Questions and Answers About Arthritis and Rheumatic Diseases, Page 5
This fact sheet answers basic questions about arthritis and rheumatic diseases. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has other fact sheets and booklets that provide more information about specific forms of arthritis and rheumatic diseases. NIAMS also has information about exercise and arthritis, pain and arthritis, and diet and arthritis. If you have further questions after reading this information, you may wish to discuss them with your doctor.
What Research Is Being Done on Arthritis?
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the National Institutes of Health (NIH), leads the Federal medical research effort in arthritis and rheumatic diseases. The NIAMS sponsors research and research training on the NIH campus in Bethesda, Maryland, and at universities and medical centers throughout the United States. Research activities include both basic (laboratory) and clinical (involving patients) research studies to better understand what causes these conditions and how best to treat and prevent them.
The NIAMS currently supports three types of research centers that study arthritis, rheumatic diseases, and other musculoskeletal conditions: Multidisciplinary Clinical Research Centers (MCRCs), Specialized Centers of Research (SCORs), and Core Centers. A list of these centers and their locations can be obtained from the Institute (listed at the end of this fact sheet).
The MCRCs are programs that focus on clinical research designed to assess and improve outcomes for patients affected by arthritis and other rheumatic diseases, musculoskeletal disorders (including bone and muscle diseases), and skin diseases. Each center studies one or more of the diseases within the NIAMS mission and provides resources for developing clinical projects using more than one approach.
Each SCOR focuses on a single disease. Currently, rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, osteoporosis, and scleroderma are being studied. Combining laboratory and clinical studies under one roof speeds up research on the causes of these diseases and hastens transfer of advances from the laboratory to the bedside to improve patient care.
Core Centers promote interdisciplinary collaborative efforts among scientists doing high-quality research related to a common theme. By providing funding for facilities, pilot and feasibility studies, and program enrichment activities at the Core Center, the Institute reinforces investigations already underway in NIAMS program areas. Current centers include Rheumatic Diseases Research Core Centers, Skin Disease Research Core Centers, and Core Centers for Musculoskeletal Disorders.
Research registries provide a means for collecting clinical, demographic, and laboratory information from patients and, sometimes, their relatives. These registries facilitate studies that could ultimately lead to improved diagnosis, treatment, and prevention. NIAMS currently supports research registries for rheumatoid arthritis, antiphospholipid syndrome (an autoimmune disorder), ankylosing spondylitis, lupus and neonatal lupus, scleroderma, juvenile rheumatoid arthritis, and juvenile dermatomyositis.
Some current NIAMS research efforts in rheumatic diseases are outlined below.
Biomarkers
Recent scientific breakthroughs in basic research have provided new information about what happens to the body’s cells and other structures as rheumatic diseases progress. Biomarkers (laboratory and imaging signposts that detect disease) help researchers determine the likelihood that a person will develop a specific disease and its possible severity and outcome. Biomarkers have the potential to lead to novel and more effective ways to predict and monitor disease activity and responses to treatment. The NIAMS supports research on biomarkers for rheumatic and skin diseases, including a new initiative on osteoarthritis. Additional studies on specific rheumatic diseases follow.
Rheumatoid Arthritis
Researchers are trying to identify the cause of rheumatoid arthritis in order to develop better and more specific treatments. They are examining the role that the endocrine (hormonal), nervous, and immune systems play, and the ways in which these systems interact with environmental and genetic factors in the development of rheumatoid arthritis. Some scientists are trying to determine whether an infectious agent triggers rheumatoid arthritis. Others are studying the role of certain enzymes (specialized proteins in the body that spark biochemical reactions) in breaking down cartilage. Researchers are also trying to identify the genetic factors that place some people at higher risk than others for developing rheumatoid arthritis.
Moreover, scientists are looking at new ways to treat rheumatoid arthritis. They are experimenting with new drugs and “biologic agents” that selectively block certain immune system activities associated with inflammation. Newly developed drugs include etanercept (Enbrel) and infliximab (Remicade). Followup studies show promise for their effectiveness in slowing disease progression. Studies for additional new drugs continue. Other investigators have shown that minocycline and doxycycline, two antibiotic medications in the tetracycline family, have a modest benefit for people with rheumatoid arthritis. Research continues in this area.
Novel studies using imaging technologies are underway as well. These techniques help identify targets for new drugs by allowing researchers to see changes in cells during the disease process.
Osteoarthritis
The NIAMS has embarked on several innovative approaches to understand the causes and identify effective treatment and prevention methods for osteoarthritis. Through a public/ private partnership, researchers are identifying biomarkers for osteoarthritis to help develop and test new drugs. Imaging studies designed to better identify joint disorders and assess their progression are taking place as well.
The National Center for Complementary and Alternative Medicine and the NIAMS at the National Institutes of Health are currently funding a study on the usefulness of the dietary supplements glucosamine and chondroitin sulfate for osteoarthritis. Previous studies suggest these substances may be effective for reducing pain in knee osteoarthritis. Researchers are also investigating whether they prevent the loss of cartilage.
Some genetic and behavioral studies are focusing on factors that may lead to osteoarthritis. Researchers recently found that daughters of women who have knee osteoarthritis have a significant increase in cartilage breakdown, thus making them more susceptible to disease. This finding has important implications for identifying people who are susceptible to osteoarthritis. Other studies of risk factors for osteoarthritis have identified excessive weight and lack of exercise as contributing factors to knee and hip disability.
Researchers are working to understand what role certain enzymes play in the breakdown of joint cartilage in osteoarthritis and are testing drugs that block the action of these enzymes.
Studies of injuries in young adults show that those who have had a previous joint injury are more likely to develop osteoarthritis. These studies underscore the need for increased education about joint injury prevention and use of proper sports equipment.
