Defining the relationship between rheumatoid arthritis, comorbidity, and adverse health-related outcomes: A precision medicine approach.

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Studentship strategic priority area:E-Health Informatics ResearchKeywords: Multimorbidity; cohorts; rheumatoid arthritis; outcomesRheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting 1% of the adult population. Therapeutic advances have improved RA prognosis but it is increasingly recognised that comorbidities may shorten life span and quality of life. Depression, asthma, and cardiovascular disorders are common comorbidities and cardiovascular disease is a leading cause of death. This proposal aims to use a precision medicine approach to delineate the relationship between RA, comorbidity, and adverse outcomes. Key research questions are:1. What is known about predictors of mortality and adverse health-related outcomes among people with RA and comorbidity? 2. How do demographic, lifestyle factors, morbidity measures, and routine clinical blood tests mediate the relationship between individuals with RA and adverse health-related outcomes (death, cancer, hospitalisation and cardiac events)?3. Is it possible to develop a predictive algorithm to identify individuals with RA and comorbidity at high risk of adverse outcome?The student will undertake a systematic literature review and interrogate several large well-defined research cohorts (UK Biobank; Scottish Early RA (SERA) cohort, Swedish Arthritis cohorts in Karolinska Institute). The intended outcome would be improved risk stratification for adverse health outcomes in people with RA, which in turn can potentially lead to improvement in the clinical management of RA.This PhD project, under the guidance of an experienced and multidisciplinary supervisory team, will provide the student with a solid grounding in systematic review, population health, and data science approaches, including in silico-type modelling approaches. The student will receive specific training and develop competencies in epidemiology and statistical analysis using complex and innovative methods. Generic research and communication skills will also be developed. The student would visit and be hosted by Professor Johan Askling in Karolinska Institute for a few months to undertake a component of the analysis. This project aligns with MRC's research priority theme of "living a long and healthy life", particularly in relation to the impact of lifestyles on health, and mission to produce skilled researchers. This project will involve experts from rheumatology, epidemiology and primary care research backgrounds with expertise in the areas being studied.