Modifiable Risk Factors for Incident and Progressive Early Knee Osteoarthritis

描述(由申请人提供)：从方便的角度来看，许多膝骨性关节炎(OA)的研究都集中在那些中到重度疾病的人，因为OA的自然病史发生在多年。更早地研究这种疾病更具挑战性，但这可能是实施有效干预的时间框架。因此，我们感兴趣的是那些没有疾病或患有早期膝骨性关节炎的人。当承受载荷所需的结构受损时，就会发生膝骨性关节炎。可能有助于这些负荷分布结构健康的潜在可改变危险因素的三个领域包括：体力活动、心血管危险因素以及心理社会特征和行为。这项建议的具体目标是：目标1：评估由运动水平定义的体力活动对早期膝关节骨关节炎的影响，期望更多地参与轻、中度运动具有保护作用，而更多地参与剧烈运动将是有害的。目的：探讨心血管危险因素对膝关节骨性关节炎的影响，推测其可能是一种动脉粥样硬化性疾病。目的3：探讨心理社会危险因素(如疼痛应对策略、自我效能感和社会支持)对膝骨性关节炎的影响。骨关节炎倡议(OAI)是执行这项建议研究的理想环境，这是一项公开的观察性研究，3284人加入了发病率队列，该组被选为有症状的膝骨性关节炎的高危人群。参与者参加了5次年度访问，以进行全面的问卷调查、身体评估和标准化的膝关节X光检查。目前处于继续阶段，参与者继续每两年面对面接触一次，这样就有机会要求提供未包括在家长研究中的额外调查信息。作为OAI正在进行的一项辅助研究的联合调查员，以及作为使用OAI数据的主要作者发表了两项研究的研究员，我熟悉这项拟议的辅助研究的母研究的设计和进行。因此，我处于执行这项拟议研究的最佳位置，该研究将潜在地识别新的可修改的风险因素，同时提供新的数据来丰富这一已经突出的公共可用资源。我是一名风湿学家，有一个坚定的职业目标，要把自己确立为一名独立的学术调查员，拥有临床骨性关节炎研究的专业知识。通过将我的研究兴趣从研究膝骨性关节炎中基于成像的决定因素扩展到包括其他临床和基于患者的因素的更广泛的方法，我将能够全面研究这种疾病，并更有可能确定确实可以改变的风险因素。为了实现这一目标，我计划接受与行为科学研究相关的调查方法、行为干预以及研究设计、分析和统计方法方面的正式培训。这一奖项将使我能够进一步扩大我的知识和技能，这样我就能够建立一个科学上强大的临床研究计划，并获得独立的资金来维持我的研究和指导其他人。

DESCRIPTION (provided by applicant): From a convenience perspective, many knee osteoarthritis (OA) studies have focused on those with moderate to severe disease because the natural history of OA occurs over years. Studying the disease earlier on is more challenging but this may be the timeframe in which an effective intervention can be implemented. Therefore, our interest is in those without disease or with early knee OA. When structures required to accommodate loading are compromised, knee OA occurs. Three domains of potentially modifiable risk factors that may contribute to the health of these load distributing structures include: physical activity, cardiovascular risk factors, and psychosocial characteristics and behaviors. Specific aims of this proposal are: Aim 1: To evaluate the influence of physical activity, defined by level of exercise, on incident and progressive early knee OA, expecting greater participation in light and moderate exercise to be protective; while greater participation in strenuous exercise will be deleterious. Aim 2: To investigate the influence of cardiovascular risk factors on knee OA anticipating that it may be an atheromatous disease. Aim 3: To examine the impact of psychosocial risk factors (e.g. pain coping strategies, self-efficacy, and social support) on knee OA. The Osteoarthritis Initiative (OAI) is an ideal setting in which to perform this proposed study, a publicly available observational study where 3284 were enrolled into the Incidence Cohort, a group selected to be at high risk for symptomatic knee OA. Participants attended 5 annual visits for comprehensive questionnaires, physical assessments, and standardized knee X-rays. Currently in the continuation phase, participants continue to have in-person encounters every 2 years allowing the opportunity to request additional survey information not included as part of the parent study. As a co-investigator of an ongoing ancillary study to the OAI and a researcher who has published 2 studies as lead author using OAI data, I am familiar with the design and conduct of the parent study to this proposed ancillary study. Therefore, I am optimally positioned to execute this proposed study that will potentially identify novel modifiable risk factors while contributing new data to enrich this already outstanding publicly available resource. I am a rheumatologist with a firm career goal to establish myself as an independent academic investigator with expertise in clinical OA research. By expanding my research interest from studying imaging-based determinants in knee OA to a broader approach including other clinical and patient-based factors, I will be able to study this disease comprehensively and more likely to identify risk factors that are indeed modifiable. To facilitate this goal, I plan to obtain formal training in survey methods, behavioral interventions, and research design, analysis and statistical methods related to behavior science research. This award will allow me to further expand my knowledge and skills, so that I will be able to establish a scientifically robust clinical research program and secure independent funding to sustain my research and mentor others.