The Arthritis Foundation and TOA are proud to provide special E-Connect issues to support the Austin Arthritis Walk. We have selected articles we hope to be of interest to Orthopaedic Practices.  We want to thank our sponsors, Balcones Imaging and Carpe-eDatum for bringing you this week’s issue.

As an active member in the orthopaedic community we would like to ask you to join TOA in supporting the Arthritis Foundation. The funds raised through the Austin Arthritis Walk directly support arthritis research, health education and government advocacy initiatives to improve the lives of people with arthritis. 

The Austin Arthritis Walk will be held on Saturday, May 19, 2007, Westlake High School.  Registration for the event begins at 9:00 a.m.; the walk begins at 10:00 a.m. You can also register on-line at www.austinarthritiswalk.kintera.org.

Thank you,
Jeseka Wallace
Texas Orthopaedic Association
2007 Austin Arthritis Walk Chair

• Intra-articular Neurotoxins May Offer Relief for Osteoarthritis Patients

• Effect Of Physical Activity On The Development of Knee Osteoarthritis

• National Arthritis Walk® Hero: Mia Alessandra Nieto

• Imaging Technique May Help With Understanding and Treating Osteoarthritis

• Thank You To Our Sponsors: Balcones Imaging Consultants & Carpe-eDatum

Intra-articular Neurotoxins May Offer Relief for Osteoarthritis Patients
  

Arthritis Today presents an American College of Rheumatology Report: Intra-articular Botulinum Toxin Type A May Offer Joint Pain Relief to Osteoarthritis Sufferers. Posted 2/12/07

Injections of intra-articular neurotoxins may offer relief from severe knee pain for osteoarthritis patients who are not candidates for joint reconstruction, according to research presented at the 2006 American College of Rheumatology Annual Scientific Meeting in Washington, DC.

For thousands of knee pain sufferers, arthroplasty is the solution of choice. This surgical replacement or reconstruction of the diseased joint restores function improves range of motion and decreases pain. However, for those who are too young, too old or too frail for such surgery, neurotoxins, which target the pain nerves within the joint, delivered to the knee joint cavity may provide sustained pain relief.

To determine the potential benefits of injecting a neurotoxin directly into the knee joint cavity, researchers embarked on a six-month study of Intra-articular Botulinum Toxin Type A (IA/BoNT/A) versus placebo in 37 patients with moderate to severe refractory knee pain due to osteoarthritis. IA/BoNT/A, otherwise known as Botox, disrupts pain nerve function and may reduce nerve-related inflammation.

The 36 men and one woman participating received either 100 units of IA/BoNT/A with lidocaine (a short-acting anesthetic) or a saline placebo with lidocaine. Double-blind assessments were scheduled for baseline, 1-month, 3-month and 6-month time points. Primary outcomes to be measured at each milestone include self-reported total pain score and a physical function score. A walking pain score, day pain severity, night pain severity and an observed timed-stands test were also measured.

At the 1-month interim analysis of this study, two placebo patients had dropped out from lack of benefit. Of the 18 patients in the severe pain group (half on IA/BoNT/A and half on placebo), there was a significant decrease in pain and improvement in physical function for those who received the botulinum toxin injection. Those injected with the placebo experienced minimal improvement. In the moderate pain group, neither injection produced significant changes in the primary outcome measures. Interestingly, in the moderate pain group, there was a 25% reduction in daytime pain severity after the placebo injections.

Three-month measurements will be completed by January of 2007, and the trial is scheduled for completion in August of 2007. To date, however, researchers point to clinically and statistically significant decreases in severe osteoarthritis knee pain and improvements in physical function.

“If this novel approach to local treatment for refractory join pain continues to prove beneficial, it offers a very welcome solution for fragile patients,” explains Maren L. Mahowald, MD, Rheumatology Section Chief at the Minneapolis VA Medical Center, Professor of Medicine at the University of Minnesota, Minneapolis, Minnesota, and principal investigator in the study. “Local joint treatment with injection could replace oral medications that carry the risk of systemic side effects, and may negate or delay the need for joint surgery. Much more research will be needed to determine the most effective and safe dose of toxin for the joint injections and the most appropriate dosing intervals.
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Effect Of Physical Activity On The Development of Knee Osteoarthritis
    

Posted 1/31/07 Felson DT, Niu J, Clancy M, Sack B, Aliabadi P, Zhang Y. Effect of recreational physical activities on the development of knee osteoarthritis in older adults of different weights: The Framingham Study. Arthritis Rheum (Arthritis Care Res) 2007;57:

