National Institute of Arthritis and Musculoskeletal and Skin Diseases
|This article relies on references to primary sources. (April 2009)|
The National Institute of Arthritis and Musculoskeletal and Skin Diseases, or NIAMS, is part of National Institutes of Health. NIH is the nation's medical research agency — making important discoveries that improve health and save lives. It includes 27 Institutes and Centers and is a component of the United States Department of Health and Human Services. It is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. 
NIAMS Mission 
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. NIAMS supports and conducts basic, clinical, translational and epidemiologic research and research training at universities and medical centers throughout the nation.
NIAMS Legislative Chronology 
August 1950—An arthritis program was established within the National Institute of Arthritis and Metabolic Diseases under Public Law 81-692.
May 1972—P.L. 92-305 renamed the Institute the National Institute of Arthritis, Metabolism, and Digestive Diseases. 1973—Senator Alan Cranston introduced legislation that would eventually lead to the National Arthritis Act. Companion legislation was introduced in the House by Congressman Paul Rogers.
January 1975—The National Arthritis Act (P.L. 93-640) established the National Commission on Arthritis and Related Musculoskeletal Diseases to study the problem of arthritis in depth and to develop an arthritis plan. The act also established the position of associate director for arthritis and related musculoskeletal diseases and authorized an interagency arthritis coordinating committee; community demonstration project grants; an arthritis data bank; an information clearinghouse; and comprehensive centers for research, diagnosis, treatment, rehabilitation, and education.
April 1976—After a year of study and public hearings, the commission issued a comprehensive plan aimed at diminishing the physical, economic, and psychosocial effects of arthritis and musculoskeletal diseases. It laid the groundwork for a national program encompassing research, research training, education, and patient care.
October 1976—The Arthritis, Diabetes, and Digestive Diseases Amendments of 1976 (P.L. 94-562) established the National Arthritis Advisory Board to review and evaluate the implementation of the Arthritis Plan, prepared in response to the National Arthritis Act (P.L. 93-640).
December 1980—P.L. 96-538 changed the name of the Institute to the National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases. 1982—The U.S. Department of Health and Human Services (HHS) conferred bureau status on the Institute, resulting in creation of the Division of Arthritis, Musculoskeletal, and Skin Diseases and the appointment of a division director.
November 1985—The Health Research Extension Act of 1985, P.L. 99-158, established the National Institute of Arthritis and Musculoskeletal and Skin Diseases to bring increased emphasis to research on these disorders. The legislation provided for the development of a plan for a national arthritis and musculoskeletal diseases program, and establishment of two interagency coordinating committees, one on arthritis and musculoskeletal diseases and one on skin diseases. It also expanded the activities of the National Arthritis Advisory Board to include musculoskeletal and skin diseases.
September 1993—The NIH Revitalization Act of 1993 (P.L. 103-43) called on the NIAMS to establish "an information clearinghouse on osteoporosis and related bone disorders to facilitate and enhance knowledge and understanding on the part of health professionals, patients, and the public through the effective dissemination of information."
October 2000—The Children's Health Act of 2000 (P.L. 106-310) called on the NIAMS to expand and intensify research programs on juvenile arthritis and related conditions, in coordination with other NIH Institutes and the Arthritis and Musculoskeletal Diseases Interagency Coordinating Committee. Further language stipulated that the Institute's current information clearinghouse include resources on juvenile arthritis and associated conditions.
November 2000—The Lupus Research and Care Amendments of 2000, which passed as part of the Public Health Improvement Act (P.L. 106-505), required the NIAMS to expand and intensify research and related activities regarding lupus, and to coordinate such efforts with other NIH Institutes, as appropriate. Among other provisions, the bill called for information and education programs for health professionals and the public.
December 2001—The Muscular Dystrophy Community Assistance, Research, and Education Amendments of 2001, or the MD-CARE Act (P.L. 107-84), called on several components of the NIH, including the NIAMS, to enhance research on muscular dystrophy, including establishing Centers of Excellence.
February 2003—The Office of the Secretary, HHS, was called on to establish a Federal working group on lupus for the purpose of exchanging information and coordinating Federal efforts regarding lupus research and education initiatives (P.L. 108-7, Omnibus Appropriations Act for FY 2003). The NIAMS, as the lead Institute at the NIH for lupus research, was asked to lead this Federal working group. The group has representatives from all relevant HHS agencies and other Federal departments having an interest in lupus.
