Flinders Medical Centre Foundation
Flinders Medical Centre Foundation




New Research To Soothe Sore Joints

Improving Longer Term Outcomes For Joint Replacement Patients

Researchers Revolutionise The Treatment Of Rheumathoid Arthritis 


New Research To Soothe Sore Joints
First Published: Investigator - August 2008


Despite osteoarthritis being the leading cause of joint replacement and the most common form of arthritis world-wide, very little is known about the mechanisms which lead to this degenerative condition.


Flinders researchers are hoping to change this with a study into the effects of treating the inflammation of osteoarthritis at the very early stages of the disease.


Professor Malcolm Smith, Senior Consultant at the Rheumatology Unit at the Repatriation General Hospital, and Professor Peter Roberts-Thomson, Head of Immunology at Flinders Medical Centre, are looking at whether corticosteroid injections can help the inflammatory changes which take place in the joint in the early stages of osteoarthritis, and whether this can lead to clinical improvement.


Osteoarthritis is a progressive disorder of the joints caused by gradual deterioration of cartilage that results in the painful development of bony spurs and cysts, particularly in weight-bearing joints such as the knees and hips.


Rather than focusing on the cause of osteoarthritis, current treatments concentrate on the symptoms, namely the pain, which is managed with pain relievers or anti-inflammatory treatments or, in later stages of the disease, joint replacement.


“At the moment treatment is limited, and patients are basically waiting for their joint to fail and have it replaced,” Professor Smith said.


Professors Smith and Roberts-Thomson hope that if they can prove that the chronic inflammation in the early stages of osteoarthritis can be reduced, progression to late stage disease requiring joint replacement surgery can be prevented.


“If we can demonstrate that the inflammation that is low grade, but known to occur in osteoarthritis, is relevant to the disease progression we can change the treatment to target inflammation rather than just treating the symptoms, which would prevent the gradual damage which is occurring to the joint,” Professor Smith said.


Improving Longer Term Outcomes For Joint Replacement Patients
First Published: Investigator - August 2006

Each year between 400 and 450 people face the prospect of joint replacement surgery largely due to the damage caused by arthritis. While many of this group are over 70 years old, around 30-40% are younger.


It is people in this younger group who face a higher risk of needing further joint replacement surgery due to the first replacement joint wearing out. Current statistics indicate that between 95-98% of hip and knee replacements last in excess of 15 years in people 65 and above, however for those in the 50-65 year age group the replacements only last around 10 years.


For Professor Jegan Krishnan and his team of researchers at Flinders Medical Centre the focus is on introducing new materials that will help to reduce wear and subsequent need for further surgery.


“The problem we have is that each time a person needs to replace the worn out artificial joint, the procedure is more complex and the loss of bone stock generally means that the joint will not last that long again – only half the time,” says Professor Krishnan.


Currently most common joints are made out of plastic and metal. However, the plastic tends to wear and the debri from this can lead to an inflammatory response in the joint causing it to become loose.


Professor Krishnan and the team are trialling a number of surfaces including metal on metal, ceramic on plastic and a new surface called oxonium with the aim of reducing wear and helping to ensure that the implants will last longer.


To aid their research they are using a technique called Radio Stereometric Analysis (RSA). This involves placing radiographic markers in and around the implant and by measuring the relative movement between these markers they can predict how long these implants are going to last. The benefit of this technique is that it can show within 18 months to two years whether the new surfaces are going to be significantly beneficial to the patient.


“Rather than wait 15 years to introduce a new material with this technique we can work out if it is safe or as safe as previously used devices and whether it is going to be a better long term outcome for patients,” says Professor Krishnan.


Researchers Revolutionise The Treatment Of Rheumathoid Arthritis
First Published: Investigator - August 2003
Updated: July 2011

After more than a decade of international collaboration, Flinders researchers have helped to develop a new therapy for the treatment for rheumatoid arthritis - a debilitating disease that effects 2% of the population.

Rheumatoid arthritis is the most common form of inflammatory arthritis in the western world, affecting most small joints in the body. While there is no cure, Flinders research, led by Professor Malcolm Smith, Head of Rheumatology at Flinders Medical Centre, has made a number of significant advances in the pain management and slowing the progression of this devastating disease.

Flinders investigators continue to work on early diagnosis and pain management of rheumatoid arthritis to help slow the progression of the disease. The FMC Arthritis Tissue Bank, established in 1996 by Professor Smith, provides a rich resource for researchers wanting to understand the impact of existing and new drug therapies. This resource has been utilised by many research groups both within Australia and internationally, to further our understanding of this inflammatory joint condition.

This research is now resulting in significant breakthroughs in the treatment of Rheumatoid Arthritis, with a number of new, more effective treatments available on the PBS and the promise of more to come in the near future.

These treatments will revolutionise the treatment of Rheumatoid Arthritis but are costly (about $25,000 per year to treat one patient), so selecting the right patient for the right treatment is important.

The latest study being undertaken by Professor Smith’s research group, run by his PhD student Dr. Mihir Wechalekar, is using the Tissue bank resource to try and find answers to this problem of treatment selection.

"At present our research efforts are establishing whether taking a biopsy before someone starts treatment will direct what their outcome will be or, alternatively, by taking the biopsy during treatment we can determine whether the treatment is working or not, and if so change the therapy,” Professor Smith said. “Ultimately, we want to avoid treating people unnecessarily."

Professor Smith was awarded a member of the Order of Australia in the Queens Birthday honours in 2011 in recognition of his service to Australian Rheumatology and Rheumatology research.

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