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

学生战略重点领域：电子卫生信息学研究关键词：多发病；军团;类风湿性关节炎;类风湿关节炎（RA）是一种影响1%成年人的慢性全身性炎症性疾病。治疗的进步改善了RA的预后，但人们越来越认识到合并症可能缩短寿命和生活质量。抑郁症、哮喘和心血管疾病是常见的合并症，心血管疾病是导致死亡的主要原因。本提案旨在使用精确医学方法来描述RA，合并症和不良后果之间的关系。重点研究的问题有：1。对于类风湿关节炎和合并症患者的死亡率和不良健康相关结果的预测因素，我们知道什么？2. 2 .人口统计学、生活方式因素、发病率测量和常规临床血液检查如何调节RA患者与不良健康相关结局（死亡、癌症、住院和心脏事件）之间的关系？是否有可能开发一种预测算法来识别RA和合并症患者的高风险不良后果？该学生将进行系统的文献综述，并询问几个大型明确的研究队列（英国生物银行；苏格兰早期RA （SERA）队列，卡罗林斯卡研究所瑞典关节炎队列）。预期的结果将是改善类风湿关节炎患者不良健康结果的风险分层，这反过来可能导致类风湿关节炎临床管理的改善。在一个经验丰富的多学科监督团队的指导下，该博士项目将为学生提供系统综述、人口健康和数据科学方法（包括硅型建模方法）的坚实基础。学生将接受专门的培训，并使用复杂和创新的方法发展流行病学和统计分析的能力。还将发展一般的研究和沟通技巧。该学生将访问卡罗林斯卡研究所的约翰·阿斯克林教授，并由他接待几个月，进行分析的一个组成部分。该项目符合MRC的研究优先主题“健康长寿”，特别是在生活方式对健康的影响方面，以及培养熟练的研究人员的使命。该项目将涉及来自风湿病学、流行病学和初级保健研究背景的专家，他们在所研究的领域具有专业知识。

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.