Physicians

Chief, Division of Rheumatology and Immunology

Departments / Divisions

• Medicine / Medicine-Rheumatology and Immunology
• Immunology

Address
DUMC 3874
Durham, NC 27710

Appointment Telephone
919-613-2243

Office Telephone
919-684-4499

Fax Telephone
919-684-8358

Training

• MD, West Virginia University School of Medicine, 1980

Residency

• Rheumatology, Duke University Medical Center, 1980-1983, 1983-1985

Clinical Interests
Rheumatoid arthritis, Sjogren's syndrome, vasculitis

Research Interests
The main focus of my research is the pathogenesis and treatment of rheumatoid arthritis (RA). This work has been conducted using patient-oriented research methodologies in collaboration with basic scientists and other clinical investigators. A major area of interest has been the development of novel therapies for RA, which has primarily included studies of novel biologics. Another important area of investigation has been the possible role of nitric oxide in the pathogenesis of RA.

My research is conducted in our Clinical Trials Unit which is built around a staff of three clinical research coordinators and a collaborative relationship with Dr. William E. Wilkinson, a Ph.D. biostatistician. Our group has been involved in numerous clinical trials sponsored by the pharmaceutical industry. Another important project has been a study of doxycycline therapy in RA, which has been supported by the National Institutes of Health (NIH). Recently, we have
begun an epidemiologic study of SLE in collaboration with Glinda Cooper, an epidemiologist from the National Institutes of Environmental Health Services in the Research Triangle Park. The General Clinical Research Center, an NIH-supported facility, has frequently served as the site for our research.

The current biologic therapies under investigation in patients with RA include a peptide vaccine, IL-4, IL-10, and anti-tumor necrosis factor-à chimeric monoclonal antibody (anti-TNF). The peptide vaccine consists of a "shared HLA-DRB1 epitope", a short amino acid sequence common to the -chain of those HLA-DR molecules associated with RA. IL-4 and IL-10 are inhibitory cytokines that ameliorate arthritis in experimental animal models and are in the early stages of development as a possible treatment for human disease. The most promising of the novel biologics are those agents inhibiting TNF. Our center is now involved in a phase III clinical trial of anti-TNF in patients with RA, a study involving over 20 other sites in the United States and Europe. I am also principal investigator of an NIH-sponsored study investigating the treatment efficacy of doxycycline in RA and the ability of this antibiotic to suppress collagenase activity in vivo. The work involving nitric oxide has been supported by a Specialized Center for Research in RA (Barton F. Haynes, M. D., Principal Investigator). Other current studies include a clinical trial of DHEA in SLE, and the epidemiologic study of SLE, which is based in North and South Carolina and will examine the relationship between environmental exposures and the incidence of disease.

I have been a consultant for several pharmaceutical companies who are developing new therapies for RA. In addition, I have served as a consultant on NIH study sections for applications related to clinical trials of new anti-rheumatic therapies. I have also organized a Sjogren's Syndrome Clinic at Duke that attracts referrals from the southeastern part of the United States. I have also spoken at the Annual Scientific Meeting of the American College of
Rheumatology on subjects related to my research and clinical interests, including Sjogren's Syndrome, vasculitis, and autoantibodies. Finally, I am developing an investigator's network in the southeastern United States, which should provide the patient base and infrastructure to conduct large clinical trials in rheumatology.

Key words: rheumatoid arthritis, biologics, clinical trials, Sjogren's syndrome, systemic lupus erythematosus, nitric oxide

Industry Relationships and Collaborations (What's this?)

This faculty member (or a member of their immediate family) has a working relationship (i.e. consulting, research, and/or educational services) with the companies listed below. These relations have been reported to the health system leadership and, when appropriate, management plans are in place to address potential conflicts.

• American College of Rheumatology
• Biogen Idec Inc.
• Cleveland Clinic Foundation
• Genentech, Inc (Roche Holding)

Representative Publications
Iwata, Y; Matsushita, T; Horikawa, M; Dilillo, DJ; Yanaba, K; Venturi, GM; Szabolcs, PM; Bernstein, SH; Magro, CM; Williams, AD; Hall, RP; St Clair, EW; Tedder, TF. Characterization of a rare IL-10-competent B-cell subset in humans that parallels mouse regulatory B10 cells. Blood. 2011;117:530-541. (2011) Abstract

Tomasson, G; Lavalley, M; Tanriverdi, K; Finkielman, JD; Davis, JC; Hoffman, GS; McCune, WJ; St Clair, EW; Specks, U; Spiera, R; Stone, JH; Freedman, JE; Merkel, PA; Wegener's Granulomatosis Etanercept Trial (WGET) Research Group. Relationship between markers of platelet activation and inflammation with disease activity in Wegener's granulomatosis. Journal of Rheumatology. 2011;38:1048-1054. (2011) Abstract

Bluestone, JA; Auchincloss, H; Nepom, GT; Rotrosen, D; St Clair, EW; Turka, LA. The Immune Tolerance Network at 10 years: tolerance research at the bedside. Nature Reviews Immunology. 2010;10:797-803. (2010) Abstract

Desjardins, C; St Clair, EW; Ehrenberg, RG. Analysis of the workforce and workplace for rheumatology and the research activities of rheumatologists early in their careers. Arthritis and Rheumatism. 2010;62:3528-3536. (2010) Abstract

