One of the most challenging times in life is dealing with the loss of a spouse or partner. You must not only deal with the sorrow and grief of your loss, but also attend to many details and decisions that need to be made. The Arthritis Foundation has a resource guide called When the Time Comes (WTTC) to help both prior to and during this difficult time. Continue reading Practical Advice for a Difficult Time
Fewer people may get joint replacement procedures in the future than previously thought. That’s according to research presented recently at the 2018 annual meeting of the American Association of Orthopaedic Surgeons (AAOS) in New Orleans. Lead author Matthew Sloan, MD, an orthopedic surgery resident at the University of Pennsylvania, says the number of procedures will continue to rise but at a slower rate.
Knee and hip replacements have been the standard treatment for end-stage arthritis for more than 40 years. During that time, the rate of surgeries has skyrocketed, more than doubling between 2000 and 2008 alone. There has also been an increase in so-called “revision surgeries” – do-over procedures to replace a failed or worn-out implant after the initial surgery.
Thank your doctor today – it’s National Doctor’s Day!
The first Doctors’ Day observance occurred in 1933 in Winder, Georgia, where Eudora Brown Almond, the wife of Dr. Charles B. Almond proposed setting aside a day for mailing greeting cards and placing flowers on the graves of deceased doctors. In 1958, the U.S. House of Representatives adopted a resolution commemorating Doctors’ Day. And in 1990, following overwhelming approval by Congress, President George H.W. Bush turned the commemoration into a national holiday.
National Doctor’s Day is a day we celebrate “the contribution of physicians who serve our country by caring for its citizens.”
Last week, the 2018 Arthritis United Conference took place over a long weekend in Washington, D.C., bringing together approximately 200 attendees from across the country and globe through a virtual, live-streamed experience to learn, connect and grow together.
The weekend featured notable keynote speakers, medical experts, educational breakout sessions and volunteer-led panels covering a variety of topics for adults living with arthritis and related rheumatic conditions as well as loved ones. For the first time, seven selected sessions were also live-streamed through an online, interactive forum for those that were not able to attend in person.
The United States has been grappling with a growing opioid epidemic that is forcing doctors, policymakers and patients to come up with alternative ways to manage both chronic and acute pain and reduce the amount of opioid prescribing in the country. A pair of studies presented recently at the 2018 meeting of the American Association of Orthopaedic Surgeons (AAOS) in New Orleans examine two possibilities for patients undergoing surgery.
The first study found that counseling before surgery significantly cuts the number of opioids patients take after hand surgery. And the second study, led by the same doctor, showed that ibuprofen and acetaminophen each treats postsurgical pain from hand surgery as well as oxycodone.
Osteoarthritis Center of Excellence Research Story
Over the last month, we’ve kept you updated on the work being done by the researchers in our osteoarthritis (OA) center of excellence (OA COE). The COE is currently funding three Clinical Trial Network demonstration studies that may lead to better diagnosis and earlier treatments for arthritis. Researchers from six different institutions will collaborate in various aspects of these cutting-edge studies. This is the last in a series of three blogs describing these studies.
Most people with partial or complete rupture of the anterior cruciate ligament (ACL) develop post traumatic OA (PTOA) within 10 to 20 years after their injury. Unfortunately, current ACL injury treatment options (both surgical and non-surgical) are successful in the short-term but do little or nothing to reduce the risk of developing PTOA later.
All three of the current OA COE are demonstration projects that build on knowledge gained from earlier foundation-funded ACL and PTOA research.
- Xiaojuan Li and her team of investigators are working to refine and standardize biomarker assessment in cartilage images obtained through magnetic resonance imaging (MRI) to allow earlier diagnosis.
- Virginia Byers Kraus and her team are working to identify which biomarkers are most critical for predicting risk of OA after injury and to confirm the earliest and best timepoints to start treatments.
- Christian Lattermann and his research team are working on establishing a clinical trials platform to put it all together in a demonstration project allowing for the exploration of new therapeutic strategies to prevent PTOA. This platform is designed to incorporate and further validate findings with regards to early biochemical biomarkers and (MRI) imaging biomarkers and patient reported outcomes (PROs) for pain and function.
