RA Comorbidity Bone Health in Men and African Americans

描述（由申请人提供）： 博士Mikuls的职业目标是参与对肌肉骨骼疾病的流行病学和结果的有意义的调查，并在此过程中发展独立的临床研究职业生涯，并获得NIH的持续资助。为了满足他的近期和长期目标，申请人提出了一个职业发展计划，主要依靠与队列设计，管理和分析的实践研究经验。教学培训将包括研讨会和面对面的辅导会议与经验丰富的NIH资助的研究人员。职业发展培训将涵盖与拟议研究项目直接相关的领域。该项目包括对参与NIH资助的非裔美国人风湿性关节炎纵向评价联盟（CLEAR）和VA风湿性关节炎（VARA）登记的RA患者的横断面和前瞻性评价。这项研究的目的是：1）确定患有早期RA的AA患者和患有已确诊疾病的男性退伍军人中的基线腰椎和股骨颈骨矿物质密度（BMD）值以及骨质减少/骨质疏松症患病率，2）鉴定环境因素和候选等位基因，其在患有早期RA的AA患者和患有已确诊疾病的男性退伍军人中赋予基线BMD降低和BMD随时间损失的风险增加。受试者将在入组时和标准随访期（VARA为2年，CLEAR为3 - 5年）后通过双能X线吸收测定法测量股骨和腰椎的骨矿物质密度（BMD）。将以横断面方式将基线BMD测量值与来自国家健康和营养检查调查（NHANES）III和Hologic，Inc.的规范性数据进行比较。将对患有伊拉的绝经后AA女性的BMD进行纵向比较，数据来自前瞻性妇女健康倡议（WIII）。使用多变量模型，我们将研究候选等位基因和环境因素（特别是糖皮质激素的使用）作为BMD和BMD损失的决定因素的作用。这项队列研究将大大提高我们对传统研究不足人群中RA相关骨丢失的理解，并将为Mikuls博士作为独立临床研究者的持续发展提供最佳背景。

DESCRIPTION (provided by applicant): Dr. Mikuls' career goals are to participate in meaningful investigations of the epidemiology and outcomes of musculoskeletal disorders and in the process develop an independent career in clinical research with consistent NIH funding. In order to meet his immediate and long-term objectives, the applicant has proposed a career development plan that relies predominantly on hands-on research experience with cohort design, management, and analysis. Didactic training will include seminars and face-to-face mentoring sessions with experienced NIH-funded investigators. The career development training will cover areas that are directly pertinent to the proposed research project. This project includes cross-sectional and prospective evaluations of patients with RA participating in the NIH-funded Consortium for the Longitudinal Evaluation of African- Americans with eady Rheumatoid Arthritis (CLEAR) the VA Rheumatoid Arthritis (VARA) registries. The aims of the study are: 1) to determine baseline lumbar spine and femoral neck bone mineral density (BMD) values and osteopenia / osteoporosis prevalence among AA patients with early RA and among male veterans with established disease and, 2) to identify environmental factors and candidate alleles, which confer increased risk of reduced baseline BMD and BMD loss over time among AA patients with early RA and among male veterans with established disease. Subjects will undergo bone mineral density (BMD) measurement of the femur and lumbar spine via duel energy x-ray absorptiometry at the time of enrollment and again after a standard period of follow-up (2 years for VARA, 3 to 5 years for CLEAR). Baseline BMD measurements will be compared in a cross-sectional manner with normative data from the National Health and Nutrition Examination Survey (NHANES) III and from Hologic, Inc. Longitudinal comparisons in BMD will be made among post-menopausal AA women with IRA with data from the prospective Women's Health Initiative (WIll). Using mulitvadable modeling we will examine the role of candidate alleles and environmental factors (particularly glucocorticoid use) as determinants of BMD and BMD loss. This cohort study will greatly enhance our understanding of RA-associated bone loss in traditionally understudied populations and will provide an optimal context for Dr. Mikuls' continued development as an independent clinical investigator.