Oct 7 2011
How people walk, jump and run and how their knees look in an MRI scanner may hold the secret to predicting years or even decades in advance whether they will develop osteoarthritis, the common degenerative joint disease that strikes half of all Americans by the time they reach the age of 70.
Doctors today cannot look at a person's gait, leap, stride or scan and tell you definitively whether or not they will develop osteoarthritis, but a new translational research center at the University of California, San Francisco (UCSF) Medical Center and the University of California, Davis seeks to change this.
Funded by a $6.3 million grant from the National Institutes of Health, the center will bring together radiologists, orthopedic surgeons, rheumatologists, laboratory scientists, mathematicians and physical therapists under one umbrella with a single purpose: finding new tools for predicting and preventing osteoarthritis in young people and improving care and outcomes for the tens of millions of American adults already suffering from the disease.
"Osteoarthritis is one of the major age-related illnesses of our times, and there's no way to slow or reverse it once it starts," said Sharmila Majumdar, PhD, UCSF Professor in Residence and Vice-Chair of Research in the Department of Radiology and Biomedical Imaging. "The diverse group of experts at the center will all be seeking to address this problem, but from different perspectives, integrating imaging, biomechanics and the symptoms of the individual."
Specifically, these experts will combine advanced MRI imaging with sophisticated analyses of movement, clinical medicine, countrywide statistics and all the latest laboratory research on cartilage composition. They will seek to translate this research into clinical tools that can predict, prevent, and possibly slow damage to soft tissue in the joints.
"We're very excited about this research because it will allow us to assess the progressive degeneration and risk factors in osteoarthritis of the knee, identify its association with hip osteoarthritis, and determine how changes in cartilage may be a predictor for the disease," said professor Nancy E. Lane, MD, who leads the UC Davis Musculoskeletal Diseases of Aging Research Group, is co-principal investigator of the project and will direct one of the four major projects funded by the new grant.
The Appeal of Biomarkers to Medicine
An unfortunate reality of osteoarthritis is that the changes happening to the joints can go unnoticed for years. People in the early stages of the disease may not have any visible health problems, and much of the damage occurs long before someone develops soreness in their knees.
"By the time a patient sees a physician for walking knee pain, the disease is often very advanced," said Lane.
Part of the problem is that there is no effective way to screen for the earliest signs of osteoarthritis. X-rays taken of the knees and other joints are often inconclusive. While they may show the bones of a patient, they do not necessarily reveal the subtle changes to the soft tissue, where some of the earliest signs of disease may be hidden.
With some of the most advanced MRI imaging techniques now available, doctors can identify these subtle changes. Motivation for the new center stems from the fact that tools for identifying the early signs of osteoarthritis may already exist in laboratory, but more work needs to be done to push them into the clinic.
The new grant will fund several projects aimed at pushing the science forward by defining and standardizing biomarkers of the disease. These definitive, measurable quantities collected from something like a MRI scan would signal early joint degeneration.
According to Majumdar, the new center is uniquely positioned to define these biomarkers because developing them will require many experts from many different fields - from experts in imaging to researchers who study patient movement and clinicians who see patients and recognize physical signs of disease.
Other center projects will utilize a treasure trove of osteoarthritis data gathered through a large national study, the Osteoarthritis Initiative sponsored by the National Institute of Arthritis and Musculo-Skeletal Disease (NIAMS).
Developing these biomarkers, Majumdar said, would be a boon for patients because, by giving pharmaceutical companies a useful way to test how effective the drugs are, it would speed up development of new drugs to fight osteoarthritis.
Source: University of California - San Francisco
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