Each academic year the Rheumatology Fellowship Program matriculates one, two or three rheumatology fellows who will complete two years of subspecialty training. Following these two years, fellows will have fulfilled the American Board of Medical Examiners requirements to be eligible to sit for the Rheumatology Board examination. The first year of training is clinical and fellows participate in a variety of continuity care clinics. These clinics include the NIAMS Community Health Clinic, NIAMS Clinical Center Arthritis Clinic, and NIAMS Clinical Center Pediatric Rheumatology Clinic. In addition to these clinics, other patient care activities include the NIAMS inpatient ward, and the inpatient and outpatient consultative services. First year fellows also spend time participating in a Day Hospital infusion service. All fellows participate in core curriculum lectures that provide didactics concerning general rheumatology during the first five weeks of training. Additional teaching sessions include weekly core lectures, business meetings, clinical journal clubs, Rheumatology Grand Rounds, and a weekly translational journal club. Other core conferences include Director's Rounds, Intra-City Grand Rounds, and the District of Columbia Rheumatism Society meetings. Attendance is required of all trainees to NIH-sponsored events to fulfill the requirements for training. During the first year, all fellows are encouraged to discuss research activities with faculty such that in the second year they can begin a mentored research activity. During the second year of fellowship, ACGME guidelines mandate a continuity care clinic and didactic activities. This leaves up to 80% protected time for the fellow to gain a meaningful research exposure. The research is encouraged to be either basic bench science or clinical research. Recent examples of research projects include the study of hereditary forms of inclusion body myositis, study of monogenic periodic fever syndromes, and examination of anti-cytokine antibody profiles. The NIAMS Clinical Program also serves as a clinical and research training site for the Children's National Medical Center (CNMC) (Washington, DC) - NIH Pediatric Rheumatology Fellowship Training Program. The first year of clinical training is primarily at CNMC, with rotations through NIAMS rheumatology clinics. Fellows who match with research mentors located at the NIH may spend the final two years of their training at NIH and participate in clinical care at both institutions. On a case by case basis, uniquely meritorious candidates may be accepted for combined med-peds rheumatology training leading to dual certification. The Clinical Fellowship program is vital to clinical research at the NIH Clinical Center because all fellows provide care for patients enrolled in the following protocols: 03-AR-0173 Studies of the Natural History and Pathogenesis of Neonatal Onset Multisystem Inflammatory Disease (NOMID) 11-AR-0223 Studies on the Natural History and Pathogenesis of Spondyloarthritis 18-AR-0081 Investigation of the natural history, genetics and pathophysiology of systemic juvenile idiopathic arthritis and adult onset Stills disease and related inflammatory conditions 99-AR-0004 Molecular Basis of Primary Immunodeficiencies 94-AR-0066 Studies of the Pathogenesis and Natural History of Systemic Lupus Erythematosus (SLE) 15-AR-0185 Safety of tofacitinib, an oral Janus kinase inhibitor, in Systemic Lupus Erythematosus; a Phase Ib clinical trial and associated mechanistic studies 15-AR-0060 The role of PPAR-gamma agonists in immunomodulation and vascular prevention in SLE (PPAR-SLE) 14-AR-0200 Studies of the natural history, pathogenesis and outcome of idiopathic systemic vasculitis 91-AR-0196 Studies on the natural history and pathogenesis of polymyositis, dermatomyositis, and related diseases 00-AR-0222 Studies of the pathogenesis and natural history of arthritis and related conditions 15-AR-0165 Studies of the natural history, pathogenesis and outcome of melorheostosis, a rare osteosclerotic disease 01-AR-0227 Natural history of rheumatic disease in minority communities 04-AR-0205 Progression of spinal fusion in ankylosing spondylitis 13-AR-0056 Stopping anti-TNF agents in rheumatoid arthritis (STARA) trial