|
|
|
Profile in Research:
The Power of a Team
One of the Arthritis Foundation’s key prevention messages is that if you are
overweight, even modest weight loss can help you reduce your risk for knee
osteoarthritis (OA). This recommendation is based on research findings published
by David T. Felson, MD, MPH, Professor of Medicine and Epidemiology and
Principal Investigator of the Multidisciplinary Clinical Research Center at
Boston University. In the 1980s, Dr. Felson and his colleagues were the first to
provide strong evidence linking obesity to the development of knee OA. They
later found that women who lost about 11 pounds over the previous ten years
decreased their risk in half for developing knee OA. For this work, as well as
his many other outstanding research contributions, Dr. Felson was awarded the
2004 Lee C. Howley Sr. Prize for Arthritis Research, the Arthritis Foundation’s
highest research honor. The award is not only a testament to Dr. Felson’s
individual achievements but also reflects the tremendous synergistic impact that
can be achieved by a collaborative research team. As he says, “Physicians can’t
make much progress working by themselves. They need to collaborate with experts
in study design, statistics, in non-medical impacts of disease and from other
fields to bring important insights into arthritis prevention and treatment.”
A Team Effort
Over his 20-year career, Dr. Felson has been part of Boston University’s
Arthritis Center research team, becoming the Center’s director in 1993. The
National Institutes of Health (NIH) and the Arthritis Foundation have played
complementary roles in supporting the Boston team. The National Institute of
Arthritis and Musculoskeletal and Skin Diseases (NIAMS) at NIH funds research
projects as well as the Center’s infrastructure which fosters interdisciplinary
research teams. Arthritis Foundation grants support specific research projects,
particularly for team members early in their careers. This dual support has
allowed researchers representing different scientific
disciplines—rheumatologists, behavioral scientists, epidemiologists, health
services researchers, statisticians and others—to integrate their different
research tools, approaches, and technologies. The successes of Dr. Felson and
his colleagues show that this collaborative approach can greatly accelerate
research progress and more powerfully address major public health issues.
A Snapshot of Success
Dr. Felson’s contributions to the arthritis field began early in his career,
when during his fellowship, he conceptualized the “Framingham OA Study.” Since
the 1940s, researchers had been studying heart disease in the residents of a
Boston suburb called Framingham. Felson recognized that this aging study
population provided a unique opportunity to learn more about what causes and how
to prevent knee OA. Supported by an NIH Center grant and an Arthritis Foundation
Arthritis Investigator Award, he began the Framingham OA study in 1984.
Dr. Felson and his colleagues applied the same rigorous epidemiologic approaches
that had been used in cancer and heart disease to study OA—first with the
original Framingham study population, then with this group’s offspring and
extending their work through multicenter studies and even abroad. These
population studies provided important insights about the complex causes of OA,
including behavioral and environmental risk factors such as obesity, estrogen
use, occupational joint overload, bone density and nutritional factors, as well
as genetic factors that may protect against or increase the risk for developing
OA. Similarly, by instituting the Framingham Osteoporosis Study, Felson’s group
has contributed many insights about risk factors in osteoporosis. Such work has
been key in identifying possible prevention strategies in OA and osteoporosis.
The group has also helped to document the impact of OA, informing public health
efforts. For instance, they showed that knee OA is the leading cause of mobility
disability among elders and that even hand OA, often considered a minor issue,
is a very common problem that can significantly impair hand function in older
adults.
More recently, Boston team members, Dr. Felson and Dr.Yuqing Zhang conducted the
first international comparative epidemiology study in OA. Along with an
international research team, they studied OA prevalence and risk factors in
China and the U.S., expanding our understanding of how racial differences might
impact prevalence. A high prevalence of knee OA is a major public health problem
in China, where access to total joint replacement is limited. The study
documented that despite their thinner size, the Chinese were more likely to have
knee OA than American Whites—due in part to the common Chinese practice of
squatting, which increases stress on the knee joint. Chopstick use was
associated with an increased risk of OA in finger joints, supporting the
important role that repetitive, mechanical stress plays in the development of
OA. On the other hand, they showed that the Chinese did not exhibit the hip
abnormalities associated with hip OA in the U.S., providing a persuasive
explanation for the lower rate of hip OA in China.
