Physicians

Chief, Division of Rheumatology and Immunology

Departments / Divisions

• Medicine / Med-Rheumatolgy & 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, scleroderma, systemic lupus erythematosus, 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 physician (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
• MedImmune, Inc.
• UpToDate, Inc.

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 Jan 13;117(2):530-41. (2011) Abstract

Tomasson G, Lavalley M, Tanriverdi K, Finkielman JD, Davis JC Jr, Hoffman GS, McCune WJ, St Clair EW, Specks U, Spiera R, Stone JH, Freedman JE, Merkel PA. Relationship Between Markers of Platelet Activation and Inflammation with Disease Activity in Wegener's Granulomatosis. J Rheumatol. 2011 Mar 16. (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. Nat Rev Immunol. 2010 Nov;10(11):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 Rheum. 2010 Dec;62(12):3528-36. (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. Alpha₁-antitrypsin deficiency-related alleles Z and S and the risk of Wegener's granulomatosis. Arthritis Rheum. 2010 Dec;62(12):3760-7. (2010) Abstract

St Clair EW. Good and bad memories following rituximab therapy. Arthritis Rheum. 2010 Jan;62(1):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, . Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med. 2010 Jul 15;363(3):221-32. (2010) Abstract

Finkielman JD, Merkel PA, Schroeder D, Hoffman GS, Spiera R, St Clair EW, Davis JC Jr, McCune WJ, Lears A, Ytterberg SR, Hummel AM, Viss MA, Peikert T, Stone JH, Specks U, . Glycosylation of proteinase 3 (PR3) is not required for its reactivity with antineutrophil cytoplasmic antibodies (ANCA) in Wegener's granulomatosis. Clin Exp Rheumatol. 2009 Jan-Feb;27(1 Suppl 52):S45-52. (2009) Abstract

Shah A, Diehl LF, St Clair EW. T cell large granular lymphocyte leukemia associated with rheumatoid arthritis and neutropenia. Clin Immunol. 2009 Aug;132(2):145-52. (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, . 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. Ann Rheum Dis. 2009 Jun;68(6):823-7. (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. Ann Rheum Dis. 2009 Oct;68(10):1535-40. (2009) Abstract

St Clair EW. Novel targeted therapies for autoimmunity. Curr Opin Immunol. 2009 Dec;21(6):648-57. (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 (Oxford). 2009 Sep;48(9):1114-21. (2009) Abstract

Furst DE, Halbert RJ, Bingham CO 3rd, 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 (Oxford). 2008 Feb;47(2):194-9. (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 Rheum. 2008 Apr 15;59(4):510-4. (2008) Abstract

Levesque MC, St Clair EW. B cell-directed therapies for autoimmune disease and correlates of disease response and relapse. J Allergy Clin Immunol. 2008 Jan;121(1):13-21; quiz 22-3. (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, . Assessment of the item selection and weighting in the Birmingham vasculitis activity score for Wegener's granulomatosis. Arthritis Rheum. 2008 Jun 15;59(6):884-91. (2008) Abstract

St Clair EW. The calm after the cytokine storm: lessons from the TGN1412 trial. J Clin Invest. 2008 Apr;118(4):1344-7. (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, . Effects of glucocorticoids on weight change during the treatment of Wegener's granulomatosis. Arthritis Rheum. 2008 May 15;59(5):746-53. (2008) Abstract

Yanaba K, Bouaziz JD, Matsushita T, Magro CM, St Clair EW, Tedder TF. B-lymphocyte contributions to human autoimmune disease. Immunol Rev. 2008 Jun;223:284-99. (2008) Abstract