Duke Department of Medicine is honored to recognize March as Women’s History Month, celebrating the many women who have made significant contributions to move medicine forward.
“Historically, some features of lupus have not been appreciated and women often feel unheard in the health care system. I was drawn to that, and I felt it was an area where I was needed and could make a difference,” said Jennifer Rogers, MD, associate professor of Medicine in the Division of Rheumatology and Immunology. She is the director of the Duke Lupus Clinic (DLC), one of the largest of its kind in the southeastern United States.
Systemic lupus erythematosus (SLE or lupus) is an autoimmune disease that causes the immune system to attack its own tissues and organs. The inflammation it causes leads to issues that affect the joints, skin, kidneys, blood cells, brain, heart, and lungs. “Lupus is so heterogeneous as an illness that it can present in a variety of ways. It can be a challenge and a bit of a mystery, putting all the pieces together,” Dr. Rogers said. She is one of seven rheumatologists that treats patients in the DLC on Wednesday and Friday mornings.
She wanted to be a physician for as long as she can remember. “I wanted to pursue medicine at an early age. My pediatrician inspired me. He was so kind and knowledgeable, and I really respected him,” Dr. Rogers said. She became fascinated with rheumatology and its complex presentations during her internal medicine residency the University of North Carolina at Chapel Hill.
“Rheumatic diseases affect so many areas of the body, as a rheumatologist and especially as a lupologist, you care for a wide range of symptoms, really the whole person,” Dr. Rogers said. After completing UNC’s residency and rheumatology fellowship programs, she joined Duke faculty in 2017, where the breadth of her work expanded.
Dr. Rogers was named as director of the DLC and selected to lead the Duke Lupus Registry and Biorepository. As a physician dedicated to serving the community, Dr. Rogers has worked to ensure that patients across the state have access to the clinic’s services. They’ve developed an educational series for patients and led studies aimed at addressing social determinants of health and improving disease management.
Her clinical and research work complement each other. “Most of my research is derived from clinical observations, the things you see, don’t understand, and want to improve. We then apply that research back to the clinic, and it enhances both patient care and its delivery. One informs the other,” Dr. Rogers said.
90% of all cases of lupus occur in women, with many developing the illness between ages 15-44. Dr. Rogers, Division Chief, Dr. Megan Clowse, Drs. David Pisetsky, Lisa Criscione-Schreiber, and epidemiologist Dr. Amanda Eudy, created a novel classification system that categorizes lupus activity into two groups to capture the full spectrum of symptoms and manifestations at the DLC.
Type 1 SLE activity includes traditional inflammatory aspects of lupus such as arthritis, nephritis, and rash. Type 2 SLE includes intangible symptoms like pain, extreme fatigue, brain fog, and sleep impairment.
“Despite being a main concern for patients’, Type 2 symptoms are often inadequately addressed in rheumatology. There's not a biomarker or imaging test to assess these symptoms and they can be influenced by many non-autoimmune factors such as stress, prior trauma, and a range of social determinants of health, which makes it difficult for physicians and patients to determine the cause of these symptoms.” Dr. Rogers said. “The connection to the immune system is not well understood.”
The WHEEL Program
Dr. Rogers and the Duke Lupus Research group developed the Whole Health Empowerment for Endotypes of Lupus (WHEEL) program to better understand the mechanisms that drive Type 2 SLE symptoms. It’s a four-month, health coach-led peer support program for patients with Type 2 SLE. “We wanted to recognize what the needs were, the symptoms patients were having, and how we could improve them,” Dr. Rogers said.
It’s funded by a grant from the Department of Defense and based on the Duke Center for Personalized Medicine’s model of Personalized Health Planning in Shared Medical Appointments (PHP-SMA). Patients participate in eight virtual small group sessions that focus on setting goals for medication adherence, movement, and mindfulness, which may help reset pain signals.
Patients learn how to manage symptoms, and about the neurobiology that contributes to the experience of pain. “The beauty of the program is people living with lupus, are helping each other, and giving each other tips in a safe, moderated space.”
The team recently received overwhelmingly positive feedback from user testing. Preliminary results showed there was some improvement in self-reported pain, physical health, stress, and exercise. The team is currently enrolling patients in a randomized clinical trial set to begin in April to determine the feasibility and acceptability of the WHEEL program. They hope to expand the program to institutions outside of Duke in the future.
They recently submitted a grant application to study how the WHEEL program impacts the central nervous system and the neural pathways associated with Type 2 SLE symptoms in collaboration with Duke neuroscientist Dr. Katherine Martucci. “We’ll be measuring functional MRI changes in the brain’s threat-perceiving circuits in the amygdala, reward and motivation pathways in the brain’s nucleus and the medial prefrontal cortex before and after participants complete the WHEEL program,” Dr. Rogers said.
Since becoming a leader at Duke, Dr. Rogers has seen patient care evolve. The Duke Lupus Clinic now treats over 600 patients annually, the Duke Urgent Lupus Clinic has opened, and the Duke Lupus Registry has grown to include over 500 patients.
“Sharing and collaborating has really been the key to my success, and it makes the journey fun. I’ve been very lucky to have amazing mentors and colleagues in the lupus clinic and lupus research group,” Dr. Rogers said. “Building and maintaining those relationships is important. We all have our own strengths, but you learn and grow by working with others.”