What problem was studied? Regular physical activity is recommended for all people. However, how exercise affects the development of osteoarthritis (OA) is uncertain. One school of thought is that frequent load-bearing exercise causes cartilage to become thicker, thereby preventing knee OA. Another school of thought is that the repetitive motions associated with physical activity, particularly in overweight individuals, may contribute to the “wear and tear” component of knee OA. David Felson, MD, and his team from Boston University School of Medicine and Brigham and Women’s Hospital in Boston performed a longitudinal, prospective study examining the effect of recreational physical activity on the development of knee OA in people at risk for OA, many of whom were overweight or obese. Although this particular study was funded by the National Institutes of Health and Boston University, Dr. Felson has received two research grants from the Arthritis Foundation, one to study bone density and another to study the effects of vitamin K on OA. What was done in the study? Members of the Framingham Offspring study were recruited as part of a study of the inheritance of OA. Of the subjects, 1,279 were included in an evaluation of physical activity and OA development. The participants answered a questionnaire about physical activity, had knee X-rays taken and answered questions about knee symptoms. They then had the same evaluation approximately nine years later. The participants included older individuals (mean age, 53.2 years), many of whom were overweight (mean body mass index, 27.4), allowing the scientists to evaluate the effects of activity on OA development and to test whether weight had any influence on the results. What were the study results? Of the 2,259 knees evaluated at the end of nine years, 222 (9.8%) had narrowing of joint space evident in the X-rays, 215 (9.5%) developed OA apparent by X-ray and 173 (7.2%) had knee symptoms (pain and stiffness). Walking for exercise was the most commonly mentioned physical activity among the participants, and none of the measured parameters were affected by walking -- risk of developing OA was neither increased nor decreased by walking for exercise. Likewise, those exercising at a more vigorous intensity (enough to work up a sweat) had no greater risk of developing OA than participants who did not exercise. When analyzing the data separated by sex and body mass index, the results were the same. Those whose BMI was above the median of the group and who performed regular physical activity had no greater risk of developing knee OA than those whose BMI was below the median and engaged in regular exercise. What is the relevance to people at risk of developing OA? Patience White, MD, Chief Public Health Officer of the Arthritis Foundation pulls together the significance of this research. “The finding of Dr. Felson’s study of middle aged and elderly peoples’ physical activity levels and their risk of OA is welcome news for people who are at risk for developing osteoarthritis, the most common form of arthritis in the US, affecting 21 million Americans and resulting in significant joint pain and disability. This study reassures them that moderate to high intensity recreational physical activity with its many health benefits will not result in increasing their risk of developing painful osteoarthritis. Now middle-aged and older Americans at risk for osteoarthritis can act to improve their health by consulting their physician about following the Centers for Disease Control and Prevention recommendations to undertake 30 minutes of physical activity of at least moderate intensity most days of the week.” [top] [back to e-card archive page]

National Arthritis Walk® Hero: Mia Alessandra Nieto

Imaging Technique May Help With Understanding and Treating Osteoarthritis
  

	Recent years have seen an influx of new treatments for arthritis, with a number of drugs slowing or even stopping the progression of some forms of the disease. Yet treatment for the most common form of arthritis, osteoarthritis, is still limited to easing its symptoms. The problem, in
part, is the difficulty in measuring disease progression and determining if a treatment is making an impact on it. X-rays, which show narrowed joint space due to cartilage loss, are often used to monitor disease progression; however, they cannot show small changes in the joint, so it may take one to three years for joint deterioration to be detected. A new development by researchers supported in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has the potential to one day change that. By combining a technique called microcomputed tomography (microCT) – which yields high-resolution, three-dimensional x-ray images – with an x-ray-absorbing contrast agent, researchers at the Georgia Institute of Technology in Atlanta have been able to image the distribution of molecules called proteoglycans in the laboratory. The molecules are critical to the proper functioning of cartilage. "By detecting proteoglycan content and distribution, the technique reveals information about both the thickness and composition of cartilage," says Marc Levenston, Ph.D., associate professor in Georgia Tech’s George W. Woodruff School of Mechanical Engineering. "Both of these are important factors for monitoring the progression and treatment of osteoarthritis." Levenston and his colleagues first used the technique in vitro to monitor the breakdown of bovine cartilage samples and then to visualize the thin layer of cartilage in a rabbit knee. The next step of the research, which is being funded by a two-year grant from NIAMS, will be to study the use of the technique to nondestructively examine the cartilage of rat knee joints and then attempt to evaluate osteoarthritis progression and monitor cartilage changes in the same live rats over time. The researchers don’t know yet if the technique would be successful in people. "At this point, we are really focusing on developing it as a research tool for preclinical studies on small animals," says Levenston. "We feel that we may be able to provide a lot of additional information about disease progression, especially in the early stages, that can't currently be obtained." The hope is that their research will lead to ways to monitor cartilage changes with good resolution and little or no invasion of the tissue, and that eventually the technique will allow pharmaceutical researchers to obtain more detailed information about the effects of new drugs and other treatment strategies for osteoarthritis, Levenston says. In addition to NIAMS, funding for the research was provided by the Arthritis Foundation and National Science Foundation. The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the Department of Health and Human Services’ National Institutes of Health, is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS Web site by clicking here. Palmer AW, Guldberg RE, Levenston ME, Analysis of cartilage matrix fixed charge density and three-dimensional morphology via contrast-enhanced microcomputed tomography. PNAS 2006:103(51):19255-19260. [top] [back to e-card archive page]

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