Systemic Lupus Erythematosus
Researchers are looking at how genetic, environmental, and hormonal factors influence the development of systemic lupus erythematosus. They are trying to find out why lupus is more common in certain populations, and they have made progress in identifying the genes that may be responsible for lupus. Researchers also continue to study the cellular and molecular basis of autoimmune disorders such as lupus. Promising areas of research on treatment include biologic agents; newer, more selective drugs that suppress the immune system; and bone transplants to correct immune abnormalities. Contrary to the widely held belief that estrogens can make the disease worse, clinical studies are revealing that it may be safe to use estrogens for hormone replacement therapy and birth control in women with lupus.
Scleroderma
Current studies on scleroderma are focusing on overproduction of collagen, blood vessel injury, and abnormal immune system activity. Researchers hope to discover how these three elements interact to cause and promote scleroderma. In one study, researchers found evidence of fetal cells within the blood and skin lesions of women who had been pregnant years before developing scleroderma. The study suggests that fetal cells may play a role in scleroderma by fostering the maturation of immune cells that promote the overproduction of collagen. Scientists are continuing to study the implications of this finding.
Treatment studies are underway as well. One study in particular is looking at the effectiveness of oral collagen in treating scleroderma.
Fibromyalgia
Scientists are looking at the basic causes of chronic pain and the health status of young women affected by fibromyalgia. The effectiveness of behavior therapy, acupuncture, and some alternative medical approaches for dealing with pain and loss of sleep are being tested. Researchers are also studying whether certain genes contribute to this disease.
Spondyloarthropathies
Researchers are working to understand the genetic and environmental causes of spondyloarthropathies, which include ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, and reactive arthritis (Reiter’s syndrome), as well as related conditions of the eye. They are also looking at new imaging methods that will help with early and accurate diagnosis, guide treatment, and detect responses to treatment. Research on new treatments is also underway.
The Health Partnership Program: A Local Diversity Outreach Initiative in the Rheumatic Diseases
In the winter of 2000, the NIAMS launched the Health Partnership Program (HPP), a local model of research and service that addresses disparities in preventing and treating rheumatic diseases in multicultural communities. The initiative focuses on four key areas: (1) public health education, (2) patient care, (3) access to clinical investigations, and (4) recruitment for research careers. The partnership includes community leaders and organizations representing the populations being served. They promote awareness of the program and its services and advise the Institute on community outreach activities.
One component of the HPP is the NIAMS Community Health Center located in Washington, DC. The health center provides a platform for conducting health disparities research by implementing the four key areas of the HPP. The center offers patients quality health care and health information in a community clinic setting. Patients are also given the option of participating in clinical studies. More information about the HPP is available at www.niams.nih.gov/hi/outreach/index.htm.
Where Can People Find More Information About Arthritis and Rheumatic Diseases?
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484 or
877-22-NIAMS (226-4267) (free of charge)
TTY: 301-565-2966
Fax: 301-718-6366
E-mail: niamsinfo@mail.nih.gov
www.niams.nih.gov
NIAMS provides information about various forms of arthritis and rheumatic diseases and bone, muscle, joint, and skin diseases. It distributes patient and professional education materials and refers people to other sources of information. Additional information and updates can be found on the NIAMS Web site. Listings of clinical trials recruiting patients who have or are at risk of developing a rheumatic disease can be found at www.ClinicalTrials.gov.
American Academy of Orthopaedic Surgeons
P.O. Box 2058
Des Plaines, IL 60017
Phone: 800-824-BONE (2663) (free of charge)
www.aaos.org
The academy provides education and practice management services for orthopaedic surgeons and allied health professionals. It also serves as an advocate for improved patient care and informs the public about the science of orthopaedics. The orthopaedist’s scope of practice includes disorders of the body’s bones, joints, ligaments, muscles, and tendons. For a single copy of an AAOS brochure, send a self-addressed stamped envelope to the address above or visit the AAOS Web site.
American College of Rheumatology/Association of Rheumatology Health Professionals
1800 Century Place, Suite 250
Atlanta, GA 30345-4300
Phone: 404-633-3777
Fax: 404-633-1870
www.rheumatology.org
This association provides referrals to rheumatologists and physical and occupational therapists who have experience working with people who have rheumatic diseases. The organization also provides educational materials and guidelines about many different rheumatic diseases.
Arthritis Foundation
1330 West Peachtree Street
Atlanta, GA 30309
Phone: 404-872-7100 or 800-283-7800 (free of charge)
or call your local chapter (listed in the telephone directory)
www.arthritis.org
This is the main voluntary organization devoted to arthritis. The foundation publishes free pamphlets on many types of arthritis and a monthly magazine for members that provides up-to-date information on arthritis. The foundation can provide physician and clinic referrals. The American Juvenile Arthritis Organization (AJAO) is under the umbrella of the Arthritis Foundation. It shares the same address, phone numbers, and Web site.
Acknowledgments
The NIAMS gratefully acknowledges the assistance of Barri Fessler, M.D., Cleveland Clinic Foundation, OH; John H. Klippel, M.D., Arthritis Foundation, Washington, DC; Reva Lawrence, M.P.H., NIAMS, NIH; Eric Matteson, M.D., Mayo Clinic, Rochester, MN; and Barbara Mittleman, M.D., NIAMS, NIH in the preparation and review of the current and earlier versions of this fact sheet.
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the National Institutes of Health (NIH), is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. The National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse is a public service sponsored by the NIAMS that provides health information and information sources. Additional information can be found on the NIAMS Web site at www.niams.nih.gov.
Publication Date February 2002
Source: NIAMS
