ENACT's recent webinar, "Results of Two Clinical Trials Testing Interventions to Support Continued...
Category: Winter 2014 Newsletter
The time to register for the Arthritis State of the Science Meeting Promoting Activity and Participation among Persons with Arthritis is now! The deadline to register March 28th.
Join us for this one-day conference at the Ritz Carlton in Pentagon City, VA on April 7th, 2014. Evidence-based approaches to address promoting activity and participation among persons with arthritis across rehabilitation, community and employment settings will be discussed. Our speaker panel includes experts from advocacy organizations, federal government, clinical professional organizations, as well as leading scholars. The dialogue created by bringing together these experts will serve the ultimate goal of moving the arthritis activity and participation research and policy agenda forward.
On the afternoon of April 6th, ENACT will hold its New Investigator Workshop on Advancing Arthritis Research to foster growth in the area of rheumatological rehabilitation research. We had an enthusiastic response to our call for applications and are very pleased to have accepted 20 outstanding new investigators. Applicants represent distinguished international academic and clinical institutions in the field of arthritis research.
The Workshop aims to enhance the capability of new investigators to employ innovative and novel research methods to address critical clinical research questions. The Workshop will include opportunities for individual mentoring, as well as presentations on using large data sets and selecting optimal outcome measures.
Register now for the meeting! We hope you will join us for this exciting opportunity for interdisciplinary discourse.
Story by Ammarah Usmani
Many myths exist regarding arthritis. Perhaps the most common is that arthritis is not a serious public health issue. This myth is easily disputed by the following facts derived from the Arthritis Foundation:
Arthritis is a leading cause of disability in the United States and the leading cause of mobility limitation
Arthritis is actually a more frequent cause of activity limitations than heart disease, cancer or diabetes
By 2030, an estimated 67 million Americans will have arthritis, unless the trend is reversed
Although these findings seem daunting, increased awareness of arthritis as a serious health threat has led to an increase in research efforts to better understand and treat arthritis and other rheumatic conditions that include diseases, such as Lupus, Scleroderma, and Fibromyalgia. Because these conditions can affect all aspects of a person’s life, a comprehensive approach to research projects and training activities is needed.
Boston University’s clinical arthritis research program is university-wide and includes the BU School of Medicine (BUSM) Department of Clinical Epidemiology Research and Training, BUSM Scleroderma Research Center, and Center for Enhancing Activity and Participation among Persons with Arthritis (ENACT) at the BU College of Health and Rehabilitation Sciences. These groups are engaged in ongoing research projects to identity factors that may be causes of arthritis and rheumatic diseases as well as factors that prevent disease progression and promote active living.
Founded by Director Dr. Julie Keysor in 2010, the ENACT Center collaborates with the Arthritis Foundation’s New England Chapter and students and researchers from Boston University’s School of Medicine, School of Public Health, and School of Communications to improve the lives of individuals with arthritis through various means, such as engaging in investigative research, training the next generation of clinical researchers, and disseminating evidence-based information to consumers in Greater Boston.
Supported by the National Institutes of Health, the BUSM Clinical Epidemiology Research and Training Unit is led by Director David Felson, MD, MPH, and Assistant Director Tuhina Neogi, MD, PhD, FRCPC. Established in 2001, the department is an internationally recognized center in research and training, designed to advance basic, clinical, and epidemiological research in rheumatology and to translate clinical findings into new therapeutic strategies. A focus of this group’s research is osteoarthritis, the most common type of arthritis. Faculty also have expertise in general rheumatology.
Supported by the National Institute of Health (NIH) and Scleroderma Foundation, Boston University School of Medicine’s Scleroderma Program is one of the world’s leading centers of scleroderma treatment and research. For those who aren’t quite familiar with the illness, “Scleroderma, or systemic sclerosis, is a chronic connective tissue disease generally classified as one of the autoimmune rheumatic diseases. The word “scleroderma” comes from two Greek words: “sclero” meaning hard, and “derma” meaning skin. Hardening of the skin is one of the most visible manifestations of the disease. However, the scarring process that affects the skin also affects internal organs, leading to severe life-threatening complications in the lungs, intestines and kidneys.
Dr. Lafyatis works closely with the BUMC Rheumatology Section Chief, Dr. Robert Simms; the Arthritis Center Director, Dr. Maria Trojanowska; and a research team consisting of 30 investigators, including basic scientists, specialists, and trainees of various fields. Dr. Lafyatis said uncovering the cure for the condition will require much more effort. “I don’t see a cure coming anytime soon,” he said. “But we feel several of the medications we are currently studying provide great hope for finding better treatment for this very difficult illness.”
Arthritis and other rheumatic conditions are becoming more and more widespread, but thanks to BU researchers, the mysteries of the illness are beginning to unravel. An increasing number of affected people can be treated, learn how to improve their lives, and discover that, despite the illness, there are still ways to experience life as they wish.
