I am a Rheumatologist and Postdoctoral Fellow in the Division of Pharmacoepidemiology and Pharmacoeconomics and the Division of Rheumatology, Immunology and Allergy at Brigham and Women's Hospital (BWH), undertaking a training in Pharmacoepidemiology in the rheumatic diseases under the guidance of Drs. Daniel H. Solomon and Sebastian Schneeweiss. My long term goal is to establish a career as an independent pharmacoepidemiology researcher with expertise in the safety of drugs used in the rheumatic diseases. Previous studies have suggested that women with immunocompromised conditions including systemic lupus erythematosus, systemic sclerosis and ulcerative colitis are at a greater risk for cervical dysplasia and human papillomavirus (HPV) infection than are women in the general population. However, scant data exist regarding the risk of cervical dysplasia and HPV infection in rheumatoid arthritis (RA). I propose to use several integrative approaches to evaluate the risk of cervical dysplasia, cervical cancer and HPV infection in patients with RA, to relate the risks of these outcomes to different types of immunosuppressive therapy (i.e., traditional disease-modifying anti-rheumatic drugs versus biologic therapy) as well as demographic and other clinical factors and to examine adherence to current cervical cancer screening guidelines in patients with RA. I will be using different data sources including electronic medical records, large administrative databases, patient survey, as well as patient registries. With the advent of the cervical cancer vaccine, identification of women at high risk carries great public health relevance. The proposed research offers a better understanding of the risk of HPV infection, cervical dysplasia, and cervical cancer in RA patients on immunosuppressive treatments. In addition, it emphasizes the importance of routine surveillance of cervical cancer, which could lead to improvement in the surveillance and management of this potentially fatal, but preventable disease. Both Divisions of Pharmacoepidemiology and Rheumatology at BWH are the ideal environments to pursue my research aims and long term career goal. The Pharmacoepidemiology Division is internationally known as a center of excellence in pharmacoepidemiology research and facilitates a wide range of activities related to the use and outcomes of medications, addressed from a variety of interdisciplinary perspectives. The Rheumatology Division provides excellent clinical care to over 30,000 patients a year and has a large prospective registry of RA patients. The Section of Clinical Sciences in the Rheumatology Division, under the direction of Dr. Solomon, is renowned for excellence in clinical investigation with a focus on RA research. Both Divisions have valuable resources including space, equipment, and knowledgeable faculty including experts in RA research as well as pharmacoepidemiology to help me achieve my goals.
Although both cervical dysplasia and HPV infection are very common, the risks of these conditions in patients with RA, particularly those treated with immunosuppressive drugs is unknown. This proposal will lead to more informed management and surveillance of patients with RA for potentially life-threatening, but largely vaccine- preventable cervical cancer.
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