Dr. Lattermann and his team are basing their OA COE project on what they learned from an earlier Arthritis Foundation-funded study. In 2012, Dr. Lattermann received an Innovative Research Grant for his 2-year project, “IL-1RA Treatment in Patients with Acute ACL Tear and Painful Effusions,” which he worked on with Dr. Kraus. Due to unforeseen difficulties, this study was modified to use a corticosteroid (an anti-inflammatory agent) instead of a blocker of IL-1. The study was the first of its kind to evaluate the effect of an early anti-inflammatory intervention and biomarker profiles in the first couple of weeks after ACL injury. In brief, this study concluded that PTOA begins at the time of ACL injury. In this early study, 49 young adult patients were treated with corticosteroid or placebo at 4 days and 2 weeks following the ACL injury. The study showed that while early treatment with corticosteroid did reduce collagen breakdown in cartilage, it didn’t reduce the anti-inflammatory biomarkers (Interleukin-1 or IL-1) in patients.
Following the previous study, the team continued to work on the FDA approval to use an iL-1 blocker that we believe to be even more effective in blocking inflammation than cortisone. The current OA COE study is now looking at how this injectable drug (also known as IL‑1 receptor antagonist or IL-1Ra) may reduce the risk of developing PTOA in adolescents and young adults (aged 14 to 33) with ACL tears. The goal is that the drug will reduce the level of IL-1 in patients, thereby reducing the future risk of developing PTOA. IL-1Ra is currently used to treat rheumatoid arthritis, juvenile inflammatory arthritis, and post-surgical knee swelling. Dr. Lattermann and his team have received permission by the FDA to treat and study patients after ACL injury using IL-Ra.
Patients who take part in this study will be placed by random into one of three treatment groups:
- Group 1 will receive a placebo injection at Visit 1(about 4 days after injury) and an IL-1Ra injection at Visit 2 (about 2 weeks after injury).
- Group 2 will receive an IL-1Ra injection at Visit 1and a placebo injection at Visit 2.
- Group 3 will receive placebo injections at Visits 1 and 2.
Dr. Lattermann and his team will look at the changes in biomarkers in synovial fluid, blood, and urine at different times beginning within 7 days of the injury for up to 1 year. Knee imaging in the form of MRI scans and x-rays will also be performed for up to 2 years to look for changes.
By looking at biomarkers and knee imaging, researchers hope to pinpoint not only if the drug treatment may be effective, but also the best time to begin treatment to prevent further damage. About 60 patients are planned to be enrolled in this study, with the first patient starting in April.
Dr. Lattermann, the principal investigator, will coordinate the analyses with researchers at the University of California San Francisco and Duke University. Dr. Lattermann is currently a Professor for Orthopaedics and Sports Medicine at the UK College of Medicine (Department of Orthopaedic Surgery and Sports Medicine).
Osteoarthritis Center of Excellence Research Story
Our osteoarthritis (OA) center of excellence (COE) is currently funding three Clinical Trial Network demonstration studies that may lead to better diagnosis and earlier treatments for OA. Researchers from six different institutions will collaborate in various aspects of these cutting-edge studies. The three studies are connected to one another for a common purpose and they build on previous research funded by the Arthritis Foundation. This is the second in a series of three blogs describing these studies. Read the first one here.
Dr. Virginia Byers Kraus is working to identify biochemical biomarkers found in synovial (joint) fluid and urine from post-traumatic OA patients who have suffered anterior cruciate ligament (ACL) rupture. The samples used for this study come from samples collected from a 2013 Arthritis Foundation-funded project that validated using magnetic resonance imaging (MRI) techniques to measure the molecular changes that begin to occur in joints immediately after an ACL tear.
Urine and synovial fluid (from damaged knee joints) were collected from patients at five timepoints: baseline (less than 4 weeks after the joint injury), during surgery (about 6 weeks after the injury), 6 weeks after surgery, 6 months after surgery, and 1 year after surgery. The analysis of the 177 urine samples and 101 synovial fluid samples will take about 6 months.
The goal of this project is to evaluate which biochemical markers are connected to inflammation and cartilage breakdown following ACL rupture. The team is working to identify which biomarkers are most critical for predicting risk of OA after injury and to confirm the earliest and best timepoints to start treatments.
