The Clinical Epidemiology Research and Training Unit has approximately $7.5 million in federal grants and contracts supporting research. Most funding is from the National Institutes of Health (NIH), including a Multidisciplinary Clinical Research Center (MCRC). This funding allows the unit to be constituted as a multidisciplinary team, including doctoral non-physician level investigators who bring methodological expertise to clinical research questions.
The spectrum of research conducted in Clinical Epidemiology is broad and includes:
- An internet-based case crossover study of gout
- Large multi-center cohort studies of osteoarthritis
- Studies optimizing adherence to exercise
- Pharmacoepidemiology studies using the THIN database from the UK (the unit is the local home for this database, which can be used by others in the BU community) and from the VA
- Genome-wide association studies
- Studies of function loss and disability in elders
- Studies of outcome measurement in rheumatoid arthritis
- Evaluations of methodologic approaches in progression/outcome studies
- Studies of spondyloarthritis risk factors, comorbidities and comparative effectiveness of treatments
- Studies of pain mechanisms in osteoarthritis, rheumatoid arthritis, and other conditions
- Classification criteria for rheumatic diseases
- Studies involving synovial fluid assays, including proteomics
- Imaging studies of the knee, including MRI and CT
At the Boston University College of Health & Rehabilitation Sciences at Sargent College, The Center for Enhancing Activity and Participation among Persons with Arthritis (ENACT) works to enhance the lives of people with arthritis and other rheumatic conditions such as lupus, fibromyalgia, and scleroderma through research, training, and community-based activities. ENACT strives to change the paradigm for arthritis research and intervention from a focus on disease and limitation to a focus that emphasizes active living and participation. Supporting research efforts to develop and assess how well arthritis-focused interventions work to reduce disability, promote activity and participation in life roles, and identify strategies to promote work retention is central to ENACT’s mission.
The contents of this project were developed with funding from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant 90RT5009-01-01). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS).
Ongoing Funded Studies
The Multicenter Osteoarthritis Study (MOST)
This is a longitudinal observational study of the effects of biomechanical, bone and joint structural, and nutritional factors on the incidence and progression of knee symptoms and radiographic and symptomatic knee osteoarthritis (OA). It was the first large-scale epidemiologic study to focus on symptomatic knee OA in a community-based sample of adults with or at high risk for knee OA, based on the presence of knee symptoms, history of knee injury or surgery or being overweight. The wealth of data from this longitudinal cohort of community-dwelling older adults affords valuable opportunities for rehabilitation researchers.
The MOST study is funded by the National Institutes of Health – National Institute on Aging grants AG18820 (David Felson, Boston University), AG18832 (James Torner, University of Iowa), AG18947 (Cora Lewis, University of Alabama at Birmingham), and AG19069 (Michael Nevitt, University of California, San Francisco). Funding period: 2001-2020.
The Osteoarthritis Initiative: A Knee Health Study
The Osteoarthritis Initiative (OAI) is a nationwide multicenter, longitudinal, prospective observational study of knee osteoarthritis (OA). This Initiative is a public-private partnership between the National Institutes of Health (NIH) and private industry that seeks to improve diagnosis and monitoring of osteoarthritis (OA) and foster development of new treatments. The overall aim of the OAI is to develop a public-domain research resource to facilitate the scientific evaluation of biomarkers for osteoarthritis as potential surrogate endpoints for disease onset and progression.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Institute on Aging (NIA) lead this initiative at the National Institutes of Health (NIH). Other public partners in the Osteoarthritis Initiative at the NIH include the Office of Research on Women’s Health, National Institute of Dental and Craniofacial Research, National Center on Minority Health and Health Disparities, National Institute of Biomedical Imaging and Bioengineering, and the National Center for Complementary and Alternative Medicine. The National Center for Research Resources, the Office of Technology Transfer, the Office of the General Counsel, and the Office of Science Policy have also played pivotal roles in the establishment of this initiative. Another Department of Health and Human Services component involved is the Center for Drug Evaluation and Research of the Food and Drug Administration.
Establishing the Value of Treatment Strategies in Spondyloarthritis: The ValSpA Study
This work assesses patient preferences related to spondyloarthritis medications through patient focus groups and discrete choice experiments. A subsequent cost-effectiveness model will incorporate patient values with literature-derived estimates for medication effects, side effect rates, and costs. The hypothesis is that more expensive biological agents are not cost-effective as first line therapy for spondyloarthritis.
PI: Maureen Dubreuil
Funded by NIH/NIAMS K23 AR069127. Funding period: 2016-2021
Planning a Trial of Novel Footwear for Knee Osteoarthritis
The overall goal of the planning phase of this single center trial is to complete all of the scientific planning and administrative activities required to support a proposal for a trial of a novel footwear for the treatment of painful medial knee osteoarthritis. Specific aims for this planning grant are: 1. to test recruitment strategies so as to develop a recruitment plan 2. to develop trial protocols; 3. to create a manual of operations.
PI: David Felson
Funded by NIH R34 AR068605. Funding period: 2016-2017
Fats, Fiber and Osteoarthritis
Osteoarthritis (OA) is the most common form of arthritis affecting millions of Americans; there is a paucity of effective treatments. Inflammation is a critical factor affecting pain in OA and also causing structural deterioration in the joint. Dietary factors can modify inflammation and it is the goal of this project to test evidence regarding specific dietary factors that can affect inflammation and for which there is evidence linking that dietary factor to OA. Among factors to be studied include specific fatty acids whose effects on inflammation differ.