In addition to providing insights about OA risk factors and impact that are
guiding prevention strategies and public health efforts, Felson’s team has
increased understanding about what happens in the disease, which could improve
its diagnosis and management. In 2003, their research on the use of magnetic
resonance imaging (MRI) to understand OA was among that recognized by the
Arthritis Foundation as one of the year’s Top Ten Arthritis Research Advances.
After following people with and without knee pain over time using MRIs and
x-rays, Dr. Felson and his colleagues published several pivotal papers about
sources of knee pain and what factors contribute to OA disease progression. MRIs
identified many sources of pain not evident on x-rays, including abnormal
changes in the bone and treatable disorders of the tissues around the joint
(such as bursitis)—expanding the management options that can be considered to
treat knee pain. This research also showed the importance of bone changes and
knee alignment in disease progression. In addition, these studies demonstrated
how MRIs could make it easier to test new OA treatments in clinical trials by
identifying study subjects that are more likely to progress and providing a more
effective way to monitor disease progression. This work helped lay the
groundwork for the Osteoarthritis Initiative, a new, 5-year, multicenter study
funded by NIH and private industry that will gather MRI and other data on people
with knee OA or at high risk of disease. This major effort will greatly enhance
our understanding of OA and how to prevent and treat it.
Other Current Activities
Supported by NIH funding and an Arthritis Foundation Clinical Sciences Grant and
upcoming Innovative Grant, Dr. Felson is continuing his work to increase
understanding of how to prevent and control OA and osteoporosis. His current
team includes several highly promising researchers who also have been supported
by the Arthritis Foundation. A look at their ongoing activities provides a
glimpse of future progress in several other important areas (see side bar).
In his nomination materials for the Howley Prize, his colleagues called Dr.
Felson a “preeminent scientist” in the field of arthritis epidemiology, “a
leader over a lifetime,” and someone whose “prolific work has influenced
arthritis researchers in the U.S. and around the world.” Clearly the work of Dr.
Felson and that of his team will continue to make a major and lasting
contribution to the arthritis field.
Side bar:
Saralynn Allaire, ScD, just completed an Arthritis Foundation Clinical
Science Grant to learn more about the rates and causes of work disability
associated with knee OA, research that is being continued with support from NIH.
Other current projects include evaluating the effectiveness of job retention
vocational rehabilitation services among employed persons with arthritis or
lupus, and studying a large, national sample to determine current rates of
rheumatoid arthritis-related work disability and risk factors.
Kristin Baker, PhD, a former Arthritis Foundation Doctoral Dissertation
Award recipient, currently has an Arthritis Foundation New Investigator Grant
evaluating the use of a computer-based telephone counseling system to encourage
long-term strength training exercise in people with knee OA. She is also
interested in developing and testing nutritional interventions for OA. At the
2004 American College of Rheumatology (ACR) annual meeting, she presented work
on the relationship between low vitamin D levels and knee pain and disability.
Michael LaValley, PhD, is a former Arthritis Foundation New Investigator
Grant recipient. He is currently working on development of methods for
evaluation of biomarkers for OA, meta-analysis of arthritis clinical trials,
defining progression of knee OA from MRI data, and methods of screening for knee
OA.
Grace Lo, MD, MSc, will soon begin an Arthritis Foundation Arthritis
Investigator Award, jointly funded by the ACR Research and Education Foundation
to study abnormal bone changes in the Boston OA Knee Study, specifically
clarifying how they evolve, and evaluating their relation with pain and
cartilage. At the 2004 ACR annual meeting, she presented data from her study of
local bone mineral density at the knee and its relation to bone changes and pain
in the Framingham population.
Tuhina Neogi, MD, FRCPC, has an Arthritis Foundation Postdoctoral
Fellowship Award to study the relationship between vitamin K status and
osteoarthritis and chondrocalcinosis in the Framingham population. In
recognition of her promising work, she recently won an Abbott Scholar Award.
Yuqing Zhang, DSc, MPH, MB, has an Arthritis Foundation Clinical Science
Grant to do an internet-based study of causes of repeat acute attacks in people
already diagnosed with gout. At the recent ACR annual meeting, he presented some
important findings about the role of alcohol, diuretic use and purine intake as
triggers of repeat attacks, providing useful information on strategies to
prevent attacks and further disability. Building on earlier work on bone mineral
density and estrogen in osteoporosis, he is also studying the risk of cancer and
other estrogen related diseases.
  
|
