I studied medicine at Karolinska Institutet and did my internship at Örebro hospital. Thereafter, I worked at Karolinska University Hospital as a resident and became a specialist in Rheumatology and in Internal medicine in 1994. I have since worked with Rheumatology with a special interest in systemic lupus erythematosus (SLE) and related systemic autoimmune diseases. I defended my thesis on “Cardiovascular Disease in Systemic lupus Erythematosus” in 2003.
During many years I worked with medical responsibility for the inpatient rheumatology ward, and during that time I also organised the clinical education for medical students in Rheumatology. Presently, I hold a position as senior consultant and adjunct professor in Rheumatology. I split my time between clinical work and clinical/translational research.
I have several international collaborations, and I am now the president of SLEuro and a member of the international Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) group.
My research is mainly focused on:Autoimmune mechanisms contributing to cardiovascular disease in SLE, in the antiphospholipid syndrome (APS) and in the general population. Identifying sub-phenotypes in systemic lupus erythematosus (SLE)
Together with colleagues I initiated the Karolinska SLE cohort in 1995 and the Karolinska APS cohort in 2009. Over the years we have collected detailed clinical information and stored samples and information regarding approximately 750 SLE patients, 200 APS patients and matched controls.
Major lines of research
We have studied why patients with systemic autoimmune diseases, primarily, SLE, but also Systemic sclerosis (SSc) and APS, are affected with premature cardiovascular disease. Our studies have demonstrated that pro-thrombotic antiphospholipid antibodies (aPL), nephritis/impaired renal function, systemic inflammation with endothelial activation as well as genetic predisposition are SLE associated risk factors, which predict cardiovascular mortality (CVM) and the first cardiovascular events in patients with SLE. In a more recent study we could show that in comparison to age and gender matched controls, it is only the SLE subgroup with nephritis (30-40%), which is affected with accelerated atherosclerosis, measured as carotid plaques with ultrasound. “Non-nephritis” SLE patients did not differ from controls regarding carotid plaques.
We have also demonstrated that genetic susceptibility is important for SLE associated CVD. This work has identified STAT4, HLA-DRB1*04 and HLADRB1*13 as risk alleles for SLE associated CVD and the same risk alleles were also associated with pro-thrombotic (aPL) in SLE patients.
A more recent research focus has been to identify more homogeneous sub-groups among patients with SLE. Using various types of cluster analyses we have demonstrated that there are several fairly distinct subgroups of SLE patients. In particular we have studied differences between patients with SLE and APS and patients with SLE and Sjögren’s syndrome. Notably there is very little overlap between these two groups.
Selected publications:Svenungsson E, Gustafsson JT, Grosso G, Rossides M, Gunnarsson I, Jensen-Urstad K, et al. Complement deposition, C4d, on platelets is associated with vascular events in systemic lupus erythematosus. Rheumatology (Oxford). 2020. Grosso G, Sippl N, Kjellstrom B, Amara K, de Faire U, Elvin K, et al. Antiphospholipid Antibodies in Patients With Myocardial Infarction. Ann Intern Med. 2019(170):277-80. Idborg H, Eketjall S, Pettersson S, Gustafsson JT, Zickert A, Kvarnstrom M, et al. TNF-alpha and plasma albumin as biomarkers of disease activity in systemic lupus erythematosus. Lupus science & medicine. 2018;5(1):e000260. Gustafsson JT, Herlitz Lindberg M, Gunnarsson I, Pettersson S, Elvin K, Ohrvik J, et al. Excess atherosclerosis in systemic lupus erythematosus,-A matter of renal involvement: Case control study of 281 SLE patients and 281 individually matched population controls. PLoS One. 2017;12(4):e0174572. Gustafsson JT, Gunnarsson I, Kallberg H, Pettersson S, Zickert A, Vikerfors A, et al. Cigarette smoking, antiphospholipid antibodies and vascular events in Systemic Lupus Erythematosus. Ann Rheum Dis. 2015;74(8):1537-43. Lundstrom E, Gustafsson JT, Jonsen A, Leonard D, Zickert A, Elvin K, et al. HLA-DRB1*04/*13 alleles are associated with vascular disease and antiphospholipid antibodies in systemic lupus erythematosus. Annals of the rheumatic diseases. 2013;72(6):1018-25.