Singh employs growing registries to pave the way for risk research and more

Using data from the Veterans Administration rheumatoid arthritis (VARA) registry, which draws enrollment from twelve sites across the country, a research team including Dr. Namrata Singh, Assistant Professor of Immunology, recently published findings linking high disease activity of RA in men to an increased risk of lung cancer mortality, independent of other risk factors such as smoking and age.

The study, published this past April in the journal Arthritis & Rheumatology, linked VARA data with the national death index to gather statistics on mortality rates among RA patients, and used banked serum to examine levels of cytokine and chemokine (proteins crucial to cell signaling), finding a correlation between higher levels of those biomarkers and increased risk of cancer mortality among men.

Such information can greatly affect patient care, as Dr. Singh points out, by allowing for early cancer screening based on cytokine levels. “Of course, anything detected earlier, especially cancer, means a whole different prognosis for the patient,” she said. “That would be the biggest thing: catching early, treating early.”

Dr. Singh calls the VARA registry a “goldmine for clinical research,” given its longitudinal data stretching back to 2003, and including approximately 2,500 enrolled patients. Over the past year, she has contributed to that total by doubling the enrollment from Iowa City’s VA to 150, making it the site with the highest quarterly enrollment. To Dr. Singh, the importance of longitudinal data lies in its ability to provide large cohorts in a cost-effective way.

Indeed, her experience working with the VARA registry has inspired her to continue working with similar databases; Dr. Singh is already planning to write a grant for her next project, which she hopes will link data from VA Informatics and Computing Infrastructure (VINCI) with VA Comprehensive Cancer Registry (VACCR) to study links between RA and lymphoma in men.

But “as with anything, it takes a village,” Dr. Singh said. “Specifically with the VARA study, Dr. Liz Field was the PI before, so she’s been instrumental in helping me collaborate with other researchers. My chairman, Dr. (Scott) Vogelgesang, has also been helping me make the collaborations.”

Her own research aside, Dr. Singh has helped bolster the University of Iowa’s national reputation for excellence in rheumatology by leading teams of fellows (Drs. Bharat Kumar and Vijay Aluri) to championship victories in the annual Knowledge Bowls at the past two American College of Rheumatology national conferences. She has also been working on a study that began as a research project of recent Internal Medicine graduate Dr. Masumi Arakane, with the aim of better describing characteristics of patients with rare musculoskeletal sarcoidosis through a review of 1,500 enrolled patients. Given the recent well-received presentation by a team member of findings from a smaller cohort of 350 at a meeting of the European League Against Rheumatism in London this spring, Dr. Singh hopes to publish on their expanded survey later this year.