Karen H. Costenbader, MD, MPH
Associate Physician and Co-Director, Lupus Center, Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Associate Professor of Medicine, Harvard Medical School, Boston
Background: Dr. Costenbader earned her medical degree from Harvard Medical School, a master’s degree from Cambridge University in England, and a master’s in public health from Harvard School of Public Health. She joined Brigham and Women’s Hospital (BWH) in 2004 and serves as codirector of BWH Lupus Center. A career highlight was when she was awarded the Lupus Foundation of America’s inaugural Mary Betty Stevens Memorial Young Investigator Prize in 2009. Her investigations into risk factors and outcomes have shown that cigarette smoking greatly increases the risk of rheumatoid arthritis (RA) and geographic variation in RA incidence.
Q: What is the long-term goal of your research?
A: Understanding the epidemiology of diseases such as lupus and RA, the exposures and risk factors associated with increased disease risk, and how to identify those at the highest risk via specific pathogenic mechanisms, should allow us to intervene and prevent the development of these diseases before they inflict their damage. Wouldn’t that be amazing?
Q: If you were presenting findings of your research, what message would you deliver to rheumatologists about patients who smoke?
A: Rheumatologists, like most physicians, are aware of the long list of deleterious health effects of smoking. They may not be aware that, in addition to cancer and cardiovascular disease, smoking is extremely strongly linked to the risk of RA. The risk of developing RA is highest in those with underlying genetic risk factors and is related to cumulative cigarette exposure, i.e., number of cigarettes smoked per day and number of years of smoking. After about 10 pack-years of smoking, the risk of RA steadily rises, and unfortunately does not come back down for 20 years after smoking cessation. As we also know how addictive cigarettes are and how difficult it is to get long-term smokers to successfully quit, efforts should, in my opinion, be targeted at early smokers and those at risk for RA. Younger people, especially those with a family history of RA or other autoimmune disease, and those with less than 10 pack-years of smoking should really be encouraged to give it up before it is too late. There are also data that smoking cessation does ameliorate existing RA, but preventing its onset in the first place seems more effective.
