A new multi-disciplinary approach to osteoarthritis research in the UK was announced earlier this month with a 1.8 million pound programme comprising three clinical trials involving 300 people with osteoarthritis of the knee and a research team of radiologists, engineers, biomechanics, rheumatologists and physiotherapists.

Based at the Universities of Manchester and Salford in northwest England, the charity Arthritis Research UK is funding the five-year programme, and world expert in osteoarthritis Professor David Felson from Boston is leading it.

A statement from Arthritis Research UK describes the new multi-disciplinary programme as an exciting new approach that “could have a significant impact on the way the common joint condition is treated”.

About 6 million people in the UK have some form of osteoarthritis, the most common form of joint disease, where cartilage in joints like the knees and hips breaks down resulting in bones rubbing against each other and causing inflammation, pain and eventually structural damage and joint failure.

Estimates suggest that by 2030, the painful, debilitating condition will affect around 1 in 5 people in Europe and the US, yet currently the only way to treat it is either with painkillers or eventuallly, joint replacement.

Felson told the press that:

“Osteoarthritis remains among the last unconquered musculoskeletal diseases and one of the few chronic diseases of ageing for which there is no effective strategy to prevent disease progression.”

“And in order to conquer it successfully it has to be addressed in a multi-disciplinary fashion. We’ve assembled some real experts to pose the right questions and hopefully we can answer those questions,” he added.

Felson, who is spending one week a month in the UK, prefers to address the underlying causes of osteoarthritis, such as correcting patients’ gait and posture, rather than just repair cartilage as a way to treat the disease successfully.

Professor Alan Silman, medical director of Arthritis Research UK told the press that:

“This research can change fundamentally how we consider osteoarthritis. For generations both doctors and the general public have considered the disease as being a consequence of age-related wearing away of the cartilage that lines the joints.”

Felson and his team are already recruiting volunteers for the three trials, each of which will have patients with slightly different forms of knee osteoarthritis, affecting different parts of the joint.

The multi-disciplinary team will also be using up to date imaging and computer technology to test the effectiveness of knee braces, insoles, special shoes, and steroid injections as practical ways to treat osteoarthritis.

One of the lead investigators, Dr Terry O’Neill, consultant rheumatologist at the Arthritis Research UK Epidemiology Unit at the University of Manchester, said:

“If any of our interventions are shown to be effective, they could make a real difference to patients’ lives, and they are the kind of treatments that could easily be taken up by GPs.”

He said a lot of money has been spent with little result trying to reverse the process in the cartilage.

“This research takes an exciting new approach, backed by considerable evidence, that the cartilage damage is secondary to the mechanical stresses we place on our joints and that by altering these we can prevent and, or reduce the damage to cartilage,” said O’Neill.

From the US, where most of his past research is based, Felson created and directed the Framingham Heart Study Osteoarthritis substudy, the Beijing Osteoarthritis Study and the Multicenter Osteoarthritis Study: all large cohort studies aiming to describe how the disease develops and the risk factors behind it.

Felson’s group in the US was the first to link knee osteoarthritis with obesity and nutrition; and he was the first to use MRI to find bone marrow lesions and link them to pain, malalignment and disease progression.

Main source: Arthritis Research UK, University of Manchester.

Written by: Catharine Paddock, PhD