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A Broader Take on Lupus

Date: May 1, 2013

Lupus expert Michelle Petri is researching ways to control the disease long term—without relying on prednisone.
Lupus expert Michelle Petri is researching ways to control the disease long term—without relying on prednisone.

It was a pathophysiology course in medical school that first turned Michelle Petri on to the study of autoimmune disease. The rheumatologist directing the course presented several patients to the group, and Petri found herself “immediately attracted” to the study of diseases predominantly affecting other young women.

Today Petri is an international authority on lupus, noting that in her 25-plus years at Johns Hopkins, her interest hasn’t waned: “It’s so intellectually fascinating because autoimmune disease is so complex.”

What has changed since Petri’s medical school days is physicians’ understanding of lupus, which is now viewed as a chronic instead of acute disease. Physicians have shifted from only immediate control of the disease to long-term management of morbidity, Petri says. 

When Petri was a fellow attending clinic rounds of the lupus clinic of a large teaching hospital, the director would ask how much prednisone a patient needed and select the highest dose shouted out by one of the rheumatologists. Today, Petri tells colleagues in scientific lectures that the “p” in prednisone stands for poison.

“We’ve discovered that a low dose of prednisone—just 6 mg—increases permanent organ damage by 80 percent,” she says. “The correct answer today to my professor’s question would be the lowest dose. There’s been a real paradigm shift.”

Petri’s research focuses on several aspects of systemic lupus erythematosus (SLE), the most common type of lupus, including atherosclerosis, antiphospholipid syndrome (APS), lupus nephritis, and pregnancy. The Hopkins Lupus Cohort, started by Petri in 1987, is a longitudinal study of the incidence and pathogenesis of thrombotic events and coronary artery disease among some 2,000 patients with SLE. 

And the Hopkins Lupus Pregnancy Center, which she co-directs, has a database of more than 400 pregnant patients, providing information on lupus activity, antiphospholipid tests and pregnancy outcomes. 

Petri has consulted and served as an investigator for several clinical trials of SLE, including a phase III trial published in The Lancet in February 2011 indicating that the drug belimumab was effective in reducing disease activity and flares in patients with active SLE. The medication, approved by the FDA in March 2011, inhibits a protein called B lymphocyte stimulator, or BLyS, which increases the survival and activity of immune B cells known to be hyperactive in lupus. Petri has authored more than 300 papers and chapters on lupus, APS and SLE, and serves on the editorial board for three prestigious rheumatology journals.

Her many accomplishments in the field include resurrecting the use of hydroxychloroquine (Plaquenil), an antimalarial drug invented during World War II that has many benefits for lupus patients, such as preventing renal disease and thromboses. Last summer, she and colleagues with the Systemic Lupus International Collaborating Clinics published new guidelines in Arthritis & Rheumatism, making it easier and faster for physicians to classify SLE.

Petri says she still wants to discover predictors of the disease and how to best prevent organ damage—“a major unmet need.” She’d also like to discover how the disease rewires the brain. Similar to those with fibromyalgia, says Petri, “Our patients never feel well. They have pain and fatigue that cannot be described,” even when the disease isn’t active.

Petri’s contributions to lupus are “absolutely monumental,” says rheumatologist Allan Gelber, a faculty colleague for 15 years. He lauds Petri’s leadership in collaborations and her prowess as an educator: “I have many times been in a room of 7,000 people at the American College of Rheumatology meetings when Michelle is speaking, and you can hear a pin drop…There is no more senior statesperson in lupus in the world.” 

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