The objectives of this Program Project are to improve patient outcomes in Rheumatoid Arthritis (RA) by identifying and documenting more optimal treatment strategies, encouraging use of more effective medications, reducing drug toxicity, and making patient education programs widely available over the internet, and thus providing effective self-management treatment adjuncts. This program introduces systematic use of cumulative outcome measures, broad use of therapeutic segment concepts, identification of optimal drug sequences protein micro-array searchers for causal agents in RA inception cohorts, and internet approaches to patient education, outcome assessment, and clinical decision making. The Program builds upon the large high quality multi- disciplinary data sets of ARAMIS (Arthritis, Rheumatism, and Aging Medical Information System) built over the past 25 years, together with established collaborations, methodological and technical resources, quality control methods and outcome assessment capabilities. ARAMIS 2006 will take this Program into its 30th year of productive service. We will study in aggregate approximately 10,000 patients with over 45,000 patient years of follow up. Two Cores and four inter-related Projects are proposed. Core A provides methodologic support, including a scanning interface for outcome assessment, and Core B provides RA inception cohorts of over 1,500 patients enrolled in their first year of disease for study. Project 1 identifies optimal RA treatment sequences using decision-analysis techniques and compares effectiveness, toxicity, and costs of alternative treatments for RA. Project 2 creates and evaluates patient education programs provided over the internet. Project quantitates the neglected effects of arthritis and its treatments on the incidence of heart disease stroke, colon cancer, and lymphoma. Project 4 studies long term outcomes of RA in minority populations and examines the reasons for disparity in outcomes. In sum, this Program Project has the potential for substantially improving treatment and long term outcomes in millions of patients with RA and OA.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Program Projects (P01)
Project #
5P01AR043584-07
Application #
6620811
Study Section
Special Emphasis Panel (ZAR1-TLB-A (O1))
Program Officer
Ader, Deborah N
Project Start
1996-07-01
Project End
2006-12-31
Budget Start
2003-01-01
Budget End
2003-12-31
Support Year
7
Fiscal Year
2003
Total Cost
$891,692
Indirect Cost
Name
Stanford University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305
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Wasko, Mary Chester M; Dasgupta, Abhijit; Hubert, Helen et al. (2013) Propensity-adjusted association of methotrexate with overall survival in rheumatoid arthritis. Arthritis Rheum 65:334-42
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Bruce, Bonnie; Fries, James F (2009) Rheumatologist perceptions of sources of health care disparities in minority rheumatoid arthritis patients. J Clin Rheumatol 15:145-7
Chakravarty, Eliza F; Hubert, Helen B; Lingala, Vijaya B et al. (2008) Reduced disability and mortality among aging runners: a 21-year longitudinal study. Arch Intern Med 168:1638-46
Hueber, Wolfgang; Tomooka, Beren H; Zhao, Xiaoyan et al. (2007) Proteomic analysis of secreted proteins in early rheumatoid arthritis: anti-citrulline autoreactivity is associated with up regulation of proinflammatory cytokines. Ann Rheum Dis 66:712-9
Bruce, Bonnie; Fries, James F; Murtagh, Kirsten Naumann (2007) Health status disparities in ethnic minority patients with rheumatoid arthritis: a cross-sectional study. J Rheumatol 34:1475-9
Bruce, Bonnie; Lorig, Kate; Laurent, Diana (2007) Participation in patient self-management programs. Arthritis Rheum 57:851-4
Hueber, Wolfgang; Kidd, Brian A; Tomooka, Beren H et al. (2005) Antigen microarray profiling of autoantibodies in rheumatoid arthritis. Arthritis Rheum 52:2645-55
Bruce, B; Fries, J F (2005) The Arthritis, Rheumatism and Aging Medical Information System (ARAMIS): still young at 30 years. Clin Exp Rheumatol 23:S163-7

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