PI: David Felson
Funded by NIAMS AR071950. Funding period: 2017-2021
Central Sensitization in Post-Knee Replacement Pain and Relation to OA Pathology
While knee replacement surgery is considered to be the definitive management option for end-stage knee osteoarthritis (OA), many people still have pain after surgery. Whether alterations in the nervous system contribute to this pain persistence is not known. Further, whether OA itself contributes to development of these alterations leading to more pain is not known. This research will help address these questions and identify whether additional treatment targets may need to be pursued for knee OA pain.
PI: Tuhina Neogi
Funded by NIAMS R01 AR062506. Funding period: 2012-2018
Central Pain Mechanisms in Rheumatoid Arthritis
Many people with rheumatoid arthritis (RA) have chronic pain, but not much is understood about where this pain comes from. Little is also known about how this pain influences a patient’s response to treatments for RA, such as biologics or DMARDs. This research study aims to find out more about the relationship between what causes pain, the experience of pain, and medications to treat rheumatoid arthritis. We hope that the information gathered from this study will help improve future treatment of pain in people with RA.
Site PI: Tuhina Neogi
Funded by NIAMS R01 AR064850. Funding period: 2013-2018
The Role of Urate in Knee Osteoarthritis-Related Inflammation, Pathology and Pain
Treatments for osteoarthritis (OA) of the knee remain limited. There are some compelling data to suggest that urate, a causative factor in gout, may also play a role in OA. This research study aims to find out if urate may be linked to inflammation in OA, structural damage in OA, and the fluctuating nature of pain in OA. If tehre is a link, then it would mean that urate-lowering treatments may be a therapeutic option to study for management of knee OA.
PI: Tuhina Neogi
Funded by NIAMSK24 AR070892. Funding period: 2017-2022
Bisphosphonate Effects in Knee Osteoarthritis
Bone changes are common in knee osteoarthritis (OA). Treatments targeting bone may therefore hold promise for OA. This research study aims to find out whether bisphosphonates, a class of drug that help build up bone, may be beneficial in knee OA. Results from this study would provide insights into whether bisphosphonates should be pursued for testing in knee OA.
PI: Tuhina Neogi
Funded by Arthritis Foundation Innovative Research Grant. Funding Period: 2014-2017
Comparative Effectiveness in Gout: Allopurinol vs. Febuxostat
Gout is a common inflammatory arthritis for which the mainstay of treatment is urate-lowering therapy. Allopurinol and febuxostat are the two most commonly prescribed medications for gout, but whether they are equally effective at properly used doses is not known. This randomized clinical controlled trial aims to find out if both drugs have similar effects on lowering serum urate and flare rates. These results will help clinicians choose the most appropriate therapy for their patients with gout.
Executive Steering Committee member: Tuhina Neogi
Funded by VA CSP594. Funding period 2015-2020
Completed Funded Studies
The Framingham Osteoarthritis Study
This population-based study of independently living elderly examined the prevalence of radiographic and symptomatic knee osteoarthritis. The group was assessed in the early 1980s, at which time they had been observed for over 35 years and many risk factors for osteoarthritis had been ascertained. Results from this study suggest that knee osteoarthritis increases in prevalence throughout the elderly years, more so in women than in men. Also, studies of risk factors have shown that obesity precedes and increases the risk of knee osteoarthritis, especially in women.
PI: David Felson
The Framingham Osteoarthritis Study was funded by the National Institutes of Health – National Institute on Aging AG018393
The Osteoarthritis Before and After Bariatric Surgery Study (OABS)
Individuals with chronic knee pain often develop central and/or peripheral sensitization (altered pain processing of the nervous system). Whether improvements in knee pain are accompanied by resolution of pain sensitization is not clear. For example, obesity is related to knee pain, and musculoskeletal pain improves after massive weight loss. As obesity is also associated with systemic low-grade inflammation, which itself may contribute to pain sensitization, weight loss may theoretically lead to a reduction in pain sensitization. However, whether this actually occurs is not known. We sought to determine if knee pain and sensitization improve after massive weight loss in individuals undergoing bariatric surgery.
PI: David Felson
The OABS Study was funded by NIH AR43873 and AR20613, and NIH/NHLBI N01-HC-38038
The Beijing Osteoarthritis Study
Through his colleague Dr. Nevitt and other colleagues at UCSF, linkage with a Chinese investigator, Ling Xu, based at the Peking Union Medical College in Beijing, was established. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) funded a study to compare knee, hip, and hand OA among Chinese to Caucasians in the Framingham study and the UCSF Study of Osteoporotic Fractures
This study was funded by NIH AR43873
Predictors and Consequences of Subchondral Bone Attrition in Osteoarthritis
In this study, we evaluated mechanical and systemic risk factors for bone pathology in osteoarthritis (OA), including an evaluation of vitamin K’s role in OA.
PI: Tuhina Neogi
Funded by NIAMS K23 AR055127
Vitamin K Supplementation in Osteoarthritis
This was the first randomized clinical controlled trial to test whether vitamin K has a beneficial effect on hand osteoarthritis.
PI: David Felson, Co-I: Tuhina Neogi
Funded by Arthritis Foundation Innovative Research Grant
Evaluating Synovitis as a Link Between Knee Osteoarthritis (OA) and Muscle-Related Morbidities
Knee osteoarthritis (OA) is a common joint disease. It causes knee pain and can cause difficulty in carrying out daily activities, such as walking. The research is being done to understand if changes in the knee joint fluid can cause any muscle weakness which can perhaps lead to slower walking speed and/or decreased hand grip strength.
PI: Devyani Misra