Pediatric rheumatic diseases, pediatric systemic lupus erythematosus, pain in children with juvenile rheumatoid arthritis, musculoskeletal pain syndromes including juvenile fibromyalgia
I am involved in both hypothesis driven clinical research as well as clinical trials, both of which are described below.
My research team consists of health psychologists, medical fellows, and graduate students in clinical psychology. Most broadly, the research team has interests in studying stress and coping processes in children with chronic disease and their families. Particular interests include describing the pain experience of children with chronic arthritis and the role of parental processes in child adjustment to chronic disease.
The research team has several ongoing active research projects. These include a recently NIH funded study of daily pain in children with arthritis using an electronic device. This study is investigating the daily pain of children with arthritis in real time and their responses to pain, including activity and school function, as well as emotional regulation. In addition, parents will also record their responses to their child's pain in real time using a similar electronic device. We also continue data analysis of a paper diary study of stress, mood and disease activity in children with juvenile rheumatoid arthritis. A specific goal of the diary study is to determine the relationships of child daily ratings of stress and mood with measures of pain, physical disability, psychological distress, and worsening disease as measured clinically and with biological markers of disease and immune activation. This study is investigating the role of stress responsive hormones, such as prolactin and cortisol, and pain coping efficacy as mechanisms by which child stress and mood influence immune activation and worsening disease. Most recently we are engaged in developing a smart phone intervention to teach pain coping skills.
I am also active in the several clinic trials in pediatric rheumatology. I was the Principal Investigator for an NIH funded 21 center interventional trial entitled Prevention of Cardiovascular Complications of SLE: Atherosclerosis Prevention in Pediatric Lupus (APPLE) in conjunction with the Duke Clinical Research Institute (DCRI) and the Childhood Arthritis and Rheumatology Research Association (CARRA). This trial enrolled 221 children and adolescents with SLE and studied the efficacy and safety of statin therapy in children with SLE. The results were published this year. In addition, I am the DCRI Principal Investigator for the RAPPORT trial, a multicenter clinical trial studying the efficacy of rilonacept, a biologic agent that blocks interleukin 1 activity, in treating systemic-onset juvenile idiopathic arthritis. I lead the safety, data management, and data analysis aspects of RAPPORT. Enrollment for this trial has concluded and the results will be available in the coming year. As part of RAPPORT, we will be looking at the role of pain and disease symptoms as markers of response to medication, as well as more conventional outcome measures.
In addition, I am actively engaged with the CARRA network to develop infrastructure to make more pediatric rheumatology sites able to participate in clinical research, including the development of treatment protocols for all rheumatic diseases and a national registry of rheumatic disease to study medication safety and comparative effectiveness. This effort was jump started by a grant from the NIH as part of the American Recovery Act. The CARRA registry includes 60 CARRA sites and has enrolled 7700 children with rheumatic disease in the last 2 years. From this information, we hope to learn more about the outcomes of childhood rheumatic disease and establish best treatment practices.