October 2008—The Paul D. Wellstone Muscular Dystrophy Community Assistance, Research, and Education (MD-CARE) Amendments of 2008 (P.L. 110-361) officially named the muscular dystrophy Centers of Excellence as the Paul D. Wellstone Muscular Dystrophy Cooperative Research Centers. In addition, the Muscular Dystrophy Coordinating Committee was authorized to give special consideration to enhance the clinical research infrastructure to test emerging therapies for the various forms of muscular dystrophy.
NIAMS Directors 
|Name||In Office from||To|
|Stephen I. Katz, M.D., Ph.D.||August 1995||Present|
|Michael D. Lockshin, M.D. (Acting)||November 1994||July 1995|
|Lawrence E. Shulman, M.D., Ph.D.||April 1986||October 1994|
NIAMS Overview 
NIAMS supports a multidisciplinary program of basic, translational, and clinical investigations; epidemiologic research; research centers; and research training for scientists within its own facilities, as well as grantees at universities and medical schools nationwide. It also supports the dissemination of research results and information through the NIAMS Information Clearinghouse and through the NIH Osteoporosis and Related Bone Diseases National Resource Center.
NIAMS supports research and research training through both extramural and intramural activities. More than 80 percent of the funds appropriated to the NIAMS is awarded to the extramural biomedical research community through grants and contracts. The extramural research community is composed of scientists, clinicians, and other research personnel affiliated with universities, medical schools, hospitals, and other research facilities located throughout the United States and abroad. Approximately 10 percent of the NIAMS’ funding supports research and training activities carried out by NIAMS scientists in NIAMS laboratories on its campus in Bethesda, Maryland (including the NIH Clinical Center). Principal investigators lead intramural research projects that involve trainees ranging from high school students to postdoctoral and clinical fellows.
NIAMS Extramural Research Program (EP) supports research via grants and contracts in two Divisions: the Division of Skin and Rheumatic Diseases and the Division of Musculoskeletal Diseases. A wide array of basic, translational, and clinical research and research training in the fields of rheumatology, muscle biology, orthopaedics, bone and mineral metabolism, and dermatology is being pursued through these programs.
The Intramural Research Program (IRP) of NIAMS conducts innovative basic, translational, and clinical research relevant to the health concerns of the Institute and provides training for investigators interested in careers in these areas. The ultimate goals are: 1) to provide new insights into the normal function of bones, joints, muscles, and skin, and diseases that affect them; and 2) to generate a cadre of well-trained investigators to continue research towards a complete understanding of these structures and the disease conditions that affect them adversely.
Extramural Research Program (EP) 
Known as "extramural" research, most funding for NIAMS supports investigators involved in a wide spectrum of basic, clinical, epidemiologic, training, and other programs in universities, medical schools, academic health centers, and small business concerns. The NIAMS Extramural Program's three Divisions—the Division of Extramural Research Activities, the Division of Skin and Rheumatic Diseases, and the Division of Musculoskeletal Diseases—are as follows:
Division of Extramural Research Activities This Division manages the NIAMS grants policies and procedures, including oversight of grants and contract administration, scientific review, and clinical research functions. It serves as the primary liaison for NIAMS with the NIH Office of Extramural Research and with other Institutes that share research interests. The Division handles scientific integrity and ethical questions in research and manages the NIAMS Council, a congressionally mandated second tier of the NIH peer review system.
- The Scientific Review Branch conducts initial peer review of specific research applications assigned to the NIAMS. These include applications for Centers, program projects, multi-site clinical trials, scientific meetings, and training and career development, as well as applications responding to initiatives published by the NIAMS. External peer reviewers selected from the grant community conduct reviews.
- The Grants Management Branch works with scientists and institutional research administrators to issue, manage, and close out awards. The branch has legal responsibility for the fiscal management of the Institute’s extramural grants and contracts.
Division of Skin and Rheumatic Diseases The mission of this Division is to promote and support basic, translational, and clinical studies of the skin in normal and disease states and research leading to the prevention, diagnosis, treatment, and cure of rheumatic and related diseases. Research is managed under two main areas:
- Arthritis and Rheumatic Diseases. The overall goals of the programs in this area are to advance high-quality basic, translational, and clinical biomedical and biopsychosocial research to treat, cure, and prevent arthritis and rheumatic diseases. This includes work that advances the understanding of the natural history of these disorders, as well as mechanisms of disease susceptibility and development. The programs support research in rheumatoid arthritis; adjuvant and chemically induced inflammatory arthritis; systemic lupus erythematosus; systemic scleroderma; spondyloarthropathies; dermatomyositis and myositis; vasculitis; fibromyalgia; juvenile arthritis and general autoimmunity; gout; Lyme disease; and infection-related arthritis. An important dimension of these programs involves taking advantage of new insights in the fields of genetics, genomics, proteomics, and imaging related to arthritis and rheumatic diseases. The NIAMS is committed to pursuing new opportunities that identify risk factors for these disorders, enhance disease prediction, and advance prevention strategies.
