April 2013 (historical)

Organization Chart

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Appropriation Language

NATIONAL INSTITUTES OF HEALTH

National Institute of Arthritis and Musculoskeletal and Skin Diseases

For carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases, $540,993,000.

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Amounts Available for Obligation

¹Excludes the following amounts for reimbursable activities carried out by this account:
FY 2012 - $9,826     FY 2013 - $11,000     FY 2014 - $7,500

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Budget Mechanism Total

1/ All items in italics and brackets are "non-adds."

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Major Changes in the Fiscal Year 2014 President's Budget Request

Major changes by budget mechanism and/or budget activity detail are briefly described below. Note that there may be overlap between budget mechanism and activity detail and these highlights will not sum to the total change for the FY 2014 President’s Budget for NIAMS, which is $6.2 million more than the FY 2012 Actual level, for a total of $541.0 million.

Research Project Grants (+$2.732 million; total $357.429 million): NIAMS will support a total of 1,024 Research Project Grant (RPG) awards in FY 2014. Noncompeting awards will decrease by 50 awards and $16.3 million. Competing RPGs will increase by 56 awards and $17.6 million. NIH budget policy for RPGs in FY 2014, continues FY 2012 policy of eliminating inflationary increases for future year commitments. However adjustments for special needs (such as equipment and added personnel) will continue to be accommodated. NIAMS continues to place a priority on support to new investigators.

Research Training (+$0.428 million; total $15.513 million): NIAMS will support 296 pre- and postdoctoral trainees in full-time training positions, a flat level from the number funded in FY 2012. Support for NRSA training mechanism will be increased by $0.4 million amount to cover the cost of increased stipends. The Ruth L. Kirschstein NRSA budget reflects a stipend increase to $42,000 for the entry level postdoctoral trainees and fellows along with 4 percent increases for each subsequent level of experience. These increases are consistent with stipend increases recommended by the Advisory Committee to the NIH Director and the National Research Council. In addition, this increase is consistent with 42 USC 288(b)(5), which anticipates periodic adjustments in stipends "to reflect increases in the cost of living.”

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Summary of Changes

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Fiscal Year 2014 Budget Graphs

History of Budget Authority and FTEs:

 

Distribution by Mechanism:

Change by Selected Mechanisms:

 

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Budget Authority by Activity

1. Includes FTEs whose payroll obligations are supported by the NIH Common Fund.
2. Includes Transfers and Comparable Adjustments as detailed in the "Amounts Available for Obligation" table.

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Authorizing Legislation

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Appropriations History

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Justification of Budget Request

National Institute of Arthritis and Musculoskeletal and Skin Diseases

Authorizing Legislation: Section 301 and title IV of the Public Health Service Act, as amended.

Budget Authority: (BA)

Program funds are allocated as follows: Competitive Grants/ Cooperative Agreements; Contracts; Direct Federal/Intramural and Other.

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DIRECTOR'S OVERVIEW

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) supports a broad range of research, training, and information dissemination activities. Some conditions within the NIAMS mission are rare, affecting only a few thousand people world-wide; others are very common. All have a major influence on the quality of people’s lives. Diseases addressed by NIAMS affect individuals of all ages and of all racial and ethnic backgrounds; many disproportionately affect women and minorities. Over the years, NIAMS-funded research teams have made significant progress in uncovering the causes and improving the treatment of many disorders of the bones, muscles, joints, and skin. The activities described below are a subset of Institute efforts that are advancing the NIH Director’s priority areas for FY 2014.

Much of the NIAMS budget supports basic research into the biological processes underlying health and disease. Over time, discoveries have led to new treatments for people with a range of debilitating conditions. For example, NIAMS-funded basic research during the 1990s enhanced the understanding of molecular mechanisms of inflammation and immune system dysfunction that causes rheumatoid arthritis. The laboratory results were translated to biologics—drugs in the form of biological molecules that are widely prescribed for millions of patients who have rheumatoid arthritis. Ongoing NIAMS-funded studies are identifying the factors that contribute to differences in symptoms and severity. These findings are helping to match appropriate drugs for the management of individual patients.

Scientists also are focusing on genetic changes that are involved in both common and rare diseases within the NIAMS mission. The American Recovery and Reinvestment Act of 2009 (ARRA) enabled researchers to map genetic variations at millions of sites in the genomes of several thousand men and women who have or are at high risk of osteoporotic fracture or knee osteoarthritis. The data will be a valuable resource that many research groups can use to uncover the genetic underpinnings of musculoskeletal diseases and to identify drug discovery targets.

