Eugene William St. Clair, MD

Professor of Medicine
W. Lester Brooks, Jr. Professor of Medicine
Chief, Division of Rheumatology and Immunology
Professor in Immunology
Campus mail 34229 Hosp South, Durham, NC 27710
Phone (919) 684-4499
Email address stcla003@mc.duke.edu

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

Education and Training

  • Chief Resident, Medicine, Duke University, 1984 - 1985
  • Fellow in Rheumatology, Medicine, Duke University, 1983 - 1985
  • Medical Resident, Medicine, Duke University, 1980 - 1983
  • M.D., West Virginia University, 1980

Publications

Aviña-Zubieta, JA, Alarcón, GS, Bischoff-Ferrari, HA, Fischer-Betz, R, Schneider, M, Gall, V, Liang, MH, Schur, P, Illei, G, Mikdashi, J, Petri, M, Phillips, C, Pouchot, J, and Clair, WS. "Measurement of fatigue in systemic lupus erythematosus: A systematic review." Arthritis Care and Research 57, no. 8 (2007): 1348-1357.

PMID
18050225
Full Text

Visvanathan, S, Marini, JC, Smolen, JS, Clair, EWS, Pritchard, C, Shergy, W, Pendley, C, Baker, D, Bala, M, Gathany, T, Han, J, and Wagner, C. "Changes in biomarkers of inflammation and bone turnover and associations with clinical efficacy following infliximab plus methotrexate therapy in patients with early rheumatoid arthritis." Journal of Rheumatology 34, no. 7 (2007): 1465-1474.

PMID
17552048
Scholars@Duke

Visvanathan, S, Wagner, C, Smolen, J, St Clair, EW, Hegedus, R, Baker, D, and Keenan, G. "IgG and IgM anticardiolipin antibodies following treatment with infliximab plus methotrexate in patients with early rheumatoid arthritis." Arthritis Rheum 54, no. 9 (September 2006): 2840-2844.

PMID
16948115
Full Text

Stone, JH, Holbrook, JT, Marriott, MA, Tibbs, AK, Sejismundo, LP, Min, Y-I, Specks, U, Merkel, PA, Spiera, R, Davis, JC, St Clair, EW, McCune, WJ, Ytterberg, SR, Allen, NB, Hoffman, GS, and Wegener's Granulomatosis Etanercept Trial Research Group, . "Solid malignancies among patients in the Wegener's Granulomatosis Etanercept Trial." Arthritis Rheum 54, no. 5 (May 2006): 1608-1618.

PMID
16646004
Full Text

Bluestone, JA, St Clair, EW, and Turka, LA. "CTLA4Ig: bridging the basic immunology with clinical application." Immunity 24, no. 3 (March 2006): 233-238.

PMID
16546089
Full Text

Smolen, JS, Han, C, van der Heijde, D, Emery, P, Bathon, JM, Keystone, E, Kalden, JR, Schiff, M, Bala, M, Baker, D, Han, J, Maini, RN, and St Clair, EW. "Infliximab treatment maintains employability in patients with early rheumatoid arthritis." Arthritis Rheum 54, no. 3 (March 2006): 716-722.

PMID
16508932
Full Text

Smolen, JS, Van Der Heijde, DMFM, St Clair, EW, Emery, P, Bathon, JM, Keystone, E, Maini, RN, Kalden, JR, Schiff, M, Baker, D, Han, C, Han, J, Bala, M, and Active-Controlled Study of Patients Receiving Infliximab for the Treatment of Rheumatoid Arthritis of Early Onset (ASPIRE) Study Group, . "Predictors of joint damage in patients with early rheumatoid arthritis treated with high-dose methotrexate with or without concomitant infliximab: results from the ASPIRE trial." Arthritis Rheum 54, no. 3 (March 2006): 702-710.

PMID
16508926
Full Text

Savage, C, and St Clair, EW. "New therapeutics in rheumatoid arthritis." Rheum Dis Clin North Am 32, no. 1 (February 2006): 57-viii. (Review)

PMID
16504821
Full Text

Tedder, TF, and Clair, EWS. "Reply [7]." Arthritis and Rheumatism 54, no. 7 (2006): 2344-2345.

Full Text

Savage, C, and Clair, EWS. "Erratum to "New Therapeutics in Rheumatoid Arthritis" [Rheum Dis Clin N Am 32 (1) (2006) 57-74] (DOI:10.1016/j.rdc.2005.10.004)." Rheumatic Disease Clinics of North America 32, no. 2 (2006): ix-.

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