Mechanisms, Outcomes and Treatment of Non-Articular Pain in Rheumatoid Arthritis

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DESCRIPTION (provided by applicant): Dr. Lee's long-term goal is to be an independently funded investigator with expertise in the mechanlsnns and treatment of pain In patients with rheumatic disease. Her Immediate objectives are to gain skills in: 1) epidemiologic techniques to analyze longitudinal data, 2) mechanistic pain studies using quantitative sensory testing techniques and 3) clinical trials. The goal of her research Is to study the role of central mechanisms In rheumatoid arthritis (RA) pain and to define the effect of widespread, non-artlcular pain on change In physical function. Physicians often attribute RA pain to Inflammation, but many patients have pain despite well-controlled disease activity. Dr. Lee proposes that widespread, non-Inflammatory, non-articular pain significantly affects physical function and that better understanding the mechanisms of non-artlcular pain may lead to improved pain treatments. Her proposal involves three studies: 1) a two-year prospective, observational study to examine the effects of widespread, non-articular pain on change in physical function among 154 RA patients; 2) a cross-sectlonal study using quantitative sensory testing to assess central pain mechanisms among 80 RA patients and 40 healthy controls; and 3) a proof-of-concept clinical trial to study the role of serotonin-norepinephrine reuptake Inhibitors on widespread, non-articular pain in 30 RA patients. This research will take place in the Brigham and Women's Hospital Arthritis Center and the Pain Management Center, two high volume centers dedicated to clinical care and research. Dr. Lee will benefit from the mentorship of Drs. Elizabeth Karlson and Daniel Clauw and members of her Scientific and Career Advisory Boards, who have backgrounds in patient-oriented research in rheumatology, anesthesiology and psychiatry. As a junior faculty member In the Division of Rheumatology, Immunology and Allergy, Dr. Lee will interact with many experienced clinical Investigators, basic scientists and clinicians. She will take classes In biostatistics, epidemiology and neurobiology at the Harvard School of Public Health, Harvard Medical School and University of Michigan School of Public Health to further her knowledge of methods and theory.