Dr. Michelle Petri: A Guiding Light for Patients with Lupus

Systemic lupus erythematosus (SLE) affects a substantial number of patients worldwide, with an estimated prevalence in North America of 241 per 100,000 people.¹ The morbidity and mortality associated with the condition can be significant, and thus research on this disease continues to be of utmost importance. The story of one of the world’s leading experts on lupus—Michelle Petri, MD, MPH, MACR—is fascinating and highlights the role that mentorship and collaboration can play in shaping an outstanding research and clinical career.

Dr. Petri

Dr. Petri completed her medical degree at Harvard University, Cambridge, Mass., followed by a medical residency at Massachusetts General Hospital, Boston, and a rheumatology fellowship at the University of California, San Francisco.

Mentors

Early in the course of her training, Dr. Petri encountered several physicians who left an indelible imprint on the way in which she thinks about medicine.

“My most important clinical mentor,” she says, “was Peter Singleton, MD, DSc, FACR, when he was chief of rheumatology at Letterman Army Medical Center, [San Francisco]. He was a wonderful teacher and mentor—and the first to tell me to find a niche, an area that would be mine. He was such a superb clinician—he could go into a room and absolutely inspire a fibromyalgia patient to adopt exercise. I have never forgotten the day I got a phone call from a hospital resident who told me Peter had just died and that Peter had given him instructions to tell me.

“Peter, if I had known how sick you were I would have come to say goodbye and thank you.”

Another role model for Dr. Petri was John Mills, MD, a widely respected rheumatologist at Massachusetts General Hospital. Dr. Petri recalls how Dr. Mills allowed her to spend several weeks in his clinic and, as she saw firsthand, he examined each patient in a detailed and meticulous manner, palpating for splenomegaly and other subtle findings of disease. Dr. Mills was generous with his time and teaching, and Dr. Petri notes, “I now understand how having me at his side slowed him up; teaching takes time.”

Dr. Petri arrived at Johns Hopkins in 1986 and it was in Baltimore that she worked with Marc Hochberg, MD, MPH, MACP, MACR. Dr. Hochberg, who is now head of the Division of Rheumatology and Clinical Immunology at the University of Maryland School of Medicine, demonstrated the importance of understanding epidemiology and statistics—including the concepts of confounding, interaction, etc.—and how such knowledge could improve the scope and quality of research work. As Dr. Petri recalls, “That was my inspiration to get a Master of Public Health during weekends and evenings in Washington, D.C. While I attended classes on weekends, my daughter Megan would color quietly in the back of the auditorium.

“I learned SAS programming by sitting next to Quinn Whiting-O’Keefe, MD, when I was a fellow and then junior faculty at the University of California, San Francisco,” she says. “Things are easier now—back then, if you missed a semi-colon, the entire statistical program would not run. Thank you, Quinn, for taking the time to teach.”

Career Highlights

The result of all of these interactions was the establishment of a career that has been defined by excellence and wide-ranging research on issues that matter to patients with lupus. Dr. Petri is now professor of medicine in the Division of Rheumatology and director of the Lupus Center at the Johns Hopkins University School of Medicine and Johns Hopkins Hospital, Baltimore.

The Hopkins Lupus Cohort, started by Dr. Petri in 1987, is a longitudinal study of the incidence and pathogenesis of thrombotic events and coronary artery disease in systemic lupus erythematosus (SLE). Dr. Petri notes that starting and keeping the Hopkins Lupus Cohort running for 36 years has been her proudest research accomplishment. In fact, the serum and plasma bank from the cohort serves as an invaluable resource for many other researchers around the country and the world.

Through this and other endeavors, Dr. Petri’s research has focused on a range of subjects, including atherosclerosis, antiphospholipid antibody syndrome (APS), lupus nephritis and pregnancy in patients with rheumatic disease. As part of the Systemic Lupus International Collaborating Clinics, Dr. Petri and colleagues at Johns Hopkins also participate in studies of atherosclerosis, malignancy and neuropsychiatric lupus.

Dr. Petri’s list of accomplishments is long. She has served as study chair or principal investigator for many landmark studies of the SLE patient population. Recent research has focused on the genetics of SLE and the role of gene signatures in monitoring disease activity.

Dr. Petri has mentored and trained numerous fellows in clinical research who have gone on to successful academic careers, as well as training residents and fellows in the diagnosis, treatment and care of lupus patients.

She has authored more than 500 papers and chapters on lupus, APS and SLE. She has served on the editorial board of Arthritis & Rheumatology and other journals. She served on the Medical Advisory Board of the Lupus Foundation of America and chaired the Lupus Now Education Program.

In 2018, the Lupus Foundation of America presented her with the Evelyn V. Hess Award, which recognizes the exceptional contributions of a clinical or basic researcher whose body of work has advanced the understanding of the science of lupus treatment. In 2019, she was named a Master of the ACR.

Insights for Others

For other clinicians and researchers who hope to achieve similar success in the future, Dr. Petri has a number of insightful comments. “In the ‘old days,’ she says, “the goal was to be a triple threat—clinician, teacher and researcher. I tried to be a clinical researcher and found it very rewarding, as when I found an answer to a clinical challenge through  analysis of our Hopkins Lupus Cohort. I could change my practice for the better the very next day.”

She encourages young rheumatologists to pursue a similar path to help enrich the lives of patients and expand the research literature. Dr. Petri also explains the practice of medicine is not without obstacles. These include the need to:

• Adapt to the world of telemedicine while ensuring that important clinical clues from the physical exam and history are not lost;
• Maintain collaboration and civility with colleagues even in the age of electronic records and less face-to-face interaction;
• Confront the ongoing challenges of uncertainty in medicine.

On this last topic, Dr. Petri states, “When someone has a little autoimmunity, but not enough to warrant a diagnosis of lupus, I use the term undifferentiated connective tissue disease. It doesn’t mean that it is a garbage diagnosis. There is uncertainty, and 10–20% in this category may progress to another named rheumatic disease. Life is uncertain, and rheumatology is no exception. I explain to patients that if symptoms/signs are changing in a meaningful way, then we need to revisit the diagnosis.”

In Sum

Clearly, Dr. Petri’s journey in medicine has been a remarkable one, and the world of lupus research and care has benefited from her work in innumerable ways. As she points out, the foundations of this career began with great mentorship from colleagues who contributed their time and expertise in a very generous manner. With the Hopkins Lupus Cohort still going strong, the future is bright for Dr. Petri, a shining star in the world of rheumatology.

Jason Liebowitz, MD, completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his medical degree. He is currently in practice with Skylands Medical Group, N.J.

Reference

1. Rees F, Doherty M, Grainge MJ, et al. The worldwide incidence and prevalence of systemic lupus erythematosus: a systematic review of epidemiological studies. Rheumatology (Oxford). 2017 Nov 1;56(11):1945–1961.