Research
World renowned, and Australia’s leading, centre for lupus research including basic, translational, and clinical. Headquarters of Australian Lupus Registry and Asia Pacific Lupus Collaboration. Multiple principal investigators in top 1% of world rankings in lupus research.
Major national and international centre for research in scleroderma, fibromyalgia, psoriatic arthritis, vasculitis, rheumatoid arthritis; both leading and collaborating in significant projects. Major member of Australian Scleroderma Interest Group (ASIG), national lead of Vasculitis registry, largest national fibromyalgia database, and multiple projects investigating rheumatoid arthritis comorbidity.
We principally study the role of glucocorticoids-induced molecules in the human diseases rheumatoid arthritis (RA) and systemic lupus (SLE). Glucocorticoids have broad-spectrum effects on immune-inflammatory activation and are widely used in the treatment of inflammatory diseases, but their use is complicated by significant toxicity owing to non-anti-inflammatory effects. Work includes clinico-pathological correlations using human samples, animal models of disease including novel gene knockout mice, and in vitro work on signal transduction pathways. It is our hypothesis that a greater understanding of the actions of glucocorticoids will lead to the development of new therapeutic agents for the treatment of inflammatory disease.
Lupus
Australian Lupus Registry and Biobank (ALRB)
Australia’s first Lupus Registry, the Monash Lupus Database and serum bank, was founded by the Lupus and Arthritis Research of the Monash University School of Clinical Sciences at Monash Health. The Australian Lupus Registry builds on and develops the idea of longitudinal data collection across multiple centres nationwide, based on the knowledge that large numbers of patients are needed to make a difference to lupus research. The ALRB is an online platform that enables the longitudinal collection of systematic and comprehensive data.
One of the first studies using the registry aimed at understanding the disease characteristics and treatment patterns in Australia. The effects of long term use of immunosuppressive medication in SLE patients are not well understood, and data from the registry may give us a better understanding of the incidence of adverse effects and benefits, such as reduction in flares and accumulated damage over time. In addition, biomarker studies examining the interferon-α gene signature and disease manifestations, response to treatment, vitamin D status and disease manifestations, and patient-reported quality of life are in the planning stages.
The registry also collects patient-reported outcomes, such as Short Form 36 and multidimensional health assessment questionnaires. Patients’ self-reported data complement physician-reported data in the ALRB to capture the breadth of experiences of patients with SLE in Australia and provide a meaningful assessment of the disease burden and treatment shortfalls.
Asia Pacific Lupus Collaboration (APLC)
The Asia Pacific region has a high frequency and severity of SLE, which allows a special advantage to better understand lupus. This allows the APLC to make contributions of a global impact to knowledge on the disease.
The APLC was formed in November 2012 with the HQ located at Monash Health, to bring together physicians and researchers dedicated to improving the quality of care provided to patients with SLE. The APLC has >50 Investigators from 25 sites across 13 countries in the Asia Pacific region. Given the lack of established treatment algorithms and treatment targets in lupus, the APLC has pooled resources to create the largest cohort of lupus patients ever studied. This has facilitated multiple epidemiological studies which produce robust evidence on which to base recommendations for the management of SLE.
Lupus low disease activity state (LLDAS) validation study from 2013-2017 was a multi-national, prospective study established to validate the Lupus Low Disease Activity State (LLDAS) as a treat-to-target endpoint for SLE. We demonstrated that LLDAS attainment provides significant protection from organ damage accrual and flare in patients with systemic lupus erythematosus (SLE).
From 2018-2022 the treat-2-target SLE study was an extension and expansion of the LLDAS validation study to capture longer follow up and increase patient recruitment to further examine LLDAS and study remission definitions, mortality, and quality of life. We demonstrated protective effects of LLDAS and remission on mortality, the harmful effects of failing to reach treatment targets, and the low persistence of current lupus medicines.
The next phase of the APLC’s research ambitions encompasses quantifying the determinants of long-term outcomes in SLE. We will examine the interplay among multiple determinants, including co-morbidities and biopsy-proven lupus nephritis, and their contribution to long-term outcomes of SLE.
Scleroderma
The Monash Scleroderma Clinic has been running since 2003. Over 380 patients with Scleroderma are reviewed annually at Monash, providing clinical and wound care as well as annual screening for heart and lung complications of scleroderma. Patients requiring further cardiac or respiratory assessment can be referred to our onsite cardiologist, Dr Roger Peverill and Respiratory physician, Dr Chris Daley who form part of our team.
Patients attending our clinic are eligible to enrol in the Australian Scleroderma Cohort Study. This national study is a longitudinal study involving patients from a number of centres around Australia which has facilitated improvement in our understanding of Scleroderma and its treatment.
At Monash, our particular interest has been in the cardiac and pulmonary complications of Scleroderma. Ongoing research interest include identification of predictors of progression of Scleroderma related lung fibrosis and defining the effect of Scleroderma on cardiac structure and function. The Monash Scleroderma clinic has also collaborated with an experienced team of scientists on site in the Monash Centre of Inflammatory diseases to undertake laboratory-based research to advance our understanding of the disease mechanisms underlying Scleroderma. Monash also has a clinical trials unit which enrols patients in studies examining new treatments which may provide benefit beyond our existing treatment options.
Fibromyalgia
Fibromyalgia presents with symptoms of widespread pain, fatigue, sleeping and cognitive disturbances as well as other somatic symptoms. Fibromyalgia is highly prevalent in most rheumatic diseases as well as non-rheumatic chronic diseases and if unrecognised results in high morbidity.
The Monash Fibromyalgia clinic is the only specialised fibromyalgia clinic in Australia and is actively involved in research with the largest national fibromyalgia database. This has led to a number of publications investigating the effects and pathophysiology of fibromyalgia.
Vasculitis
Patients with specific types of vasculitis attending the vasculitis clinic will be invited to enrol in the Australia and New Zealand Vasculitis Society (ANZVASC) registry. This registry houses de-identified information about patients with vasculitis for use in research projects aiming to further our understanding and advance treatments options for these rare and complex conditions. Participation is entirely optional and will be discussed in more detail at clinic appointments.
Psoriatic arthritis
Psoriatic Arthritis (PsA) is a heterogenous immune-mediated condition, with manifestations including skin and nail psoriasis, peripheral and axial arthritis, dactylitis and enthesitis. PsA is associated with metabolic syndrome and other immune-mediated diseases such as inflammatory bowel disease. Despite significant advances in therapy, PsA has a significant impact on patient quality of life and function.
The Monash Health Psoriatic Arthritis clinic is co-located with the Monash Dermatology clinic and provides care to patients with Psoriatic Disease. A longitudinal cohort study incorporating clinical, imaging and patient-reported outcome measures has been established within the clinic in order to answer pertinent research questions utilising real-world observational data.
Rheumatoid arthritis
The specialised Rheumatoid Arthritis clinic at Monash Health has been involved in many research projects over the past two decades that investigate the links with rheumatoid arthritis and their co-morbidities. Clinical research has included publications that investigate the impact of rheumatoid arthritis and severe infections; the introduction and perception of biosimilars in rheumatoid arthritis management; the burden of fibromyalgia in rheumatoid arthritis.
More information
Further information regarding Rheumatology research can be found on the Monash University website.