Variations in Hip Morphology: Frequency and Impact on Osteoarthritis Outcomes

描述（由申请人提供）：候选人是一名风湿病学家，具有临床研究和流行病学方法的基础，对应用于骨关节炎（OA）的新型成像技术有浓厚的兴趣。候选人的长期职业目标是成为一名独立资助的学术临床科学家，广泛研究OA，特别强调OA的先进成像和多关节参与。候选人的短期职业目标是1）设计一个协议，并获得实践经验与影像学评估髋关节形态（包括股骨髋臼撞击[FAI]和活动形状模型的髋关节形状），2）获得先进流行病学和统计方法的专业教学培训，3）学习与其他大型正在进行的队列合作，4）收集数据，建立网络，并积累必要的出版跟踪记录，需要竞争独立的资金，和5）获得额外的培训，在负责任的研究行为。拟议的研究计划，职业发展活动，导师计划，咨询小组和机构环境非常适合帮助申请人实现这些目标。拟议研究的基本原理是，了解髋关节形状改变（包括FAI）的频率和临床影响，以及这些改变对OA发展的影响，对于制定有关髋关节OA诊断和治疗干预的知情政策和临床决策至关重要。在目标1中，主要研究者将评估大型人群队列中FAI影像学结果的患病率，在目标2中，将确定这些结果与经验证的临床结局之间的相关性。目的3将允许PI确定髋关节形态（通过FAI或主动形状模式）是否可预测发生的影像学或症状性髋关节结局。该提案的预期结果将是提高对髋关节形态学在髋关节OA发展中的患病率和临床重要性的认识。为了支持候选人的职业发展，她将继续学习先进的数据分析方法和研究道德方面的课程，沿着专业成像方法和解释方面的实践培训。咨询团队包括具有广泛专业知识的多学科合作者（Renner，Schwartz，DeVellis和Helmick）以及具有OA流行病学（Jordan）和OA成像和形状评估（Kraus，Lane和Aspden）专业知识的国际公认的独立资助的研究人员，将指导纳尔逊博士的研究和职业发展。研究环境将提供一个富有成效的，合议和协作的氛围中，纳尔逊博士可以追求她的研究和培训目标。 公共卫生相关性：据估计，美国有2700万成年人患有骨关节炎，这是一种使人衰弱的慢性关节疾病，可影响一个或多个关节部位，最常见的是手、膝、髋和/或脊柱，导致大量发病。尽管这种疾病的负担很大，特别是在负重关节中，但没有疾病修饰治疗可用于治疗或预防OA中的关节损伤。本研究和后续研究的目标是评估髋关节OA的潜在独特风险因素，这可能导致特定的诊断和治疗干预，从而减少髋关节OA的残疾。

DESCRIPTION (provided by applicant): The candidate is a rheumatologist with a foundation in clinical research and epidemiologic methods, and a strong interest in novel imaging techniques as applied to osteoarthritis (OA). The candidate's long-term career goal is to become an independently funded, academic clinician-scientist, with a broad research focus on OA, and particular emphasis on advanced imaging and multiple joint involvement in OA. The candidate's short- term career goals are to 1) design a protocol for and gain practical experience with radiographic estimates of hip morphology (including femoroacetabular impingement [FAI], and hip shape by active shape models), 2) obtain specialized didactic training in advanced epidemiologic and statistical methods, 3) learn to collaborate with other large ongoing cohorts, 4) collect data, establish networks, and amass the necessary publication track record needed to compete for independent funding, and 5) obtain additional training in the Responsible Conduct of Research. The proposed research plan, career development activities, mentorship plan, advisory panel, and institutional environment are well suited to assist the applicant in achieving these goals. The rationale for the proposed research is that knowledge of the frequency and clinical impact of alterations in hip shape (including FAI), and the effects of such alterations on the development of OA, is essential to allow informed policy and clinical decisions regarding diagnostic and therapeutic interventions for hip OA. In Aim 1, the PI will assess the prevalence of radiographic findings of FAI in a large population-based cohort, and in Aim 2 will determine associations between these findings and validated clinical outcomes. Aim 3 will allow the PI to determine whether hip morphology (by FAI or active shape modes) predicts incident radiographic or symptomatic hip outcomes. The expected result of this proposal will be an improved knowledge of the prevalence and clinical importance of hip morphology in the development of hip OA. To support the candidate's career development, she will pursue coursework in advanced data analysis methods and research ethics, along with practical training in specialized imaging methods and interpretation. The advisory team, which includes multi-disciplinary collaborators with a wide range of expertise (Renner, Schwartz, DeVellis, and Helmick) as well as internationally-recognized, independently-funded investigators with expertise in OA epidemiology (Jordan) and imaging and shape assessments in OA (Kraus, Lane, and Aspden), will guide Dr. Nelson's research and career development. The research environment will provide a productive, collegial, and collaborative atmosphere in which Dr. Nelson can pursue her research and training goals. PUBLIC HEALTH RELEVANCE: An estimated 27 million adults in the United States have osteoarthritis, a debilitating chronic joint disease that can affect one or more joint sites, most commonly the hands, knees, hips, and/or spine, leading to substantial morbidity. Despite the large burden of this condition, particularly in weight-bearing joints, there are no disease modifying treatments available to treat or prevent joint damage in OA. The goal of this and subsequent research is to assess potential unique risk factors for OA at the hip, which may lead to specific diagnostic and therapeutic interventions, thereby reducing disability from hip OA.