This proposal describes in detail a plan to strengthen and expand the programs and research activities of the Boston University Multipurpose Arthritis and Musculoskeletal Diseases Center (MAMDC). Research activities proposed in both the Research Component and the E/E/HSR Component will build on a strong existing base of funded research. Two Core Units are proposed that will leverage unique strengths in amyloid studies and in arthritis epidemiology and health services research. An effective Administrative Unit will be continued. The Research Component includes proposals for four Developmental and Feasibility Studies: 1) The Role of Novel Transcriptional Factors in the Pathogenesis of Rheumatoid Arthritis; 2) The Descriptive Epidemiology of Primary Amyloidosis; 3) Attributing Health Problems to Arthritis Causes; and 4) Evaluation of a Job Raising Program Approach to Vocational Rehabilitation for Persons with Arthritis. Two of these studies bring established investigators into arthritis research, and two support new investigators. In the E/E/HSR Component, education efforts will continue for a broad spectrum of physician education and training activities. Community activities will continue to focus on inner city residents and the elderly in collaboration with major local agencies, and on leadership activities in national professional organizations. Four specific research projects are proposed: 1) Heredity in Generalized Osteoarthritis: A Study of the Framingham Offspring Group; 2) The Relationships of Knee OA, Musculoskeletal Impairment and Pain to Functional Limitations in the Elderly; 3) Econometric Models of the Demand for Out-Patient Rheumatologist Care, and 4) The Comparative Efficacy and Toxicity of Second Line Drugs in Rheumatoid Arthritis. These projects are designed to support ongoing research themes in health status assessment and metaanalysis, and to open new research efforts in genetic epidemiology and health care economics. Two highly successful Core Units are proposed for ongoing funding: an Amyloid Studies Core Unit and a Research and Evaluation Support Core Unit. The Core Units will provide critical support for numerous studies in areas of special interest to investigators at this Center. The Administrative Unit will consist of a Center Director and Component/Core Unit Directors and Associate Directors who have proven track records in managing the complex activities of a Multipurpose Center.
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