Already, analysis of the ARRA-funded data sets suggests that defects in the same biologic pathways can cause both osteoporosis and osteoarthritis. This finding is consistent with the increasing recognition that musculoskeletal diseases and disorders such as osteoporosis, osteoarthritis, and muscle atrophy share certain biologic processes. Because all have at least some common pathways, strategies for rebuilding any given tissue are likely to have multiple effects. This is prompting NIAMS to encourage additional basic and preclinical research into the implications that these connections may have for the development and testing of compounds to build, restore, or preserve musculoskeletal tissues or treat bone, joint, or muscle disorders.

The discovery that adult skin or blood cells can be reprogrammed to produce “induced pluripotent stem (iPS) cells,” which then can become any cell type, was recognized by the 2012 Nobel Prize in Physiology or Medicine. Because iPS cell-based interventions can generate patient-specific cells that should not trigger immune rejection when returned to a donor, the advance has dramatic implications for cellular therapies and regenerative medicine. In addition, iPS cells can produce disease- and patient-specific models to study the development of diseases such as muscular dystrophies and blistering skin diseases, and the toxicity and effectiveness of drugs against these and other conditions. Consistent with the translational science opportunities afforded by the NIH’s Center for Regenerative Medicine, NIAMS is exploring strategies to expand the application of iPS cells to studies of diseases in the Institute’s mission areas (see Program Portrait: Regenerative Medicine in Skin and Musculoskeletal Disorders, below).

Testing promising cellular, molecular, surgical, or behavioral interventions in clinical trials is an essential step in the translation of discoveries into improvements in health and clinical care. To improve the cost-effectiveness and timeliness of its studies, NIAMS funds most clinical trials through a two-part grant process. Begun in FY 2012, this phased process will continue for grants funded through FY 2014. NIAMS also will continue mechanisms to support arthritis and musculoskeletal and skin disease research that utilizes resources from ongoing clinical projects and preliminary studies on which larger clinical trials could be based. NIAMS encourages investigators to use existing resources, such as the research infrastructures that the Clinical Effectiveness Research Network developed for studies of psoriasis, and the Childhood Arthritis and Rheumatology Research Alliance implemented for pediatric rheumatic diseases. Already, studies using these programs have yielded results on which doctors can base treatment decisions.

Basic science and technologic improvements in imaging allow for assessments of bone quality that were impossible a decade ago. Looking to FY 2014, the Institute is exploring ways to help researchers leverage new imaging tools and approaches for examining bone health. These techniques, many of which were developed or refined with NIAMS funding, allow investigators to probe the relationship between bone’s inner structure and its strength. The ability to visualize how bone changes with disease is guiding the development and use of surrogate markers for fracture and is expected to provide clear evidence of whether and how treatments are working.

Many diseases of interest to NIAMS cause patients to have pain or experience fatigue, impact patients’ sleep, alter patients’ ability to physically or mentally function on a daily basis, or otherwise interfere with social relationships and overall quality-of-life. Building on the NIH Common Fund initiative called the Patient Reported Outcomes Measurement Information System (PROMIS®), NIAMS is encouraging investigators to integrate patients’ self-assessments in chronic diseases representative of the NIAMS portfolio. The goal of these projects, which will run through FY 2016, is to facilitate the availability of improved and more personalized therapeutic options for people who have arthritis or musculoskeletal or skin conditions.

The Institute remains highly committed to supporting the next generation of talented researchers. Recognizing that the transition from a mentored environment to an independent tenure-track faculty position is a critical point in the development of junior investigators’ research careers, NIAMS convened a roundtable discussion in May 2012 to address the challenges rheumatologists who are interested in research face during this career phase. NIAMS expanded the effort in December 2012 to include scientists across the full spectrum of research topics within its mission. The Institute hosted a forum for physician-scientists who have NIAMS-funded mentored career development awards, former award recipients who have recently begun independent research careers, and established investigators. Approximately thirty researchers discussed the challenges that junior scientists face when pursuing research independence.

Overall Budget Policy: The FY 2014 request for NIAMS is $540.993 million or 1.1 percent above the FY 2012 Actual level. Investigator-initiated research project grants and research conducted by new scientists continue to be the Institute’s highest priorities. As part of this effort, NIAMS is committed to training and supporting a diverse biomedical research community that will continue to make advances for generations to come. Funds are included in R&D contracts to support trans-NIH initiatives, such as the Basic Behavioral and Social Sciences Opportunity Network (OppNet).

