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In Search of the Keys to Treating Creaky Knees

08/08/2016

According to the Centers for Disease Control and Prevention, osteoarthritis (OA), a degenerative condition attacking the joints, affects at least 26.9 million adults in the United States. Although it is the most common form of arthritis, OA may also be the most overlooked and under- treated. That’s why researchers in the Division of Rheumatology have made it their mission to discover and develop disease modifying drugs and other interventions to diagnose and treat OA in the knee. 

“Knee osteoarthritis can be very disabling—causing pain, swelling and stiffness —but it is often dismissed as a normal side effect of old age, and therefore untreatable,” said Rheumatologist-in-Chief Timothy McAlindon, MD. “As a result, OA research has been neglected for years, resulting in a huge unmet need for treatment options. We hope our efforts will result in new products to slow disease development and progression in knee OA patients.” 

Measuring risk & progression

Since very little OA data existed, Dr. McAlindon and his research team were faced with the initial challenge of determining how to quantify and measure disease progression of OA. By using MRI, which provides a detailed, three-dimensional picture of soft tissue structure, the researchers can measure and quantify changes in knee joint structure and the volume of cartilage and fluid in the knee. Since this process can be quite time-consuming and labor-intensive, Dr. McAlindon’s team has integrated computer interfacing, ultrasound and bone density scanning to hasten the data-gathering process and supplement the MRI information on knee OA development and advancement. While it is a lengthy process, good progress has been made and Dr. McAlindon is confident that within two years, his team will have figured out how to combine all these imaging techniques into one simple composite score for measuring the risk of knee OA progression. 

“Having an accurate biomarker is a key step towards developing effective interventions,” said Dr. McAlindon. “Once we have established an imaging biomarker of knee OA disease progression, we can develop predictive models to understand which patients are most at risk and then use targeted strategies to treat them.” 

Testing interventions 

Dr. McAlindon’s group also is intimately involved with testing interventions for knee OA. His lab is on the forefront of a number of structure modification trials, in which MRI is used to measure knee OA progression over time; three such trials are currently taking place at Tufts MC. In addition, two recently-completed NIH-funded studies examined the effect of vitamin D and intra articular corticosteroid injections on knee OA, but found no positive or negative effect on knee OA structural progression. Finally, Dr. McAlindon’s team participates in a number of industry-sponsored trials and has a close relationship with the Osteoarthritis Initiative (a group following 4,000 people, who receive annual evaluations with MRI and medications over a period of decades) to mine data on any potential connection between a given drug and knee OA progression. 

During the past five years, Dr. McAlindon and his Rheumatology research colleagues have received more than $13 million in funding, predominantly from the National Institutes of Health for investigator-initiated research projects. The group also has been steadily ramping up its industry-funded clinical trial portfolio over the past few years. 

Examining non-traditional therapies 

Dr. McAlindon’s colleagues in the Division of Rheumatology also have received NIH funding to pursue additional important knee OA studies. Researcher Jeffrey Driban, PhD, is exploring the mechanisms behind accelerated knee OA and Director of the Center for Complementary and Integrative Medicine Chenchen Wang, MD, is investigating the use of tai chi to treat knee OA; she has found it to be just as effective, if not more so, than other interventions. 

“We’ve only scratched the surface of understanding the mental aspect of chronic pain,” said Dr. McAlindon. “In the future, our Division hopes to test the effectiveness of yoga and other non-traditional therapies to expand the options for people with knee OA.”