Aleks Kostic joined OrACORe as a research assistant after graduating from Princeton University with a…
Lindsey MacFarlane, MD, completed a postdoctoral fellowship through OrACORe’s COMET T32 training program in 2018. She joins the faculty in Rheumatology at BWH and HMS this spring.
ECL: What has been the recent focus of your research, and have you seen it change in the past few years?
LM: I’ve always had an interest in OA (osteoarthritis), a common degenerative joint disease. Coming into this fellowship, [the COMET T32 training program, which supports musculoskeletal research for pre- and postdoctoral trainees] I focused on how we use imaging to predict surgical outcomes. I’ve worked a lot on MRI-based predictors of outcomes following APM (arthroscopic partial meniscectomy) and PT (physical therapy) using the MeTeOR data. More recently, we have used these same knee MRIs to look at synovitis and inflammation in knee OA and see if they are associated with outcomes.
ECL: Does that represent a turn away from surgical outcomes?
LM: It does. Inflammation drew our attention and it’s a growing area among OA researchers, particularly as we learn that inflammation has a greater role in OA than was once thought. It used to be that we thought of only RA (rheumatoid arthritis) as inflammatory. But even in OA, there is often inflammation at the joint. In clinic, I still explain the basic distinction: RA is inflammatory, OA is degenerative. But that view is changing.
Another point makes the role of inflammation in OA intriguing: Obesity increases a person’s risk of OA, even for joints in the hand, where the additional load of higher body weight is not an issue. Obesity is also an inflammatory condition. Some researchers have suggested that obesity’s inflammatory environment could contribute to OA.
ECL: What is it like to balance your research with your clinical role? How do the two interact?
LM: Clinically, I see all types of patients and disease manifestations. But I do really enjoy seeing OA patients. I love talking with them about OA. That research interest overlaps with what I find compelling in clinic.
ECL: And how do you try to maintain balance between research and clinic?
LM: We have more clinic in our first year, then focus more on research. I currently have a half-day clinic here, work at Harvard University Health Services, and also see some rheum oncology patients. These are individuals on a group of cancer treatments called checkpoint inhibitors that essentially “release the brakes” on the immune system to combat cancer. But a side effect is inflammation at the joints. Our role as rheumatologists is to help manage that inflammation so that patients can continue their treatments.
Yes, finding that research-clinical balance can be hard. Luckily, Rheumatology at the Brigham is a huge research division, and there are many researching physicians in the Division that I look to as role models.
ECL: Congratulations on joining the faculty this May. What are you looking forward to?
LM: I am looking forward to continuing to learn and grow my clinic. In Rheumatology, some of the diseases we manage are rather rare, so there is still quite a bit to see and learn after fellowship. On the research side, I would like to secure funding for my projects and become more independent. I’ve had the chance in my fellowship to really dive into research. I feel grateful for that opportunity and excited to learn more.
ECL: If there was one thing you could explain to people about your research and practice, what would it be?
LM: Sometimes people have the impression that OA management has to be surgical. But not from a rheumatologist’s perspective! I see many patients with OA who want to avoid or delay surgery. Maybe they’ve had surgeries in the past and want to avoid another, or maybe they have roles to keep up at home. A surgery like total knee replacement can be wonderful and life-changing, yet there is definitely a role for nonsurgical treatment of OA. I’m happy to guide patients in that process.