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Program Descriptions and Accomplishments

Arthritis and Rheumatic Diseases: This program advances high-quality basic, translational, and clinical biomedical and biopsychosocial research to treat, cure, and prevent arthritis and other rheumatic diseases. It supports the application of new insights in the fields of genetics, genomics, proteomics, immunology, and imaging to understand how the immune system interacts with various tissues in normal and pathological conditions, and to ensure a continuous supply of new targets on which therapies can be based. For example, a growing body of evidence points to how microbes contribute to inflammatory diseases. NIAMS-supported studies found that some cases of Lyme arthritis (joint inflammation that can result from Lyme disease) are due to lingering effects of the disease-causing bacteria. Other new NIAMS-funded discoveries about the immune system’s reaction to bacterial infections and its regulation of subsequent inflammatory responses may help control diseases such as rheumatoid arthritis and gout. In addition, NIAMS-supported researchers studying pediatric and adult lupus patients have identified abnormalities in a gene that contributes to a microbe-fighting immune system pathway; these genetic changes may cause dysregulated inflammation in a subset of lupus patients.

Budget Policy: The FY 2014 President’s Budget estimate is $116.879 million, an increase of $1.583 million, or 1.3 percent over the FY 2012 Actual level. Plans for FY 2014 include encouraging late-stage development and validation of molecular indicators, or biomarkers, for monitoring disease progression and therapeutic responses in inflammatory diseases, such as arthritis, lupus, and psoriasis. As part of a Center of Research Translation that NIAMS began funding in FY 2012, the program will continue to support studies into the clinical and societal factors that contribute to an increased prevalence of gout. The program also will build on a January 2013 roundtable discussion about partnerships to advance therapies for rheumatic diseases, which NIAMS convened with representatives from the research community, the U.S. Food and Drug Administration, and industry to discuss strategies for scientific collaborations that will lead to better, safer, and more efficient clinical studies.

Musculoskeletal Biology and Diseases: The Musculoskeletal Biology and Diseases program focuses 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 including osteoarthritis (OA). It oversees research into the causes and treatment of acute and chronic injuries, including repetitive stress and sports injuries, and is funding a long-term study into the effectiveness of various treatments for patients who have low back pain. The program supports the development of technologies—such as bone and joint imaging, tissue engineering, and regenerative medicine—to improve the diagnosis and treatment of skeletal disorders, or to facilitate repair of damage caused by trauma to otherwise healthy tissue (see Program Portrait: Regenerative Medicine in Skin and Musculoskeletal Disorders, below). Its longstanding investment in the Osteoarthritis Initiative, a trans-NIH public-private partnership to facilitate development of treatments for people who have knee OA, is the basis for a new Foundation for the National Institutes of Health Biomarkers Consortium project to evaluate biochemical and imaging biomarkers for more precise ways of measuring OA progression, and providing tools to assess the effectiveness of new treatments.

Budget Policy: The FY 2014 President’s Budget estimate is $127.121 million, an increase of $1.717 million, or 1.3 percent over the FY 2012 Actual level. NIAMS plans a focused effort to explore the biology of the hard-to-heal tendons and ligaments that comprise the joints that could hold promise for new strategies to help people recover from sports injuries or other traumatic events. NIAMS will continue to support translational research to improve the care patients receive following orthopaedic trauma; this includes strategies that clinicians could use to assess a person’s risk of developing OA, as well as efforts to forestall or prevent OA onset following a joint injury.

Bone Biology and Diseases: The Bone Biology and Diseases program covers a broad spectrum of research designed to better understand genetic and cellular mechanisms involved in the build-up and break down of bone. It studies regulation of bone remodeling; bone formation, bone resorption, and mineralization; and effects of hormones, growth factors, and cytokines on bone cells. The program supports several large epidemiologic cohorts for characterization of the natural history of osteoporosis, and for identification of genetic and environmental risk factors that contribute to bone disease. Over the past decades, these studies have provided information that health care providers are using to assess people’s bone health. The NIH Study of Osteoporotic Fractures (SOF) finding that bone mineral density (BMD) relates closely to fracture risk, for example, contributed to Medicare’s decision to pay for numerous people to get their BMD measured every two years. Many started taking bone-preserving drugs because of their results, and the rate of hip fractures dropped nearly 25 percent among female beneficiaries.¹ New, longer-term data from SOF is refining the screening guidance: women at the highest risk of osteoporosis might benefit from annual exams, while women with the lowest risk could be tested much less frequently unless other aspects of their health change.

