# Understanding disease modifying antirheumatic drug use in older adults with late-onset rheumatoid arthritis

> **NIH NIH K23** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $194,400

## Abstract

PROJECT SUMMARY/ABSTRACT
Rheumatoid arthritis (RA) is a chronic, debilitating inflammatory disease that affects 1.3 million older adults in
the US. The number of older adults living with RA is growing and one-third are diagnosed with late-onset RA
(LORA), characterized by more severe disease, greater comorbidity burden at time of diagnosis, and disability.
Older adults with RA are less likely to receive effective disease modifying antirheumatic drugs (DMARDs) and
more likely to receive long-term glucocorticoids alone for treatment which suggest we may be accepting less
than optimal management in this population and better outcomes may be achievable. Dr. Jiha Lee is an
Assistant Professor at the University of Michigan whose long-term goal is to become an independent
investigator and national leader in geriatric rheumatology focused on advancing the science of effective
medication use to improve the care of older adults with rheumatic diseases. This K23 Mentored Patient-
Oriented Research Career Development Award application (PA-20-205) will support Dr. Lee to gain additional
training and mentoring, and by completing the proposed work to become one of the few clinician-scientists with
unique qualifications at the intersection of rheumatology, aging, pharmacoepidemiology, and mixed methods
research to conduct rigorous aging research in the field of rheumatology. The overarching scientific goal of this
mentored-research proposal is to investigate suboptimal DMARD use and tolerability to different treatment
regimens in usual care among older adults with LORA and to engage patients and providers to better
understand observed outcomes. The proposed explanatory sequential mixed methods study will use nationally
representative Medicare claims data for Aims 1 and 2, followed by in-depth semi-structured interviews with
patients and providers for Aim 3. Specifically, in Aim 1, Dr. Lee will examine patient and provider/healthcare
factors associated with suboptimal DMARD use in older adults with LORA during the first 12 months after
index date of diagnosis, gathering critical information to identify targets for future efforts to improve DMARD
use. To build toward more evidence-based prescribing, in Aim 2 she will examine outcomes associated with
different treatment regimens and identify patients at greatest risk of poor outcomes. In Aim 3, she will use the
results from Aims 1 and 2 to guide the sampling strategy and discussion guide development to engage patients
with LORA and providers to examine and inform additional potentially important factors that drive treatment
approaches. Dr. Lee will conduct all work at the rich environment of the University of Michigan, with guidance
from her exceptional team of mentors and advisors led by Dr. Julie Bynum. The proposed work will lay the
foundation to identify subpopulations at risk of poor outcomes and build the evidence base for an R01-level
application to inform development and evaluation of age-appropriate approa...

## Key facts

- **NIH application ID:** 10932149
- **Project number:** 5K23AG082727-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** JIHA LEE
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $194,400
- **Award type:** 5
- **Project period:** 2023-09-20 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10932149

## Citation

> US National Institutes of Health, RePORTER application 10932149, Understanding disease modifying antirheumatic drug use in older adults with late-onset rheumatoid arthritis (5K23AG082727-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10932149. Licensed CC0.

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