The UNC Core Center for Clinical Research

摘要-总体 位于查佩尔山的北卡罗来纳州大学临床核心中心的总体目标 研究（CCCR）是为了加强风湿性关节炎临床研究的设计和实施， 肌肉骨骼疾病（RMD），重点是骨关节炎（OA），这是我们的一个特别优势 研究社区。关节炎导致的疼痛和功能丧失，加上其患病率， 使其成为残疾的主要原因。OA是关节炎最常见的形式。迫切需要作出努力， 改善OA患者的管理，以及许多其他RMD，以减轻疼痛，改善 功能和减缓或停止疾病进展。 与其他慢性疾病一样，RMD不是单一疾病，而是异质性疾病 由在其潜在的病理生物学机制上不同的多种表型组成。如果不考虑到 考虑到这些表型差异，这些表型差异导致对旨在解决特定 在“错误”的病人中的作用机制。因此，RMD的成功治疗需要有针对性 在特定的亚组或亚型中进行测试，这些亚组或亚型具有不同的潜在病理生物学，心理社会学， 和疼痛机制符合精准医疗的目标。理解和融入 在临床观察研究和试验中关于这些表型的信息将是至关重要的， 这是我们CCCR的一个主要目标。重要的是，这一追求将解决NIAMS长期- 临床研究的范围计划，强调“疾病亚型的临床表征至关重要 评估这些疾病领域的流行病学数据和有效设计临床试验。” 拟议中的UCCCR将建立在我们变革性的多学科临床研究中心的基础上 （MCRC），减轻OA的公共卫生影响。虽然CCCR将重点关注OA，但分析 用于表型分析和精确医学的方法也将应用于其他RMD， 包括类风湿性关节炎狼疮和血管炎我们的目标是优化设计， 分析和实施OA和其他RMD的临床研究和试验，以推进临床 通过以下措施，针对患有这些疾病的个人开展护理和公共卫生工作 目标：1）行政核心：提供领导，监督，协调，评估和一般 为CCCR所有活动提供行政支持; 2）方法核心：提供全面和综合的 一套以RMD为重点的服务，以优化CCCR研究的质量、效率和创新 社区，包括当地，国家和国际成员; 3）表型和精准医学 资源核心：提供服务，以增加价值和优化临床的设计和实施， 研究以及开发创新策略，以最大限度地利用和临床表型的成功， RMD中的精准医学，重点是OA。

ABSTRACT – OVERALL The overall goal of the University of North Carolina at Chapel Hill (UNC) Core Center for Clinical Research (CCCR) is to enhance the design and conduct of clinical studies in Rheumatic and Musculoskeletal Diseases (RMDs) with a focus on osteoarthritis (OA), a particular strength of our research community. The pain and loss of function that results from arthritis, combined with its prevalence, make it a leading cause of disability. OA is the most common form of arthritis. Efforts are urgently needed to improve the management of people with OA, as well as the many other RMDs, to reduce pain, improve function and slow or stop disease progression. Like other chronic conditions, RMDs are not single diseases but rather heterogeneous conditions consisting of multiple phenotypes that differ in their underlying pathobiological mechanisms. If not taken into consideration, these phenotypic differences result in the testing of interventions designed to address specific mechanisms of action in the “wrong” patients. Therefore, successful treatments for RMDs need to be targeted to, and tested in, specific subgroups or subtypes that share distinct underlying pathobiological, psychosocial and pain mechanisms consistent with the goal of precision medicine. Understanding and incorporating information about these phenotypes in clinical observational studies and trials will be crucial to move the field forward and is a major goal of our CCCR. Importantly, this pursuit will address the NIAMS long- range plan for clinical research which emphasizes that, “clinical characterization of disease subtypes is critical to assessment of epidemiological data and efficient design of clinical trials in these disease areas.” The proposed UNC CCCR will build on our transformative Multidisciplinary Clinical Research Center (MCRC), Mitigating the Public Health Impact of OA. Although the CCCR will have a focus on OA, the analytical methods used for phenotyping and precision medicine will also be applied to other RMDs that are strengths within our research community including RA, lupus, and vasculitis. Our goal is to optimize the design, analysis and implementation of clinical studies and trials in OA and other RMDs to advance clinical care and public health efforts targeted toward individuals with these conditions through the following aims: 1) Administrative Core: Provide leadership, oversight, coordination, evaluation, and general administrative support for all CCCR activities; 2) Methodology Core: Provide a comprehensive and integrated set of RMD-focused services to optimize the quality, efficiency and innovation of the CCCR research community that includes local, national and international members; 3) Phenotyping and Precision Medicine Resource Core: Provide services that will add value to and optimize the design and implementation of clinical studies as well as develop innovative strategies to maximize the use and success of clinical phenotyping and precision medicine in RMDs, with a focus on OA.