Cervical Dysplasia and Human Papillomavirus Infection in Rheumatoid Arthritis.

描述（由申请人提供）：我是Brigham and Women's Hospital（BWH）药物流行病学和药物经济学部门以及流变学、免疫学和过敏学部门的一名流变学家和博士后研究员，在丹尼尔H.所罗门和塞巴斯蒂安施内维斯。我的长期目标是建立一个职业生涯作为一个独立的药物流行病学研究与专业知识的安全性药物用于风湿性疾病。 以前的研究表明，患有免疫功能低下疾病的妇女，包括系统性红斑狼疮，系统性硬化症和溃疡性结肠炎，患宫颈发育不良和人乳头瘤病毒（HPV）感染的风险比一般人群中的妇女更大。然而，关于类风湿性关节炎（RA）中宫颈发育不良和HPV感染的风险的数据很少。我建议使用几种综合方法来评估RA患者宫颈不典型增生、宫颈癌和HPV感染的风险，将这些结果的风险与不同类型的免疫抑制治疗（即，传统的缓解疾病的抗风湿药物与生物治疗）以及人口统计学和其他临床因素，并检查RA患者对当前宫颈癌筛查指南的依从性。我将使用不同的数据源，包括电子病历、大型管理数据库、患者调查以及患者登记。 随着宫颈癌疫苗的出现，确定高危妇女具有重大的公共卫生意义。拟议的研究提供了一个更好的了解HPV感染的风险，宫颈不典型增生，宫颈癌的RA患者的免疫抑制治疗。此外，它强调了对宫颈癌进行常规监测的重要性，这可能导致对这种可能致命但可预防的疾病的监测和管理的改进。 BWH的药物流行病学和流变学部门都是追求我的研究目标和长期职业目标的理想环境。药物流行病学部是国际知名的药物流行病学研究卓越中心，促进了与药物使用和结果相关的广泛活动，从各种跨学科的角度进行讨论。风湿病科每年为超过30，000名患者提供优质的临床护理，并拥有大量RA患者的前瞻性登记。在所罗门博士的指导下，风湿病学部的临床科学科以卓越的临床研究而闻名，重点是RA研究。这两个部门都有宝贵的资源，包括空间，设备和知识渊博的教师，包括RA研究专家以及药物流行病学，以帮助我实现我的目标。

DESCRIPTION (provided by applicant): I am a Rheumatologist and Postdoctoral Fellow in the Division of Pharmacoepidemiology and Pharmacoeconomics and the Division of Rheumatology, Immunology and Allergy at Brigham and Women's Hospital (BWH), undertaking a training in Pharmacoepidemiology in the rheumatic diseases under the guidance of Drs. Daniel H. Solomon and Sebastian Schneeweiss. My long term goal is to establish a career as an independent pharmacoepidemiology researcher with expertise in the safety of drugs used in the rheumatic diseases. Previous studies have suggested that women with immunocompromised conditions including systemic lupus erythematosus, systemic sclerosis and ulcerative colitis are at a greater risk for cervical dysplasia and human papillomavirus (HPV) infection than are women in the general population. However, scant data exist regarding the risk of cervical dysplasia and HPV infection in rheumatoid arthritis (RA). I propose to use several integrative approaches to evaluate the risk of cervical dysplasia, cervical cancer and HPV infection in patients with RA, to relate the risks of these outcomes to different types of immunosuppressive therapy (i.e., traditional disease-modifying anti-rheumatic drugs versus biologic therapy) as well as demographic and other clinical factors and to examine adherence to current cervical cancer screening guidelines in patients with RA. I will be using different data sources including electronic medical records, large administrative databases, patient survey, as well as patient registries. With the advent of the cervical cancer vaccine, identification of women at high risk carries great public health relevance. The proposed research offers a better understanding of the risk of HPV infection, cervical dysplasia, and cervical cancer in RA patients on immunosuppressive treatments. In addition, it emphasizes the importance of routine surveillance of cervical cancer, which could lead to improvement in the surveillance and management of this potentially fatal, but preventable disease. Both Divisions of Pharmacoepidemiology and Rheumatology at BWH are the ideal environments to pursue my research aims and long term career goal. The Pharmacoepidemiology Division is internationally known as a center of excellence in pharmacoepidemiology research and facilitates a wide range of activities related to the use and outcomes of medications, addressed from a variety of interdisciplinary perspectives. The Rheumatology Division provides excellent clinical care to over 30,000 patients a year and has a large prospective registry of RA patients. The Section of Clinical Sciences in the Rheumatology Division, under the direction of Dr. Solomon, is renowned for excellence in clinical investigation with a focus on RA research. Both Divisions have valuable resources including space, equipment, and knowledgeable faculty including experts in RA research as well as pharmacoepidemiology to help me achieve my goals.