Portrait in Research: Karen Costenbader, MD, MPH
Karen Costenbader, MD, MPH, acknowledges the support of the Arthritis Foundation in helping get her research career off the ground. The Instructor in Medicine at Harvard Medical School and Associate Physician in the Division of Rheumatology, Immunology & Allergy at Brigham and Women’s Hospital in Boston, has received two awards from the Arthritis Foundation: the Physician Scientist Development Award in 2002 and the Arthritis Investigator Award in 2005.
“These awards enabled me to be involved in a variety of different research projects and get off to a solid start,” she says.
One of Dr. Costenbader’s recently published articles, “Cigarette Smoking and Systemic Lupus Erythematosus: A Smoking Gun? ” is highlighted in this issue. Research Update followed up with Dr. Costenbader to learn more about the work she’s done.
What has been the main focus of your research?
I am a rheumatologist and epidemiologist interested in the etiology of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) , complex autoimmune diseases that disproportionately affect women. My research has focused on the following questions: 1) What are the environmental risk factors for SLE and RA? and 2) What are the causes of long-term complications of these diseases, such as atherosclerosis, and what can be done for prevention? I have used the tools of clinical epidemiology in studies of unaffected populations and patients in clinical settings.
What key discoveries have come out of your research?
My work and that of others has firmly established cigarette smoking as a risk factor for RA, with risk related to increased dose and duration of cigarette smoking, and current cigarette smoking as a risk factor for SLE. I have studied cardiac risk factors in lupus patients and found, in general, that their management was suboptimal given the greatly increased risk of heart disease and strokes that these patients have.
How has your research impacted/will impact the lives of people with arthritis now and five years from now?
I'm hoping that we will discover more risk factors for the development of RA and SLE that are possible to change. For example, cigarette smoking is a modifiable risk factor that can definitely be changed and is linked to the development of these diseases and to worse outcomes. If we understand what causes these diseases, we will be farther along the path to understanding how to prevent them and their consequences.
Why did you choose this field? What drew you to it?
Inflammatory rheumatic diseases are chronic conditions that are debilitating and life-altering for so many, yet we know so little about them and their causes. Our model for the development of these diseases is that people inherit genes that somehow predispose them, and then they are exposed to "triggers" for the onset of the disease. I choose rheumatology because of the long-term patient relations it afforded, and because the diseases and their environmental "triggers" are so enigmatic.
What is your life like outside the lab? What do you like to do when you’re not working?
I have three kids and a husband who also works round the clock. We're a busy family! I don't have much [free time], but I like to travel with my family, swim, cook, and spend time with my kids.
You were involved in the recently published article about the ACR Response Criteria for Proliferative and Membranous Renal Disease in SLE Clinical Trials. Tell us about that.
This was a group effort, led by Matt Liang, MD, MPH [another Arthritis Foundation-funded researcher and recipient of the Lee C. Howley Prize], and others, in an effort to standardize the quality and conduct of clinical trials in SLE kidney disease. The American College of Rheumatology has organized several such groups to make trials in lupus more rigorous and more comparable, instead of each group having their own definitions and measurements. One of my colleagues and I conducted an extensive review of published SLE kidney disease clinical trials to present data to the group on the different criteria, definitions, and measurements used in the past, and then we discussed these and other data and came to a consensus about what should ideally be included in an SLE kidney disease trial.