- Skin Biology and Diseases. The programs in this area support a broad portfolio of basic, translational, and clinical research in skin. These efforts include work on the developmental and molecular biology of skin, the study of skin as an immune organ, and the genetics of skin diseases. Areas of particular emphasis include: investigations of stem cells derived from skin; studies related to wound healing and fibrosis; heritable disorders of connective tissue (such as Marfan’s syndrome); studies related to itch; metabolic studies of skin, such as the effects of hormones and the role of enzymes in skin barrier formation; and immunologically mediated cutaneous disorders, such as atopic dermatitis, contact dermatitis, and vasculitis. Research is underway to better understand keratinizing disorders such as psoriasis and ichthyosis; disorders of pigmentation such as vitiligo; and bullous diseases such as pemphigus, pemphigoid, and epidermolysis bullosa. Other studies encompass acne and the physiologic activity of the sebaceous glands, as well as disorders of the hair, such as alopecia areata. Tremendous opportunities exist in the field of skin diseases research, from work directed toward a deeper understanding of the basic biology of skin, to new approaches for developing artificial skin, to advances in imaging technologies for diagnosis and tracking of skin disease progression. The NIAMS is committed to pursuing these and other avenues of research to improve health outcomes for patients with skin diseases.
Division of Musculoskeletal Diseases The Division of Musculoskeletal Diseases supports research aimed at improving the diagnosis, treatment, and prevention of diseases and injuries of the musculoskeletal system and its component tissues: the skeleton, muscles, and connective tissues such as tendons and ligaments. Key public health problems addressed by this research include osteoporosis, osteoarthritis, and muscular dystrophy. Research is conducted at every level, from fundamental biology to clinical intervention. Research is managed under three main areas:
- Bone Biology and Diseases. The programs in these areas cover a broad spectrum of research to better understand genetic and cellular mechanisms involved in the buildup and breakdown of bone. Research areas include: regulation of bone remodeling; mechanisms of bone formation, bone resorption, and mineralization; and effects of hormones, growth factors, and cytokines on bone cells. The programs emphasize the application of fundamental knowledge of bone cell biology to the development of drug and gene therapies for bone diseases, especially osteoporosis. This program area supports several large epidemiologic cohorts for the characterization of the natural history of osteoporosis and for the identification of genetic and environmental risk factors that contribute to bone disease. Like other cohort studies supported by the NIAMS, the ultimate goals are to contribute to the development of better diagnostic tools, treatments, and prevention strategies.
- Muscle Biology and Diseases. The programs in these areas support a wide range of basic, translational, and clinical research projects in skeletal muscle biology and diseases. They focus on the fundamental biology of muscle development, physiology, and muscle imaging. Particular interests include the basic biology of satellite and muscle stem cells, excitation-contraction coupling, muscle metabolism, and adaptation of muscle to exercise. The programs address a need for translational research to develop discoveries that enhance treatment and improve management of muscle and musculoskeletal diseases and disorders. The overarching objective is to advance the understanding of—and ultimately prevent and treat—muscular dystrophies, inflammatory myopathies, muscle ion channel diseases, and muscle disorders such as disuse atrophy and age-related loss of muscle mass.
- Musculoskeletal Biology and Diseases. The programs in these areas focus on understanding the fundamental biology of tissues that constitute the musculoskeletal system, and on translating and applying this knowledge to a variety of diseases and conditions. Research includes the study of the causes and treatment of acute and chronic injuries—including carpal tunnel syndrome, repetitive stress injury, and low back pain—and clinical and epidemiological studies of osteoarthritis. The programs support the development of new technologies such as methods for imaging bone and cartilage to improve the diagnosis and treatment of skeletal disorders, or to facilitate the repair of damage caused by trauma to otherwise healthy musculoskeletal tissue. Therapeutic approaches of interest in the programs include drugs, nutritional interventions, joint replacement (including biomaterials and implant science), bone and cartilage transplantation, and gene therapy. Tissue engineering, regenerative medicine, sports medicine, and musculoskeletal fitness are areas of special emphasis.
