Clin-STAR Journey Story

Bridging Silos: How Aging Became Central to a Rheumatologist’s Clinical and Research Career

Dr. Jiha Lee, MD, MHS, is a rheumatologist and assistant professor in the Department of Internal Medicine at the University of Michigan Medical School and a member of the Institute for Healthcare Policy and Innovation at the University of Michigan. She is an expert in the care of older adults with rheumatic diseases and has focused her research at the intersection of aging, rheumatology, and pharmacoequity. Through her research and leadership, she is becoming a leading voice in advancing geriatric rheumatology.

When asked about the inspiration for focusing on aging, Dr. Lee reflected on her time in the United Kingdom. While her parents were in the UK for her father’s academic sabbatical, Dr. Lee fell in love with the environment and ended up staying to complete her education. During this time, she lived with a host family and “got a glimpse of aging as my hosts were older and had chronic conditions. I was struck by the number of medical appointments, medications, and frustrations.”

As Dr. Lee entered her professional career, she noticed a troubling pattern. Older adults with rheumatic diseases were often diagnosed later and treated more cautiously than their younger counterparts. One case in particular stayed with her—an older Veteran had persistent pain that had long been attributed to aging. His symptoms would improve with steroids, which led to prolonged use despite the risks. After pursuing advanced imaging, Dr Lee discovered that he had polymyalgia rheumatica with inflammatory arthritis overlap—a condition treatable with biologics. “I realized that preconceptions about aging were shaping care,” she reflected. But “there was little guidance on how to balance the benefits and risks of high-risk treatments in older adults with complex care needs or comorbidities.” Dr. Lee noted that most studies that inform rheumatologic patient care are based on people in their 50s or younger, and even worse, many studies exclude older adults without providing any reason.

These experiences spurred her drive to bridge rheumatology and geriatrics. Dr. Lee’s NIA-funded research (former GEMSSTAR and current K23) focuses on improving treatment among older adults with late-onset rheumatoid arthritis, ensuring that care is guided by individual needs rather than assumptions about age. A central focus of her work is navigating the use of high-risk medications, such as immunosuppressives, in older adults with complex health needs. While these therapies carry potential risks, they can also significantly improve quality of life and outcomes when used appropriately. Dr. Lee is working toward age-specific treatment guidelines for rheumatology, a goal that will require collaborative data collection, analytic support, and broad input.

In addition to her research, Dr. Lee is passionate about bringing aging-related issues to the forefront of rheumatology. She leads a geriatric rheumatology (geri-rheum) working group that includes U.S. and European collaborators. The group has successfully hosted aging-focused symposia at the American College of Rheumatology (ACR) annual meetings. Inspired by this work, European colleagues submitted a formal proposal to create a geri-rheum study group within EULAR (the European counterpart to ACR) laying the groundwork for international collaboration. Dr. Lee hopes that the group’s continued advocacy will lead to a lasting structure within ACR to support aging-focused efforts for years to come.

In looking to the future, Dr. Lee envisions a more age-inclusive approach to both rheumatology research and clinical care. Through her work with the geri-rheum group and broader aging initiatives such as the Tideswell AGS Emerging Leaders in Aging Program, she has come to appreciate the importance of understanding a professional society’s structure, mission, and priorities. “Once you can identify how your efforts align with the professional society’s needs and research goals, you can move forward.” At the 2024 Clin-STAR Annual Meeting, Dr. Lee co-facilitated a breakout session where she shared her experiences to motivate peers from other specialties to champion aging-related initiatives in their respective fields.

Through forums like the transdisciplinary Clin-STAR Inflammation Special Interest Group, Dr. Lee has also seen that the challenges caring for medically complex older adults are not unique to rheumatology. Many specialties grapple with similar dilemmas, creating opportunities to learn from each other’s strategies and develop cross-disciplinary solutions.

“I’m incredibly grateful for the support from Clin-STAR and GEMSSTAR,” she said. “They’ve given me the opportunity to bring together my interests in aging, clinical care, and equity into one coherent path. The networking and interest groups helped me learn from other fields and develop strategies that led to funding and national collaboration.”