Since receiving the K24 award, I have established a successful clinical research and training program in patient-oriented research (POR) in rheumatic disease with a focus on genetic, biomarker, and environmental risk factors for rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). I continue to have independent grant support, and have mentored 15 new clinical investigators who have published 25 peer- reviewed papers during the K24 period. Three mentees have received NIH K awards and one has received an NIH R01. With renewal of the K24, I would continue to have protected time to devote to this program that has a unique training environment and an array of important POR projects. Genetic and environmental epidemiology studies have produced convincing evidence for multiple alleles and exposures as RA risk factors. A strong gene-environment (GXE) interaction between HLA-DRB1 alleles and smoking has been demonstrated for risk of the immune phenotype of CCP positive RA but not CCP negative RA. As CCP antibodies occur years before RA onset, I hypothesize that this interaction induces anti-citrulline immunity, a critical step in RA pathogenesis. These findings emphasize the need to study genes, environment and immunity with careful phenotyping. Family history encompasses unmeasured genetic and environmental risk, yet is not measured accurately in other studies including those in my research portfolio.
Specific aims are to: 1) Maintain and expand my clinical research training program by mentoring new clinical investigators in POR in rheumatic diseases;2) Enrich my comprehensive POR program to study family history, genetic, and environmental predictors in the etiology of RA using a new collection of RA cases and controls from Partners HealthCare;2a) Collect family history data and environmental exposure data concerning smoking and reproductive factors on 1,500 RA patients and 4,500 age- and gender-matched controls by utilizing natural language processing (NLP) queries of electronic medical records;2b: Examine genetic risk factors, environmental risk factors and GXE in predicting immune phenotypes of RA: RA with and without CCP antibodies (CCP?), and RA with and without rheumatoid factor antibodies (RF?);and 2c: Apply this comprehensive risk model to RA cases and controls and to subsets of RA stratified by specific immune phenotypes and stratified by family history of RA and other autoimmune diseases. The proposed study will leverage the NIH funded Informatics for Integrating Biology and the Bedside study that used an advanced informatics infrastructure to extract clinical data on RA diagnostic features through database mining and NLP. A highly specific algorithm was used to identify RA cases and collect samples from cases and controls. The NLP techniques will be used to extract risk factor data from clinical notes. This proposal builds on my strong track record of POR, extending the work to add family history from a new case-control collection, validate data by patient interview, and develop predictive models for risk of RA that can be used to select high risk individuals for future RA prevention trials.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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Special Emphasis Panel (ZAR1-CHW-J (M1))
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Witter, James
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Brigham and Women's Hospital
United States
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Kreps, David J; Halperin, Florencia; Desai, Sonali P et al. (2018) Association of weight loss with improved disease activity in patients with rheumatoid arthritis: A retrospective analysis using electronic medical record data. Int J Clin Rheumtol 13:1-10
Prado, Maria G; Iversen, Maura D; Yu, Zhi et al. (2018) Effectiveness of a Web-Based Personalized Rheumatoid Arthritis Risk Tool With or Without a Health Educator for Knowledge of Rheumatoid Arthritis Risk Factors. Arthritis Care Res (Hoboken) 70:1421-1430
Sparks, Jeffrey A; Iversen, Maura D; Yu, Zhi et al. (2018) Disclosure of Personalized Rheumatoid Arthritis Risk Using Genetics, Biomarkers, and Lifestyle Factors to Motivate Health Behavior Improvements: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 70:823-833
Sparks, Jeffrey A; Chang, Shun-Chiao; Nguyen, Uyen-Sa D T et al. (2018) Smoking Behavior Changes in the Early Rheumatoid Arthritis Period and Risk of Mortality During Thirty-Six Years of Prospective Followup. Arthritis Care Res (Hoboken) 70:19-29
Sparks, Jeffrey A; Chang, Shun-Chiao; Nguyen, Uyen-Sa et al. (2018) Weight Change During the Early Rheumatoid Arthritis Period and Risk of Subsequent Mortality in Women With Rheumatoid Arthritis and Matched Comparators. Arthritis Rheumatol 70:18-29
Sparks, Jeffrey A; Barbhaiya, Medha; Tedeschi, Sara K et al. (2018) Inflammatory dietary pattern and risk of developing rheumatoid arthritis in women. Clin Rheumatol :
Sparks, Jeffrey A; Lin, Tzu-Chieh; Camargo Jr, Carlos A et al. (2018) Rheumatoid arthritis and risk of chronic obstructive pulmonary disease or asthma among women: A marginal structural model analysis in the Nurses' Health Study. Semin Arthritis Rheum 47:639-648
Tedeschi, Sara K; Barbhaiya, Medha; Malspeis, Susan et al. (2017) Obesity and the risk of systemic lupus erythematosus among women in the Nurses' Health Studies. Semin Arthritis Rheum 47:376-383
Hu, Yang; Sparks, Jeffrey A; Malspeis, Susan et al. (2017) Long-term dietary quality and risk of developing rheumatoid arthritis in women. Ann Rheum Dis 76:1357-1364
Tedeschi, Sara K; Cui, Jing; Arkema, Elizabeth V et al. (2017) Elevated BMI and antibodies to citrullinated proteins interact to increase rheumatoid arthritis risk and shorten time to diagnosis: A nested case-control study of women in the Nurses' Health Studies. Semin Arthritis Rheum 46:692-698

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