As a clinician who is dually trained as a rheumatologist and a neurologist, as well as having a Masters in Clinical Investigation, my long-term career goal is to improve the diagnosis and treatment of neuropathic pain in rheumatic diseases. When I started my faculty career at Johns Hopkins, there was no pre-existing infrastructure which would allow me access to the spectrum of patients I desired to study. Therefore, I started a novel Neuro-Rheumatology Clinic, which rapidly recruited a large cohort of Sjgren's syndrome (SS) patients with neuropathic pain, allowed me to establish an expansive serum and skin biopsy biospecimen repository, and enabled me to forge multi-disciplinary collaborations. This thriving infrastructure will enable me to accomplish the Aims of this proposal, which are to identify biomarkers to improve diagnosis and treatment of Sjgren's patients with neuropathic pain. I will play an intimate and direct participatory role in all phasesof this project, including the ongoing recruitment and phenotyping of patients, sustaining the growth of a tissue repository, learning how to perform ELISAs and interpreting skin biopsies, and performing all biostatistical studies.
The specific Aims will be to define whether novel anti-dorsal root ganglia antibodies, skin biopsy assays, serum measurements of pro-nociceptive neurotrophins and cytokines, and novel neuroimaging studies are potential biomarkers of SS neuropathic pain. My recent publications have identified how lupus and rheumatoid arthritis patients treated with Tumor Necrosis Factor-inhibitors can develop similar phenotypes and mechanisms of neuropathic pain as described in SS patients. Therefore, biomarkers of SS neuropathic pain which we may identify in this proposal are likely to be relevant across many different rheumatic diseases. The versatility of these biomarkers would provide a natural and logical direction for future studies, and would form the basis of a competitive R01 research proposal. To prepare for a career as an independent clinician- investigator, the career development plan includes rigorous mentorship, advanced coursework in epidemiology and biostatistics, and career growth opportunities offered by a Rheumatology Division committed to my career success. Altogether, this K23 award would therefore enable me to mature into an independent clinician- investigator, such that I could devote an entire career towards improving care and treatment of neuropathic pain in rheumatic diseases.
Neuropathic pain in Sjgren's patient can be difficult to diagnose and treat. We will evaluate whether blood tests, skin biopsies, laboratory tests which may detect factors which make nerves grow or more prone to cause pain, and new imaging techniques may improve the ability to diagnose Sjgren's neuropathic pain. These studies may suggest new treatment strategies.