“With heart attacks, we treat immediately for best results,” explained Dr. Kraus. “We’re hoping to show that the same is true for joint injuries. What is important is the time from the injury to medical intervention. We must treat early to prevent further damage. What we currently see is that about half of the patients who have surgery for an ACL tear eventually develop more serious disease.”
By identifying biomarkers that appear early following an injury and by using more sensitive MRI imaging techniques, researchers hope to identify the individuals at highest risk for more serious joint disease and to determine the “window of opportunity” for providing treatment to prevent subsequent OA. Earlier interventions might include new drugs designed to halt the disease process and other anti-inflammatory drugs, thus reducing the need for joint replacements later and improving the quality of life.
Dr. Kraus was inspired to study OA by her father. Her father, a surgeon during the Vietnam War, damaged his hip and as a result endured 3 hip replacements over the rest of his life. While her father continued working into his 70’s, Dr. Kraus felt frustrated watching his daily suffering and the suffering of her clinic patients. It’s pushed her to want to make a difference and stop OA in its tracks.
“Osteoarthritis is a big and challenging beast -it’s the most prevalent disease in the world,” she explained. “It affects mobility, which in turn affects your heart and many other aspects of your health. We’ve begun to see success in understanding many types of arthritis, but up to now, we haven’t been as successful with OA. It’s so frustrating for me to see the suffering caused by this disease.”
We’re so proud to call Dr. Kraus a Champion of Yes. She explained why she likes to submit her research projects to us: “The Arthritis Foundation has stayed the course in maintaining prolonged interest in finding a cure. It has worked at building on prior innovative research – it’s hard to get funding for these types of studies. The Foundation has created a nimble mechanism for doing this type of research and moving it forward faster. This brings us closer to finding cures for patients more quickly.”
Dr. Kraus, the principal investigator in this project, is a professor of Medicine, Pathology and Orthopaedic Surgery at Duke University in Durham, NC. She will be working with other researchers from Duke University, as well as researchers from the University of California San Francisco (UCSF), Hospital for Special Surgery (HSS) in NYC, and the Mayo Clinic in Rochester, MN.
This month, we’re hosting a first of it’s kind event in Washington, DC called the Platinum Ambassador Assembly. This two-day event has been built for our most advanced and empowered advocacy volunteers – our Platinum Ambassadors. This event gives them an opportunity to learn from each other and a platform to share their stories in person with their members of Congress and their staff.
This year we are thrilled to have more Platinum Ambassador awardees than ever — in 2017, 51 amazing individuals around the country achieved this remarkable honor. The Platinum Ambassador title is awarded to dedicated volunteers that engage in each monthly Ambassador activity, complete four bonus activities, and meet or exceed a fundraising goal of $1,000 for the Arthritis Foundation. The prestigious honor will be bestowed on so many inspiring individuals around the country; like a mother daughter duo in Ohio, a married couple in New Hampshire, young adult patients, and juvenile arthritis parents alike.
We’d like to share their wisdom and words with you as they prepare to travel to Washington, DC next week. Read on to hear from some of our advocacy experts:
Osteoarthritis (OA) affects over 30 million people and is the most common cause of disability in adults in the U.S. The Arthritis Foundation has set the goal of advancing OA treatments as one of its highest priorities, making it one of the Foundation’s four scientific initiatives. To do this, we have created the OA Center of Excellence (COE), where researchers from around the county can join the Clinical Trial Network to work together to accelerate the development of new OA therapies.
The OA COE is currently funding three Clinical Trial Network demonstration studies that may lead to better diagnosis and earlier treatments. Researchers from six different institutions will collaborate in various aspects of these cutting-edge studies. We will look at each of these studies in a series of blogs.
New research predicts that the existing shortage of rheumatologists will worsen over the next decade, while the demand for arthritis specialists will continue to grow.
“In 10 years, we will have a significant challenge in America to take care of the demands of rheumatology care. Every region in the U.S. will be negatively affected by [having] far less rheumatologists than we think will be optimal,” says Daniel F. Battafarano, DO, division director, Rheumatology Service, San Antonio Military Medical Center in Texas.