Budget Policy: The FY 2014 President’s Budget estimate is $69.092 million, an increase of $0.934 million, or 1.3 percent over the FY 2012 Actual level. NIAMS plans for this program include encouraging basic and translational research to inform the development of bone-building and joint-preserving therapies for people who have brittle bones or deteriorating joints. Capitalizing on recent discoveries related to how bone and muscle communicate with each other and with other organ systems in processes as diverse as fracture healing and fat storage, the program will encourage bone researchers to collaborate with muscle experts to develop and test new hypotheses related to human health and disease.

Muscle Biology and Diseases: This program supports a wide range of basic, translational, and clinical research projects in skeletal muscle biology and diseases. It focuses on the fundamental biology of muscle development, physiology, and muscle imaging. Its overarching objective is to advance the understanding of the role that muscle plays in musculoskeletal and whole body health and, ultimately, to treat or prevent skeletal muscle diseases and disorders (including muscular dystrophies, inflammatory myopathies, muscle ion channel diseases, disuse atrophy, skeletal muscle injury and loss of muscle mass associated with aging and diseases). The development of tools that allow researchers to study genetic material that does not normally code for proteins in adult muscle led to several basic science discoveries in FY 2012 that will pave the way for tomorrow’s breakthroughs. For example, a new strategy for degradation of toxic RNA may lead to novel drugs for myotonic dystrophy. Two other recent discoveries—that small RNA fragments called microRNAs can regulate the behavior of dormant muscle stem cells, and that subtle differences in muscle RNA influence whether genes produce proteins—may one day enable therapies for muscle diseases and disorders where repair and regeneration of muscle are inadequate. Additional information about NIAMS-funded progress and plans regarding muscular dystrophy is in the Program Portrait: Innovative Approaches to Muscular Dystrophy Treatments, below.

Budget Policy: The FY 2014 President’s Budget estimate is $77.103 million, an increase of $1.045 million, or 1.3 percent over the FY 2012 Actual level. For FY 2014, the Institute will continue to participate in the Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research Centers Program, and to support a Center of Research Translation grant to assess a strategy to repair the genetic defect that causes Duchenne muscular dystrophy. Other plans include continuing to foster research into the role skeletal muscle plays in influencing other organ systems in addition to skeletal health (as described above), and to support clinician scientists who are committed to a muscular dystrophy research career.

¹Brauer CA, et al.JAMA.2009. PMID:19826027

Skin Biology and Diseases: This program supports a broad portfolio of basic, translational, and clinical research in skin, including work on the developmental and molecular biology of skin, the study of skin as an immune organ, and the genetics of skin diseases. The Institute is pursuing tissue engineering and regenerative medicine strategies involving skin tissue, and imaging tools that will facilitate studies of skin biology and diseases (see Program Portrait: Regenerative Medicine in Skin and Musculoskeletal Disorders, below). Although skin provides important protection from outside elements, it can also be a barrier to delivery of therapeutic agents. NIAMS-supported researchers have created a potential approach for gene therapy of skin diseases, such as psoriasis and skin cancer, by combining nanoscale gold particles and genetic material. These complexes can penetrate the skin after topical application, and change the expression of disease-associated genes. Atopic dermatitis, or eczema, is a chronic, inflammatory skin condition, resulting from disruption of the skin barrier function. Due to severe itching, atopic dermatitis has a tremendous impact on quality of life and was a major topic at the NIAMS 2012 scientific planning retreat. Institute staff and extramural experts discussed emerging targets, future research directions, and opportunities for intervention. Keratinocytes, the cells in the outer layer of skin, proliferate in a regulated fashion in skin wound healing, and in an unregulated manner in psoriasis. Recent NIAMS-funded research identified a molecule that controls keratinocyte growth and may be a therapeutic target for both wound healing and psoriasis. Work also continues on rare genetic diseases of the skin, such as epidermolysis bullosa and pachyonychia congenita.

Budget Policy: The FY 2014 President’s Budget estimate is $68.373 million, an increase of $0.923 million, or 1.3 percent over the FY 2012 Actual level. There have been significant gains in understanding itch sensation in recent years, which is a major quality of life issue in many skin conditions. NIAMS is encouraging research that will lead to more discoveries in the mechanisms of itch sensation, and developing interventions to modulate and control itch in disease. The Institute will continue to support shared facilities and services for skin research that will enhance and coordinate activities, and foster new innovations.