Intramural Research Program (IRP) 
The mission of the NIAMS Intramural Research Program (IRP) is to conduct innovative basic, translational, and clinical research relevant to the health concerns of the Institute, and to provide training for investigators who are interested in related research careers. Scientists perform clinical studies on the genetics, etiology, pathogenesis, and treatment of a variety of rheumatic, autoimmune, inflammatory, joint, skin, and muscle diseases. The program has recently expanded its research and training capacity by establishing a Laboratory of Regenerative Medicine and a Laboratory of Oral Connective Tissue Biology. The addition of these two accomplished research teams will spur collaborations with fields that complement the expertise of the NIAMS researchers. Meanwhile, ongoing partnerships within and outside of NIH continue. In collaboration with researchers around the world, the NIAMS scientists are exploring large genetic databases that provide insights into the immune-system defects that underlie rare inflammatory diseases such as ankylosing spondylitis (a progressive arthritis affecting the spine). Others are working closely with the private sector to move their fundamental discoveries into clinical trials. For example, an intramural investigator’s discovery of an immune system protein led to the identification of therapeutic targets for several rheumatic conditions. As a result of this advance and subsequent work facilitated by two Cooperative Research and Development Agreements (CRADAs) between NIH and industry, the U.S. Food and Drug Administration approved a new oral medication for the treatment of rheumatoid arthritis that represents a new class of drugs for the disease.
The Office of the Scientific Director is responsible for the development of broad decisions concerning program planning, budget and policy formulation, and resource allocation of the intramural program. The Scientific Director represents the NIAMS in discussions of NIH-wide intramural policies and programs, and serves as a vital member of the senior staff of the Institute. The Scientific Director serves as the principal advisor to the Director of the NIAMS concerning all ongoing and projected intramural research programs.
The Office of the Clinical Director implements innovative clinical research programs that relate to the broad field of rheumatologic, musculoskeletal, and skin disorders. Through specific programs in translational research, rheumatology fellowship training, and health partnerships, the Office of the Clinical Director plays an important role in establishing cutting-edge therapeutic paradigms, in providing medical education in the field of rheumatology, and in reaching out to the community to reduce health care disparities and to improve the understanding of rheumatic and related diseases.
The Autoimmunity Branch conducts basic and clinical research on the pathophysiology and treatment of autoimmune diseases. Signal transduction pathways that differentiate normal and pathological immune responses are studied in mouse models and human tissue samples to gain insights into how these processes drive autoimmune diseases, and how therapies that minimize generalized immune suppression can best be developed for these diseases. The TNF-family of cytokines and their receptors are a current focus of interest in the branch, from basic investigation of the trafficking and signaling by these molecules to the study of human diseases involving TNF-family cytokines and their receptors.
The Cartilage Biology and Orthopaedics Branch conducts basic and clinical research on the pathogenesis and treatment of musculoskeletal diseases relevant to the field of orthopaedic surgery. Current investigations are focused on the genetic, cellular, and molecular events involved in the development of heterotopic ossification (HO). Specific attention is paid to progenitor cells obtained from human tissue samples and their trophic and differentiation properties involved in tissue repair and regeneration.
The Clinical Trials and Outcomes Branch conducts research on the health outcomes of patients with rheumatic diseases and orthopaedic conditions. Studies focus on the development and testing of measures of health and disease, identification of predictors of good and poor health outcomes, examination of treatment effectiveness, and investigations of socioeconomic and ethnic disparities in health outcomes.
The Community Research and Care Branch coordinates the NIAMS Community Health Center, a health information resource and medical center that carries out research and provides health care services to people affected by arthritis, lupus, and other rheumatic diseases. The Center offers patient care with access to specialists, education programs, and referral to clinical investigations for the prevention and treatment of rheumatic diseases. It is located in Silver Spring, MD.
The Laboratory of Molecular Immunogenetics (LMI) conducts research on genetic and molecular regulation of normal and abnormal immune cell processes. The LMI, which includes the Molecular Immunology Section and the Genomics and Immunity Section, seeks to understand the molecular underpinnings of how inflammation is regulated in both health and disease. This knowledge can be applied to the development of targeted therapeutic agents that can ameliorate immune system disorders with minimal side effects.
The Laboratory of Muscle Stem Cells and Gene Regulation investigates the cellular and molecular mechanisms that regulate differentiation and regeneration of skeletal muscle in physiological and pathological conditions. The ultimate goal of these studies is to provide a conceptual, as well as practical, framework for the diagnosis and treatment of human diseases affecting skeletal muscle.
