Arthritis: A Joint Effort

Government and Private Researchers Seek to Understand -- And Improve -- Treatment For Osteoarthritis

Jim Jensen, age 48, director of congressional and government affairs at the National Research Council in the District, officially joined the tens of millions of Americans with osteoarthritis this month, when his podiatrist diagnosed the disease in both his feet. It wasn't entirely a surprise.

Although he's relatively young for such a diagnosis, he suspected arthritis because his feet "would get incredibly sore sometimes -- not just walking, but in the morning, upon waking up." In addition to the pain, he noticed that his feet were very stiff at times. "I could hardly walk outside to get the paper," he says.

Now that Jensen knows what's causing the discomfort, the question is what can he do to maintain his mobility and slow the course of this disease, the most common form of arthritis.

"I'm only 48 years old. What's it going to be like 30 years from now?" Jensen wonders.

Unfortunately, there are no good answers. The best available therapies for osteoarthritis (See "Treating Osteoarthritis: Current Options" on Page F7.) relieve pain and improve function, but can't stop progression of the disease, a leading cause of disability that accounts for billions of dollars in health care costs and lost wages each year. If impairment becomes severe, joint replacement or other surgery is usually the only remaining option; osteoarthritis is the most common reason for total knee and hip replacement.

In the last decade or so, research has begun to shed light on what goes wrong in people who have osteoarthritis. Although these advances should provide opportunities to prevent, slow or even reverse disease progression, drug development and testing have been hampered by a lack of reliable, objective ways to diagnose the disease in its earliest stages or measure its progression.

Now, a collaboration between the federal government and private drug makers aims to address these problems, just as millions of Jensen's fellow baby boomers begin to swell the ranks of the afflicted. The National Institutes of Health (NIH) and four pharmaceutical companies (GlaxoSmithKline, Merck, Novartis and Pfizer) are joining to support a seven-year study of 5,000 people with early osteoarthritis of the knee -- one of the most commonly affected joints -- or at high risk of developing it.

The Osteoarthritis Initiative, set to begin recruiting patients in May 2003, will be the first study to characterize the onset and early progression of the disease, says Gayle Lester, program director for the initiative at NIH's National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Its findings could spur development of treatments that "can have a much greater impact on the population with regard to disease prevention," says Marc Hochberg, who heads the Division of Rheumatology at the University of Maryland School of Medicine and was part of a group that helped plan the initiative.

Results of this research are not expected soon, but the effort may offer hope for Jensen and others like him.

A Growing Problem

Researchers used to think osteoarthritis was a simple case of age-related wear and tear. But recent studies indicate the disease process is more complicated, varies among individuals and involves numerous risk factors. Furthermore, it remains unclear why some of the 21 million Americans with the condition have more pain and disability than others.