Intramural Research Program: The mission of the 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 (see Program Portrait: Rare Autoinflammatory Diseases, below, for examples of NIAMS intramural research projects). The program conducts intensive basic scientific and clinical studies on the genetics, etiology, pathogenesis, and treatment of a variety of rheumatic, autoimmune, inflammatory, joint, skin, and muscle diseases. The NIAMS IRP consists of basic researchers and physician-scientists who have contributed many noteworthy discoveries. For example, scientists studying atopic dermatitis showed that mice that could not process a byproduct of vitamin A had skin defects which rendered them more susceptible to infectious organisms and allergens. This better understanding of how people develop atopic dermatitis may lead to new treatments for several skin conditions. Other intramural researchers are working with industry partners to translate basic research findings into clinical treatments. New breakthroughs have been made in the development of small molecules that block multiple key inflammatory pathways that underlie many autoimmune diseases. NIAMS scientists have also resolved longstanding questions about the origin of recurrent chromosomal rearrangements that drive human lymphomas and leukemias. In addition, researchers identified an enzyme that plays a key role in promoting such rearrangements, which could be a potential therapeutic target for the prevention of certain human cancers.

Budget Policy: The FY 2014 President’s Budget estimate is $54.413 million, the same as the FY 2012 Actual level. NIAMS plans for FY 2014 include maintaining its focus on translational research, in order to facilitate patient-oriented studies in the areas of arthritis, musculoskeletal, and skin diseases, including their genetic, inflammatory, and immune underpinnings. NIAMS will also continue its commitment to multidisciplinary training of rheumatology research fellows to strengthen the pipeline of highly qualified physician-scientists in this field. Both efforts will continue to synergize with the NIAMS Community Health Center facility in Silver Spring, Maryland, and will be enhanced by the recent appointment of a new clinical director to oversee clinical and translational intramural research. NIAMS is also participating in the NIH Funding Opportunity Announcement that is designed to promote collaborations between intramural and extramural investigators and take advantage of the unique research opportunities available at the NIH Clinical Center.

Research Management and Support (RMS): NIAMS' RMS budget supports the scientific, administrative management, and information technology activities associated with day-to-day operations. In FY 2012, the Institute managed more than 1,236 research grants and centers, as well as 48 research and development contracts and 296 individual and institutional full-time research training positions. NIAMS supported 496 clinical research studies, including 72 clinical trials. In FY 2012, the NIAMS continued to expand its information dissemination efforts. For example, an English and Spanish fotonovela was created to teach children and teens how to avoid sports injuries. "Ana's Story" uses a graphic format to engage readers and deliver important health messages. Social media efforts, such as daily updates on Twitter and Facebook, have enhanced public engagement and awareness of NIAMS and NIH information resources by increasing traffic to the NIAMS website. The NIAMS also hired a new Chief Information Officer to manage the information technology resources of the Institute.

Budget Policy: The 2014 President’s Budget estimate is $28.012 million, the same as the FY 2012 Actual level. In FY 2014, NIAMS will continue its efforts to improve access to, and availability of, meaningful health information for racial and ethnic minority populations through its National Multicultural Outreach Initiative (NMOI). Following the pilot testing of two health planners—targeting Hispanics/Latinos and American Indians, Alaska Natives, and Native Hawaiians—that raise awareness about the NIH and the NIAMS, two additional health planners for African Americans and Asian Americans/Pacific Islanders were created for the 2013 calendar year. All four planners are available free of charge to the public and can be used in conjunction with a newly developed online toolkit. Outreach to intermediary organizations will facilitate the distribution of health planners and the electronic toolkit in multicultural communities; the Institute will assess the effectiveness of the outreach and distribution efforts later in the year. The Institute also will continue to sponsor roundtable discussions and a scientific retreat with extramural investigators and lay representatives to inform the research priority-setting and strategic planning process. The apparent increase in estimated FY 2014 FTE compared to the FY 2012 actual FTE usage level is due to the effect of transferring positions previously funded from a centralized support operation (Division of Extramural Activities Support) to individual ICs as of year-end 2012. As a result of the DEAS transfer, estimated salaries and benefits for FY 2014 are proportionately higher than those identified for FY 2012 and previous years.

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Budget Authority by Object Class

Includes FTEs whose payroll obligations are supported by the NIH Common Fund.

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Salaries and Expenses

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Details of Full-Time Equivalent Employment (FTEs)

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Detail of Positions

Includes FTEs whose payroll obligations are supported by the NIH Common Fund.

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