The epidemiology of medication use in rheumatic diseases is a large focus of the Section of Clinical Sciences. The Section has many active research projects focused on the safety of medications for rheumatoid arthritis, osteoporosis and pain management. These include grants focused on the safety of DMARDs, bisphosphonates, NSAIDs, and opioids. Specific safety areas of interest are cardiovascular, cancer, and infection.
The Center for Clinical Therapeutics (CCT) provides support services for conducting clinical trials involving therapeutics within the Division. The CCT Co-Directors and Administrative Director meet bi-monthly to review status of pending protocols and ongoing conduct of active trials.
We have several open SLE and RA trials with newly approved agents or agents in development. We were the only site in New England to participate in the rituximab lupus nephritis study. The RA study we are currently conducting is the first head to head comparison of two biologics-subcutaneous abatacept vs. adalimumab. Performing these studies within our division has been consistent with our overall mission to provide cutting edge rheumatologic care to current and newly referred patients.
The Section of Clinical Sciences has been engaged in numerous behavioral science trials over the last several decades. Many of these intervention trials have focused on patient education and counseling strategies to improve self management of conditions like back pain, lyme disease, and osteoporosis. In addition, several interventions have attempted to improve the care of prescribing medications and exercise for rheumatic diseases by focusing on providers and the health care system. The Section is actively engaged in projects regarding osteoporosis and rheumatoid arthritis.
Many of the clinical investigators in the Section are interested in studying health disparities in the rheumatic diseases, in particular the dramatic disparities in incidence of SLE and outcomes among patients with this disease. They are also studying inequalities in access to health care and medications for RA and SLE patients, according to their age, race and sex. Several research grants within the Section are targeted to addressing the causes of such disparities.
Our section conducts clinical research on the quality of care for rheumatic diseases. The main focus has been to identify gaps and develop clinical trials to improve the care of patients with osteoporosis through a variety of approaches. We are also investigating how health information technology, such as the use of computer tablets to capture patient data in the waiting room linked with clinical decision support, can help enhance the quality of care for patients with rheumatoid arthritis. We have used administrative and clinical data to identify immunosuppressed rheumatic disease patients in our practice and measure adherence to Centers for Disease Control (CDC) guidelines on pneumococcal vaccination. Based on this pneumococcal vaccination data, we have implemented quality improvement efforts in our practice using a systems approach to target patients at their routine rheumatology visits for vaccination and increase our adherence with CDC guidelines.
The Orthopaedic and Arthritis Center for Outcomes Research is a multidisciplinary research group dedicated to improving the quality of life of individuals with musculoskeletal conditions by performing rigorous, policy relevant clinical research and by educating younger scientists to excel in this field. Center investigators perform research involving prevalent, disabling conditions including osteoarthritis, spine and upper extremity disorders, osteoporosis, trauma, pain and others. The methodologic approaches include clinical trials, cohort and case control studies, computer simulation policy modeling, cost effectiveness analysis and qualitative research. The research and training programs are funded primarily by grants from the National Institutes of Health and foundations.