Harvard Catalyst Profiles):

1. Liu X, Tedeschi SK, Barbhaiya M, Leatherwood CL, Speyer CB, Lu B, Costenbader KH, Karlson EW, Sparks JA. Impact and timing of smoking cessation on reducing risk for rheumatoid arthritis among women in the Nurses' Health Studies. Arthritis Care Res (Hoboken). 2019 Feb 21.

2. Zhong QY, Gelaye B, Karlson EW, Avillach P, Smoller JW, Cai T, Williams MA. Associations of antepartum suicidal behaviour with adverse infant and obstetric outcomes. Paediatr Perinat Epidemiol. 2019 Feb 20.

3. Sparks JA, O'Reilly ÉJ, Barbhaiya M, Tedeschi SK, Malspeis S, Lu B, Willett WC, Costenbader KH, Karlson EW. Association of fish intake and smoking with risk of rheumatoid arthritis and age of onset: a prospective cohort study. BMC Musculoskelet Disord. 2019 Jan 05; 20(1):2.

4. Jorge A, Castro VM, Barnado A, Gainer V, Hong C, Cai T, Cai T, Carroll R, Denny JC, Crofford L, Costenbader KH, Liao KP, Karlson EW, Feldman CH. Identifying lupus patients in electronic health records: Development and validation of machine learning algorithms and application of rule-based algorithms. Semin Arthritis Rheum. 2019 Jan 04.

5. Ford JA, Liu X, Marshall AA, Zaccardelli A, Prado MG, Wiyarand C, Lu B, Karlson EW, Schur PH, Deane KD, Sparks JA. Impact of Cyclic Citrullinated Peptide Antibody Level on Progression to Rheumatoid Arthritis in Clinically Tested CCP-Positive Patients Without RA. Arthritis Care Res (Hoboken). 2018 Dec 20.

6. Marshall AA, Zaccardelli A, Yu Z, Prado MG, Liu X, Miller Kroouze R, Kalia SS, Green RC, Triedman NA, Lu B, Deane KD, Iversen MD, Karlson EW, Sparks JA. Effect of communicating personalized rheumatoid arthritis risk on concern for developing RA: A randomized controlled trial. Patient Educ Couns. 2018 Dec 10.

7. Zhong QY, Mittal LP, Nathan MD, Brown KM, Knudson González D, Cai T, Finan S, Gelaye B, Avillach P, Smoller JW, Karlson EW, Cai T, Williams MA. Use of natural language processing in electronic medical records to identify pregnant women with suicidal behavior: towards a solution to the complex classification problem. Eur J Epidemiol. 2019 Feb; 34(2):153-162.

8. Mosley JD, Benson MD, Smith JG, Melander O, Ngo D, Shaffer CM, Ferguson JF, Herzig MS, McCarty CA, Chute CG, Jarvik GP, Gordon AS, Palmer MR, Crosslin DR, Larson EB, Carrell DS, Kullo IJ, Pacheco JA, Peissig PL, Brilliant MH, Kitchner TE, Linneman JG, Namjou B, Williams MS, Ritchie MD, Borthwick KM, Kiryluk K, Mentch FD, Sleiman PM, Karlson EW, Verma SS, Zhu Y, Vasan RS, Yang Q, Denny JC, Roden DM, Gerszten RE, Wang TJ. Probing the Virtual Proteome to Identify Novel Disease Biomarkers. Circulation. 2018 Nov 27; 138(22):2469-2481.

9. Ricciotti E, Castro C, Tang SY, Briggs WTE, West JA, Malik D, Rhoades SD, Meng H, Li X, Lahens NF, Sparks JA, Karlson EW, Weljie AM, Griffin JL, FitzGerald GA. Cyclooxygenase-2, Asymmetric Dimethylarginine, and the Cardiovascular Hazard From Nonsteroidal Anti-Inflammatory Drugs. Circulation. 2018 Nov 20; 138(21):2367-2378.

10. Wei WQ, Li X, Feng Q, Kubo M, Kullo IJ, Peissig PL, Karlson EW, Jarvik GP, Lee MTM, Shang N, Larson EA, Edwards T, Shaffer CM, Mosley JD, Maeda S, Horikoshi M, Ritchie M, Williams MS, Larson EB, Crosslin DR, Bland ST, Pacheco JA, Rasmussen-Torvik LJ, Cronkite D, Hripcsak G, Cox NJ, Wilke RA, Stein CM, Rotter JI, Momozawa Y, Roden DM, Krauss RM, Denny JC. LPA Variants Are Associated With Residual Cardiovascular Risk in Patients Receiving Statins. Circulation. 2018 Oct 23; 138(17):1839-1849.