Improving Outcomes and Health Equity in Patients With Lupus and Lupus Nephritis
Dr. Shivani Garg is a rheumatologist, researcher and the founding director of the UW Health Lupus Clinic, the first of its kind in Wisconsin, and the UW Health Lupus Nephritis Clinic, the nation’s fifth multidisciplinary lupus nephritis clinic.
She advances patient-oriented research to improve outcomes and disparities in lupus and lupus nephritis, and through these clinics, she has created and is maintaining a lupus data- and bio-repository.
Examining Early Predictors of Poor Outcomes
One of Dr. Garg's research interests is to examine early predictors of poor outcomes in diverse patients with lupus nephritis and lupus to close knowledge gaps regarding heterogeneity in lupus outcomes, identify subsets at-risk for poor outcomes and test targeted prevention to improve outcomes and equity in lupus and lupus nephritis.
Her research highlighting significant racial disparities in cardiovascular disease in lupus was selected for plenary presentations at the 2019 and 2020 Annual American College of Rheumatology Conferences.
Advancing Precision Medicine and Care
Dr. Garg is also investigating the role of medication blood levels and has partnered with patients and healthcare stakeholders to develop feasible interventions to improve adherence and outcomes in lupus and lupus nephritis.
Video: Dr. Garg summarizes her work in a Department of Medicine Grand Rounds, "Precision Care: Improving Outcomes & Reducing Disparities in Lupus & Lupus Nephritis."
Research Team
Research Specialist
Research Students
Charlie Dentz
Alexa Dreyfus
Robert Drake Johnson
Abigial Muhlstock
Collaborators
Dr. Garg is collaborating with Dr. Christie Bartels, Dr. Miriam Shelef, Dr. David Beebe, and Dr. Yun Liang to better understand the pathophysiology of various presentations of lupus and to improve outcome disparities as they relate to premature kidney failure, cardiovascular disease, and mortality in patients with lupus.
Dr. Garg is also collaborating with Dr. S. Sam Lim at Emory University/Grady Hospital in Atlanta, one of five CDC-funded lupus centers of excellence, to assess and target health disparities in lupus and lupus nephritis outcomes.
We are actively seeking undergraduates, graduate students, or research interns interested in clinical and translational research in lupus and lupus nephritis using patient samples and/or analyzing clinical data.
If you are interested in joining our team, please send your CV and a brief description of your research experience and interests to Dr. Garg.
Active Projects
- Early Predictors of Poor Outcomes in Lupus Nephritis
Patients with lupus nephritis (LN) face 42-fold higher risk of cardiovascular disease (CVD) and 10-fold higher chronic kidney disease (CKD) risk than peers. However, traditional risk estimates and CVD risk calculators developed in non-LN populations fail to predict CVD and CKD progression in young LN patients.
We are testing innovative risk predictors, such as renal arteriosclerosis and circulating monocytes at the time of LN diagnosis, of poor CVD & CKD outcomes in LN to improve LN outcome risk prediction and reduce CVD & CKD risk trajectories.
- Therapeutic Drug Monitoring in Lupus
Lupus disproportionately affects Black women, and is the leading cause of chronic kidney disease in young women. Physiologic and social determinants could influence medication levels and lead to poor outcomes in lupus.
We are investigating predictors of changes in medication (e.g., hydroxychloroquine) levels and clarifying clinical thresholds of medication (hydroxychloroquine) levels to predict adherence, efficacy, and identify patients at-risk for toxicity. These findings will inform practice change and increase use of targeted therapy in lupus.
- Developing Novel Methods and Interventions to Target Nonadherence in Lupus
Targeting HCQ nonadherence is an important health priority to improve health outcomes disparities and survival in lupus. We have partnered with patients with lupus and clinicians to develop novel and feasible methods to assess and target nonadherence to improve outcomes in lupus patients from diverse backgrounds.
- Developing an Innovative Shared Decision-Making Tool (HCQ-SAFE)
We developed an innovative pictogram-based shared decision-making tool, HCQ-SAFE, that can help doctors support patients in their decisions. With the tool, clinicians and patients can discuss the benefits versus rare harms of medication (hydroxychloroquine).
To ensure that a patient has all the necessary information to support them in their decisions, a clinician should discuss at least one benefit and one harm using HCQ-SAFE. Discussions can be tailored to an individual patient’s concerns using different functionalities of the tool, such as the patient information button which shares details on eye exam costs and other common questions.
Access the tool here and watch this short training video to learn more.
Funding Support
Dr. Garg is funded by the National Institutes of Health (NIH), the Rheumatology Research Foundation, the Lupus Foundation of America, the University of Wisconsin’s Clinical and Translational Science Career Development Award, and the Department of Medicine.
News and Media
- A decision-aid facilitates patient understanding of benefits vs. risk of hydroxychloriquine use as part of routine care for lupus (Lupus Science & Medicine podcast, 2024)
- Stay within hydroxychloroquine ‘therapeutic threshold’ to reduce active lupus, flare risk (Healio article, 2023)
- Hydroxychloroquine Blood Level 'Sweet Spot' May Maximize Efficacy in Lupus (Medscape article, 2023)
- Timing and Predictors of Incident Cardiovascular Disease in Systemic Lupus Erythematosus (The Journal of Rheumatology video, 2023)
