Earlier Identification Can help Slow the Progression of Osteoarthritis

By Ankit Bansal, BS, Eric Strauss, MD, and Laith M. Jazrawi, MD

The rapidly aging population of the nation’s Baby Boomers has been the root of much concern among healthcare providers. According to 2010 United States Census data, the nation’s population between 45 and 64 years of age has risen 31.5 percent from the previous decade and the number of Americans over the age of 65 has grown 13.1 percent.1 These sizeable increases are associated with a concomitant rise in disease prevalence across most healthcare disciplines. This is especially true in orthopaedic surgery, where the rate of degenerative joint disease, or osteoarthritis (OA), is expected to escalate dramatically with the aging Baby Boomer generation. Progressive osteoarthritis can potentially result in debilitating pain, longstanding dysfunction and a severely diminished quality of life.

To date, the diagnosis of osteoarthritis has mainly depended on the 1986 criteria of the American College of Rheumatology, which takes into account patients’ age, clinical signs and symptoms, as well as radiographic and laboratory evidence.2 Yet this diagnosis usually is made after the presence of longstanding disease, as clinical and radiographic signs surface only after years of repetitive joint damage. Though no absolute cure for osteoarthritis exists short of total joint replacement, recently developed medical and surgical techniques may significantly slow its progression. To this end, recent efforts in orthopaedic research have focused on methods to obtain a diagnosis at an earlier and more treatable stage as well as specific management tools to help limit the extent of disease and slow its natural history.

Looking at Joint Disease from a New Perspective

In order to further medical science, researchers and clinicians must integrate basic biologic principles with cutting-edge technologies in an effort to provide translational, collaborative, world-class patient care. As part of this mission, the leadership at NYU Langone’s Hospital for Joint Diseases recently opened the Joint Preservation Center of New York (JPC), providing access to the expertise of dedicated physicians and advanced diagnostic imaging studies to detect and treat early arthritic changes in joints. One such modality that is employed is biochemical-based magnetic resonance imaging (MRI). Techniques such as T2 mapping, T1rho imaging (spin lattice relaxation in the rotating frame), and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) have shown efficacy at visualizing early signs of degeneration in hyaline cartilage.3

Each of these techniques utilizes a certain part of the cartilage anatomy to formulate its image. For example, T2 mapping measures the intricate balance between water and collagen molecules within the cartilage tissue. T1rho imaging measures a similar interaction, except between hydrogen and free-water macromolecules. dGEMRIC effectively quantifies glycosaminoglycan (GAG) concentrations within cartilage substance; a low GAG content indicates an area of damaged articular cartilage.3 Several studies have reported superior diagnostic potential with use of these modalities when compared to conventional methods.

Once an earlier diagnosis of osteoarthritis is made, then potential prevention strategies can be implemented accordingly. Though a general consensus on ways to prevent osteoarthritis is still lacking, experts at the Joint Preservation Center remain committed to helping slow the disease process while promoting symptom relief and functional improvement. They provide highly-innovative surgical and non-surgical techniques to treat pain and delay arthritic progression. Conservative strategies include the use of hyaluronic acid (HA) viscosupplementation, bone-marrow derived mesenchymal stem cells (BMSCs), platelet-rich products, and patient-specific rehabilitation protocols. Surgical options include chondroplasty, microfracture, osteotomies, osteochondral grafting techniques, and other cell-based strategies such as autologous chondrocyte implantation (ACI) and DeNovo NT juvenile chondrocyte implantation.

Along with offering advanced patient-based care, these experts believe that through biologic solutions, they can gain insight into the microenvironment of patients’ injured joints. Researchers at the JPC are actively conducting multiple research trials to analyze synovial (joint) fluid from diseased as well as healthy joints. Results of these analyses may yield more individualized patient-care by supplying relevant prognostic information for each injury. For example, joint fluid analysis of a relatively healthy male who suffered a knee meniscus tear while playing basketball may provide insight into the severity of his injury. Joint fluid analysis may point to using specific treatments, either surgical or non-surgical, that may reduce symptoms and provide functional improvement, while delaying the potential need for joint replacement surgery. And judging from the level of damage that has occurred, it may even predict disease progression within the knee. Thus, by combining synovial fluid analysis with biochemical-based MRI techniques, researchers at the JPC are working toward a better understanding of the sources of joint damage, the body’s response to these injuries, and the development of specific treatment algorithms for future patients.

Another component of the multidisciplinary research and care at the JPC is the ability for patients to enroll in the Joint Preservation Registry. This registry collects patient-provided information regarding their level of pain, dysfunction and overall morbidity. It also collects data on the various management techniques used to treat their conditions, correlating outcomes with their patient specific information. This registry data can then be used by physicians to further optimize the care of their patients.

With an aging population and an increasingly complex health care system in the U.S., it becomes critical for physicians, scientists and health care professionals to stay dedicated to preserving natural joint function for as long as possible. The integrated clinical and research approach provided at the JPC aims to identify degenerative arthritis at an early, treatable stage with the goals of minimizing the need for joint replacement in the management of osteoarthritis. This evidence-based approach to joint care, with potential early interventional modalities to alter the natural course of degenerative joint disease, can potentially revolutionize the management of arthritic conditions.

Ankit Bansal, BS, is a research associate at NYU Langone’s Hospital for Joint Diseases; Eric Strauss, MD, is assistant professor of orthopaedic surgery and co-director of the Hospital for Joint Diseases’ Joint Preservation Center (JPC) at NYU Langone Medical Center; and Laith Jazrawi, MD, is associate professor of orthopaedic surgery, director of the sports medicine division and co-director of the JPC.; .

References

• Bureau USC. 2010 Census Shows Nation's Population is Aging. http://2010.census.gov/news/releases/operations/cb11-cn147.html. Accessed 1/3/2012.
• Altman R, Asch E, Bloch D, et al. (1986). Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum; 29(8):1039-1049.
• Jazrawi LM, Alaia MJ, Chang G, Fitzgerald EF, Recht MP. (2011). Advances in magnetic resonance imaging of articular cartilage.J Am Acad Orthop Surg;19(7):420-429.