Mahr, AD; Edberg, JC; Stone, JH; Hoffman, GS; St Clair, EW; Specks, U; Dellaripa, PF; Seo, P; Spiera, RF; Rouhani, FN; Brantly, ML; Merkel, PA. Alpha¿-antitrypsin deficiency-related alleles Z and S and the risk of Wegener's granulomatosis. Arthritis and Rheumatism. 2010;62:3760-3767. (2010) Abstract

St Clair, EW. Good and bad memories following rituximab therapy. Arthritis and Rheumatism. 2010;62:1-5. (2010) Abstract

Stone, JH; Merkel, PA; Spiera, R; Seo, P; Langford, CA; Hoffman, GS; Kallenberg, CG; St Clair, EW; Turkiewicz, A; Tchao, NK; Webber, L; Ding, L; Sejismundo, LP; Mieras, K; Weitzenkamp, D; Ikle, D; Seyfert-Margolis, V; Mueller, M; Brunetta, P; Allen, NB; Fervenza, FC; Geetha, D; Keogh, KA; Kissin, EY; Monach, PA; Peikert, T; Stegeman, C; Ytterberg, SR; Specks, U; RAVE-ITN Research Group. Rituximab versus cyclophosphamide for ANCA-associated vasculitis. New England Journal of Medicine. 2010;363:221-232. (2010) Abstract

Finkielman, JD; Merkel, PA; Schroeder, D; Hoffman, GS; Spiera, R; St Clair, EW; Davis, JC; McCune, WJ; Lears, A; Ytterberg, SR; Hummel, AM; Viss, MA; Peikert, T; Stone, JH; Specks, U; WGET Research Group. Glycosylation of proteinase 3 (PR3) is not required for its reactivity with antineutrophil cytoplasmic antibodies (ANCA) in Wegener's granulomatosis. Clinical and Experimental Rheumatology. 2009;27:S45-S52. (2009) Abstract

Shah, A; Diehl, LF; St Clair, EW. T cell large granular lymphocyte leukemia associated with rheumatoid arthritis and neutropenia. Clinical Immunology. 2009;132:145-152. (2009) Abstract

Smolen, JS; Han, C; van der Heijde, DM; Emery, P; Bathon, JM; Keystone, E; Maini, RN; Kalden, JR; Aletaha, D; Baker, D; Han, J; Bala, M; St Clair, EW; Active-Controlled Study of Patients Receiving Infliximab for the Treatment of Rheumatoid Arthritis of Early Onset (ASPIRE) Study Group. Radiographic changes in rheumatoid arthritis patients attaining different disease activity states with methotrexate monotherapy and infliximab plus methotrexate: the impacts of remission and tumour necrosis factor blockade. Annals of the Rheumatic Diseases. 2009;68:823-827. (2009) Abstract

Smolen, JS; van der Heijde, DM; Aletaha, D; Xu, S; Han, J; Baker, D; St Clair, EW. Progression of radiographic joint damage in rheumatoid arthritis: independence of erosions and joint space narrowing. Annals of the Rheumatic Diseases. 2009;68:1535-1540. (2009) Abstract

St Clair, EW. Novel targeted therapies for autoimmunity. Current Opinion in Immunology. 2009;21:648-657. (2009) Abstract

Vastesaeger, N; Xu, S; Aletaha, D; St Clair, EW; Smolen, JS. A pilot risk model for the prediction of rapid radiographic progression in rheumatoid arthritis. Rheumatology. 2009;48:1114-1121. (2009) Abstract

Furst, DE; Halbert, RJ; Bingham, CO; Fukudome, S; Anderson, L; Bonafede, P; Bray, V; Cohen, SB; Sherrer, YR; St Clair, EW; Tesser, JR; Weinblatt, M; Dubois, RW. Evaluating the adequacy of disease control in patients with rheumatoid arthritis: a RAND appropriateness panel. Rheumatology. 2008;47:194-199. (2008) Abstract

Han, C; Smolen, J; Kavanaugh, A; St Clair, EW; Baker, D; Bala, M. Comparison of employability outcomes among patients with early or long-standing rheumatoid arthritis. Arthritis and Rheumatism. 2008;59:510-514. (2008) Abstract

Levesque, MC; St Clair, EW. B cell-directed therapies for autoimmune disease and correlates of disease response and relapse. Journal of Allergy and Clinical Immunology. 2008;121:13-21. (2008) Abstract

Mahr, AD; Neogi, T; Lavalley, MP; Davis, JC; Hoffman, GS; McCune, WJ; Specks, U; Spiera, RF; St Clair, EW; Stone, JH; Merkel, PA; Wegener's Granulomatosis Etanercept Trial Research Group. Assessment of the item selection and weighting in the Birmingham vasculitis activity score for Wegener's granulomatosis. Arthritis and Rheumatism. 2008;59:884-891. (2008) Abstract

St Clair, EW. The calm after the cytokine storm: lessons from the TGN1412 trial. Journal of Clinical Investigation. 2008;118:1344-1347. (2008) Abstract

Wung, PK; Anderson, T; Fontaine, KR; Hoffman, GS; Specks, U; Merkel, PA; Spiera, R; Davis, JC; St Clair, EW; McCune, WJ; Stone, JH; Wegener's Granulomatosis Etanercept Trial Research Group. Effects of glucocorticoids on weight change during the treatment of Wegener's granulomatosis. Arthritis and Rheumatism. 2008;59:746-753. (2008) Abstract

Yanaba, K; Bouaziz, JD; Matsushita, T; Magro, CM; St Clair, EW; Tedder, TF. B-lymphocyte contributions to human autoimmune disease. Immunological Reviews. 2008;223:284-299. (2008) Abstract