Story by Ammarah Usmani
ENACT’s Project 3 is a two-part study investigating the impact of total knee replacement on participation, which is defined as participating in “life roles”, such as home and community activities like taking care of one’s home, attending social activities, and managing one’s health. Part one of Dr. Maxwell’s study uses data from the Multicenter Osteoarthritis Study (MOST)a large cohort study of over 3000 people in Iowa and Alabama with or at risk of knee osteoarthritis and the Osteoarthritis Initiative (OAI), a similar study of over 4000 subjects from four study sites. Participation was measured in these studies using the Late Life Function and Disability Instrument (LLDI), which was developed by disability researchers at Boston University. Initial results show that approximately 1/3 of people after knee replacement are having trouble with respect to participation. This information is significant given the recent dramatic rise in total knee replacement, a figure that is projected to continue increasing with the prevalence of knee osteoarthritis in the population. “As the population of older people with knee osteoarthritis is increasing, more people are getting knee replacements, so it’s important to know how they can improve their lives and what they can do to lessen pain,” Maxwell said. In part 2 of the project, Dr. Maxwell is conducting individual interviews with people who have reported continued difficulty with community participation 1 to 5 years following total knee replacement surgery. The goal of this study is to gain a better understanding of home and community participation following total knee replacement by exploring people’s perceptions regarding the factors that make participation difficult.
“The first step to finding solutions is to identify it as a problem,” Maxwell said. “Our studies have begun to prove that, so as we go on, we can begin to see how the problems can be solved.”
Findings from the first part of Dr. Maxwell’s research have been published in the Physical Therapy Journal. The article, titled “Participation following knee replacement: The MOST cohort study” appeared in the November print version of PTJ.
Dr. Maxwell is a Clinical Assistant Professor at Boston University’s Sargent College of Health and Rehabilitation Sciences and is a collaborator with Boston University School of Medicine’s Clinical Epidemiology Unit. She is a board certified Orthopedic Clinical Specialist and received her Doctorate of Physical Therapy from Massachusetts General Hospital Institute of Health Professions.
Story by Ammarah Usmani
The OA Action Alliance plays a unique role as a coalition of key organizations focused on OA. Member organizations include leaders in arthritis advocacy and research, including the Arthritis Foundation and the Centers for Disease Control and Prevention (CDC). In its mission statement, the OA Action Alliance commits to “elevating OA as a national health priority and promoting effective policy solutions that aim to address the individual and national toll of OA.” Through its work with the public health community, the OA Action Alliance helps to link people with OA to effective and proven interventions.
In particular, the Physical Activity Work Group promotes low impact, moderate intensity aerobic physical activities for adults living with OA. The work group’s initial goals are to identify and disseminate evidence-based physical activity programs that could foster physical activity adherence among people with arthritis. Follow the activities of the OA Action Alliance, or better yet, join the coalition and help make a physically active lifestyle a reality for millions of Americans.
Story by Ammarah Usmani
Dr. David Felson, Chief, Boston University Clinical Epidemiology Research and Training Unit, and Director of ENACT’s Doctoral Training Program, and internationally recognized for excellence in arthritis research, was featured in an interview that recently aired on National Public Radio (NPR). Dr. Felson discussed the evidence regarding use of glucosamine and chondroitin supplements for pain reduction in people with osteoarthritis.
While previous studies provided initial support for the notion that glucosamine and chondroitin might reduce the pain associated with osteoarthritis, results from a clinical trial show no difference between persons who were given glucosamine and chondroitin and those receiving a placebo control. In fact, both groups showed similar results – approximately 60 percent of persons with arthritis showed a 20 percent reduction in pain.
As Dr. David Felson explained, the nutritional supplement “didn’t relieve pain any better than placebo. It basically didn’t have any effect.”
Dr. Patience White, MD, MA, a rheumatologist, Vice President of Public Health Policy and Advocacy for the Arthritis Foundation, and an ENACT advisory board member, also participated in the NPR interview. Dr. White noted that losing weight and engaging in exercise may be a more effective treatment for osteoarthritis pain. “It’s quite striking,” notes Dr. White, “if you lose only five pounds, you’re talking about the equivalent of 20 pounds [less stress] across those knees, so you can imagine it would make quite a difference.”
Dr. Felson noted that persons who experience a reduction in pain when taking glucosamine and chondroitin could continue taking them, but agreed with Dr. White regarding the importance of exercise. “Pretty much any type of exercise seems to reduce pain and increase flexibility,” said Felson. “There have been a variety of different exercise studies which have tried everything from water aerobics to walking to muscle strengthening, and they all seem to work.”
The importance of increasing activity as a strategy for managing arthritis is central to ENACT’s mission. Results from the BOOST study, which investigates innovative methods to encourage adherence to exercise programs, will be available soon!
The complete NPR interview with Drs. Felson and White is available here.
Story by Ammarah Usmani