Garg Research

Improving Health Outcomes and Survival in Patients With Lupus and Lupus Nephritis

Shivani Garg, MD, is a rheumatologist, researcher and the founding director and medical 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.

In these state-of-the-art clinics, she has developed novel methods to personalize care based on individual patients' risk factors to advance the health of all patients with lupus and lupus nephritis. Her research aims to transform care in lupus by delivering precise and personalized care, and focuses on addressing existing gaps in cardiovascular risk management in lupus and lupus nephritis.

Dr. Shivani Garg examining a patient in the clinic

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 therapeutic drug level monitoring and target-site pharmacokinetics of medicines to inform precise and personalized doses at the individual patient level, challenging the old concepts of one-size-fits-all dosing. She has partnered with patients and healthcare advisors to develop a feasible patient-centric approach 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

Niriti Adhikari

Research Intern

Caroline Packee

Research Intern

Research Students

Charlie Dentz

Alexa Dreyfus

Robert Drake Johnson

Abigial Muhlstock

Collaborators

Dr. Garg is collaborating with Dr. Christie Bartels, Dr. Miriam Shelef, Dr. Brad Astor, Dr. Amish Raval, Dr. Betty Chewning, Dr. Lisa Arkin, Dr. Jose Ayuso, Dr. Nihal Ahmad, and Dr. Yun Liang to better understand the pathophysiology of various presentations of lupus and to improve outcomes (such as premature kidney failure, cardiovascular disease) and survival in patients with lupus.

Dr. Garg is spearheading multiple national projects in collaboration with Drs. April Jorge (MGH), Joann Zell (University of Colorado), David Gazeley (MCW), Nathalie Costedoat-Chalumeau (France), Candace Feldman (MGH), Kimberly DeQuattro (Stanford), Brad Rovin (OSU), Jennifer Barton (OSHU) on personalizing cardiovascular disease risk management in lupus and lupus nephritis and integrating shared decision-making and personalized medicine as routine lupus care. Dr. Garg is collaborating with Dr. S. Sam Lim (Emory), Dr. Joann Zell (University of Colorado), Dr. David Gazeley (MCW), Prof. Nathalie Costedoat-Chalumeau (France), Dr. Brad Rovin (Ohio State) to better understand the pathophysiology of lupus and lupus nephritis, and improve outcomes and advance health of all patients with lupus.

Environmental photo of Dr. Shivani Garg in the clinic

Join Us!

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.

Email 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.