The overall objectives of this Program Project are to identify management strategies and specific drug and health education therapies which improve long-term outcomes of rheumatoid arthritis (RA) and osteoarthritis (OA). The Program builds upon the large, high-quality multidisciplinary patient data sets at ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System) data centers built over the past 20 years, together with ARAMIS productive collaborations, methodological and technical resources, quality-control methods and outcome assessment capabilities. ARAMIS 2000 will take this Program into its 25th year, with a new focus upon studies directly addressing outcomes of disability, pain, and medical costs, utilizing longitudinal observational studies and randomized effectiveness trials. We will study in aggregate over 8,000 patients, with over 50,000 patient-years of follow-up. Two Cores and four Projects are proposed. Core A provides administrative, methodologic, and technical computer support to all projects. Core B establishes a new national 1,000 patient inception cohort of RA patients over-sampled for African-American and Hispanic patients, followed from their first year of disease, recruited from the practices of 100 randomly selected rheumatologists, with clinical, outcome, demographic, x-ray, and DNA-typing data. The projects address the questions: (1) Do medical management strategies for RA based upon early and consistent use of disease-modifying anti-rheumatic drugs (DMARDs) lead to better patient outcomes than traditional approaches? (2) What are the comparative effectiveness, cost-effectiveness and toxicity- effectiveness ratios of alternative specific drugs? (3) Does traditional non-steroidal anti-inflammatory drug (NSAID) therapy for OA have advantages over an analgesic-based strategy, or does it increase toxicity and costs, and perhaps accelerate joint destruction? (4) Can we establish mail-delivered arthritis self-management health education programs, accessible to all, as important treatment adjuncts for RA and OA? We expect to improve outcomes (1) in RA by identifying more optimal overall treatment strategies, better choices between specific alternative drugs and wider use of health education programs and (2) in OA by harnessing patient energies through self-management and by identifying the least toxic and least costly of effective therapies. The answers to these pivotal and complex questions will help to guide the future management of arthritis patients.
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