This proposal describes in detail a plan to expand and strengthen the Boston University Multipurpose Arthritis Center. A program of activities and specific projects will be pursued in 3 major components: Research, Education and Community/Health Services Research. The proposal also describes a plan to support areas of special research interest by means of two Core Units, and to continue an effective Administration Component. The Research Component will build on a strong base of work funded from other sources. In addition, four Developmental and Feasibility studies are proposed: 1) a study of vitamin A metabolism in prealbumin forms of amyloid disease; 2) the isolation of cDNA clones for serum amyloid A; 3) an investigation of stair climbing in arthritis; and 4) a study of the difficulty dimension in functional assessments. MAC education efforts will continue to be aimed at a broad spectrum of arthritis health professionals in conjunction with the Schools of Medicine, Nursing and Allied Health Professions of Boston University. Specific projects in the education component will include an evaluation of the current status of house officer education in rheumatology at internal medicine and family practice residency programs, a study of the effects of a targeted training program on interpersonal skills of physical therapy students and an investigation of coping in chronic arthritis. Activities in the Community/HSR component of the MAC will continue to focus on the inner-city community in conjunction with the Department of Health and Hospitals of the City of Boston. Seven specific community/health services research projects are proposed: 1) a project to modify the Arthritis Impact Measurement Scales for use in clinical practice; 2) a project to develop a computer-based community network for clinical rheumatology trials; 3) a inner-city nursing home project combining outreach and data collection for this important population; 4) a study of the rheumatology referral behavior of general internists and family practitioners; 5) an epidemiologic study of osteoarthritis in conjunction with the Framingham Heart Study; 6) an epidemiologic study of oral contraceptives and rheumatoid arthritis in conjunction with an established drug epidemiology group; and (7) an investigation of the relationship between stressful life events and disease activity in rheymatoid arthritis. Two Core Units are proposed: an Amyloid studies Core Unit and a Research and Evaluation Support Core Unit. These Core Units will support numerous investigations in areas of special interest to this Center.
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