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，许多膝关节骨关节炎（OA）的研究都集中在中度至重度疾病的患者身上，因为OA的自然史发生多年。早期研究这种疾病更具挑战性，但这可能是实施有效干预措施的时间框架。因此，我们的兴趣是那些没有疾病或早期膝关节OA的患者。当需要适应负荷的结构受损时，膝关节骨性关节炎发生。可能影响这些负荷分布结构健康的潜在可改变风险因素的三个领域包括：身体活动、心血管风险因素和社会心理特征和行为。本提案的具体目的是：目的1：评估体育活动（由运动水平定义）对偶发性和进行性早期膝关节OA的影响，期望更多地参与轻度和中度运动具有保护作用；而过多的剧烈运动是有害的。目的2：探讨心血管危险因素对膝关节OA的影响，预测其可能是一种动脉粥样硬化性疾病。目的3：研究社会心理风险因素（如疼痛应对策略、自我效能和社会支持）对膝关节OA的影响。骨关节炎倡议组织（OAI）是开展这项研究的理想环境，这是一项公开的观察性研究，其中3284人被纳入发生率队列，这是一组被选为症状性膝关节OA的高风险人群。参与者参加了5次年度访问，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。目前在继续阶段，参与者继续每两年进行一次面对面的会面，允许他们有机会要求额外的调查信息，这些信息不包括在父母研究中。作为一项正在进行的OAI辅助研究的共同研究者，以及一名使用OAI数据作为主要作者发表了两项研究的研究者，我熟悉这项拟议的辅助研究的母研究的设计和实施。因此，我处于执行这项拟议研究的最佳位置，该研究将潜在地确定新的可修改的风险因素，同时提供新的数据，以丰富已经非常出色的公共可用资源。我是一名风湿病学家，我的职业目标是成为一名独立的学术研究者，在临床OA研究方面具有专业知识。通过将我的研究兴趣从研究基于影像学的膝关节炎决定因素扩展到更广泛的方法，包括其他临床和患者因素，我将能够全面研究这种疾病，并更有可能识别出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、分析和统计方法的正规培训。这个奖项将使我进一步扩展我的知识和技能，使我能够建立一个科学可靠的临床研究项目，并获得独立的资金来维持我的研究和指导他人。

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.