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

描述(申请人提供)：李博士的长期目标是成为一名独立资助的研究人员，在风湿病患者的疼痛机械和治疗方面具有专业知识。她的近期目标是掌握以下方面的技能：1)分析纵向数据的流行病学技术；2)使用定量感觉测试技术进行机械性疼痛研究；3)临床试验。她的研究目标是研究中枢机制在类风湿性关节炎(RA)疼痛中的作用，并确定广泛的非关节疼痛对身体功能变化的影响。医生通常将RA疼痛归因于炎症，但许多患者尽管疾病活动得到了很好的控制，仍有疼痛。Lee博士提出，广泛性、非炎症性、非关节疼痛显著影响身体功能，更好地了解非关节疼痛的机制可能会导致疼痛治疗的改进。她的建议涉及三项研究：1)一项为期两年的前瞻性观察性研究，以考察154名RA患者广泛的非关节疼痛对身体功能变化的影响；2)一项使用定量感觉测试的跨部门研究，以评估80名RA患者和40名健康对照的中枢疼痛机制；以及3)一项概念验证性临床试验，以研究5-羟色胺-去甲肾上腺素再摄取抑制剂对30名RA患者广泛的非关节疼痛的作用。这项研究将在布里格姆妇女医院关节炎中心和疼痛管理中心进行，这两个中心致力于临床护理和研究。李博士将受益于伊丽莎白·卡尔森博士和丹尼尔·克劳夫博士以及她的科学和职业咨询委员会成员的指导，他们在风湿学、麻醉学和精神病学方面具有以患者为导向的研究背景。作为风湿学、免疫学和过敏学系的初级教员，李博士将与许多经验丰富的临床研究人员、基础科学家和临床医生互动。她将在哈佛大学公共卫生学院、哈佛医学院和密歇根大学公共卫生学院学习生物统计学、流行病学和神经生物学，以加深她对方法和理论的了解。

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.