The Laboratory of Oral Connective Tissue Biology studies the molecular biology of dental-oral-craniofacial development, with a focus on the teeth, gums, and related jaw structure. The aim of these studies is to understand cells and signals influencing tooth, bone, and periodontal ligament development in order to identify improved regenerative strategies.
The Laboratory of Skin Biology conducts research on the regulation of epidermal differentiation, skin barrier formation, and inflammatory responses associated with barrier dysfunction. A major focus is basic investigation of ectodermal appendage development and the study of human ectodermal dysplasias.
The Laboratory of Stem Cell Biology studies cell fate and tissue development. It is using various types of stem cells to generate neurological disease models, to discover and test drugs, and to develop replacement therapies for neurodegenerative diseases and disorders.
The Laboratory of Structural Biology Research conducts research into the structural basis of the assembly and functioning of macromolecules and their complexes (such as viruses and cytoskeletal proteins), and the mechanisms and proteins that control their assembly. These studies make extensive use of cryoelectron microscopy and three-dimensional image processing in studies of virus infection and replication; renewal of the epidermis, with maintenance of barrier function; prionogenesis (structural transitions of infectious proteins called prions); and intracellular protein quality control by energy-dependent proteases.
The Molecular Immunology and Inflammation Branch conducts basic and clinical investigations of the molecular mechanisms underlying immune and inflammatory responses in rheumatic and autoimmune diseases. A major focus is the study of receptor-mediated signal transduction and how these processes link to the regulation of genes involved in inflammatory responses.
The Office of Science and Technology encompasses an infrastructure of research and support facilities designed to enhance the research capabilities of all IRP scientists. In addition, staff members advise the Scientific Director, Laboratory and Branch Chiefs, and other key officials on collaborative and cooperative activities, training programs, and proper use of laboratory animals. Staff members also negotiate and facilitate scientific collaborations that involve trans-institute and trans-NIH initiatives and agreements. The Office includes the following:
- The Flow Cytometry Section provides state-of-the-art multiparameter analytic and sorting capabilities for IRP investigators.
- The Laboratory Animal Care and Use Section supports all IRP branches and laboratories studying animals.
- The Light Imaging Section offers IRP scientists access to state-of-the-art light imaging equipment and expertise in light imaging techniques.
- The Biodata Mining and Discovery Section assists with computational and bioinformatics approaches to NIAMS intramural research.
- The Translational Immunology Section provides NIAMS investigators with services, consultative advice, and in-depth instructions in a variety of immunologic methods to interpret immunoassays.
The Pediatric Translational Research Branch, which includes the Translational Autoinflammatory Disease Section, conducts basic, translational, and clinical research to dissect the pathways involved in the pathogenesis of immune-mediated inflammatory diseases. The mechanisms by which specific gene mutations and polymorphisms predispose to inflammation, and how they contribute to unique phenotypic manifestations of individual diseases, are being investigated using a variety of approaches.
The Protein Expression Laboratory plans and conducts research on the expression, purification, and structural characterization of human immunodeficiency virus (HIV) and HIV-related proteins. Laboratory scientists also collaborate with NIH intramural researchers studying the structure and function of HIV and HIV-related proteins. The lab serves as a support and resource group for the expression and purification of these proteins.
The Rheumatology Fellowship and Training Branch is dedicated to the clinical and research training of physicians wishing to pursue careers in biomedical or translational research related to rheumatic diseases. The fellowship program is two years in duration, with extensions available for individuals interested in advanced research training. The program is accredited by the Accreditation Council for Graduate Medical Education (ACGME), and graduates are eligible to sit for the certifying examination in the subspecialty of rheumatology.
The Career Development and Outreach Branch advises the Scientific Director, Lab and Branch Chiefs, and other key officials within the NIAMS IRP on current and potential training programs; coordinates resources available for NIAMS fellows and their sponsors; and works in partnership with existing NIAMS and NIH components to ensure that the NIAMS continues to attract the highest caliber of trainees at the postdoctoral, postbaccalaureate, and graduate student levels. The Branch enables NIAMS fellows to become leaders in the biomedical research community and provides trainees with a genuine growth experience, enhancing their ability to compete for independent research or other science-related careers in government or the private sector. In addition, the Branch leads Institute career outreach activities, administers the summer internship program, and supports the annual Intramural Retreat.