This MAC proposal engages scholars and scientists from various schools and departments of Northwestern University and from the community in a comprehensive arthritis program. Five feasibility projects are proposed: cell cytotoxicity in rheumatoid arthritis; phenytoin modulation of collagen and collagenese synthesis in synovial cells and effect on macrophages; connective tissue constituent immunogenicity in juvenile chronic arthritis; synovial pathology in early osteoarthritis; and analysis of osteoarthritic and rheumatoid bone for use in prothesis design. These projects will support new young scientists as well as allow three senior scientists to extend or redirect their work. The second area of focus is an interdisciplinary educational program, utilizing a problem solving approach, aimed at both professionals and patients. The three projects proposed are; train and evaluate rheumatology fellows as teachers of medical residents using a new curriculum to be developed in outpatient musculoskelatal disease; evaluation of a problem -oriented, aerobic-like exercise program for arthritics and; the use of a discussion group format to enhance problem solving skills in the older osteoarthritic. The interdisciplinary team includes professional educators, a medical education evaluator and health professionals at the medical school. The third area of focus, community and health services research, draws upon a strong base of community involvement combined with the research excellence of Northwestern's Center for Health Service and Policy Research (CHSPR). Three interrelated projects explore various aspects of knee pathology. The first will develop and validate a measure of outcome for a subsequent comparative study. The second will examine the costs of treatments for osteoarthritis of the knee. The third builds upon the work of the earlier two to compare costs and efficacy of arthroscopic surgery and alternatives. Three additional projects add breadth to the research agenda focusing upon musculoskelatal impairment in the elderly, status of families with juvenile arthritic children and a multi-center study of Social Security payment allocation systems. The Biostatistics and Data Management Core will provide individual project technical assistance as well as data base management for a computerized case finding patient index.
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