Arthritis Information

What Research Is Being Done On Arthritis And Rheumatic Diseases

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health (NIH), leads the Federal medical research effort in arthritis and rheumatic diseases. NIAMS sponsors research and research training on the NIH campus in Bethesda, Maryland, and at universities and medical centers throughout the United States. Both clinical studies (involving patients) and basic (laboratory) research result in a better understanding of what causes these conditions and how best to treat and prevent them.

NIAMS currently supports three types of research centers that study arthritis, rheumatic diseases, and other musculoskeletal conditions: Centers of Research Translation (CORTs), Multidisciplinary Clinical Research Centers (MCRCs), and Research Core Centers (RCCs). A list of these centers and their locations can be obtained from the Institute (See "Where Can People Find More Information About Arthritis and Rheumatic Diseases?")

CORTs are designed to bring together basic and clinical research in a way that helps translate basic discoveries into new drugs, treatments, and diagnostics. Currently there are four CORTs, including one focusing on lupus and another focusing on scleroderma.

MCRCs 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.

RCCs 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 RCCs, the Institute reinforces investigations already under way 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 from their relatives. These registries facilitate studies that could ultimately lead to improved diagnosis, treatment, and prevention. NIAMS currently supports research registries for rheumatic diseases such as rheumatoid arthritis, fibromyalgia, antiphospholipid syndrome (an autoimmune disorder), ankylosing spondylitis, lupus and neonatal lupus, scleroderma, juvenile idiopathic arthritis, and juvenile dermatomyositis.

Some current NIAMS research efforts that pertain to 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 both the likelihood that a person will develop a specific disease as well as its possible severity and outcome. Biomarkers have the potential to lead to novel and more effective ways of predicting and monitoring both disease activity and responses to treatment. NIAMS supports research on biomarkers for rheumatic and skin diseases, including initiatives to identify and validate biomarkers for osteoarthritis and lupus.


PROMIS

NIAMS has responsibility for managing an NIH-wide initiative known as PROMIS (Patient-Reported Outcomes Measurement Information System). The goal of this initiative is to develop ways to measure patient-reported symptoms such as pain and fatigue as well as other aspects of health-related quality-of-life across a wide variety of chronic diseases and conditions. Arthritis and many other diseases that compromise daily life involve pain, fatigue, and other quality-of-life outcomes that are hard to measure. A means of measuring changes in these symptoms could enhance clinical research and practice, providing a significant benefit to patients and their health care providers.

Studies on specific rheumatic diseases are described as follow.

Fibromyalgia

In recent years, NIAMS has supported an increasing amount of research into this condition, which is not well understood. Scientists are using imaging studies of the central nervous system to better understand the overresponsiveness to painful stimuli in people with this disorder. They are studying the role of sex hormones, stress, and other factors on fibromyalgia. They are also examining the effectiveness of behavior therapy, exercise, medications, micronutrients, acupuncture, and other alternative approaches for dealing with pain, fatigue, and loss of sleep.
Osteoarthritis

NIAMS has embarked on several innovative efforts to understand the causes and identify effective treatment and prevention methods for osteoarthritis. Through a public/private partnership, researchers are identifying biomarkers for osteoarthritis that will help develop and test new drugs. Imaging studies designed to better identify joint disorders and assess their progression are taking place as well.

NIHs National Center for Complementary and Alternative Medicine and NIAMS funded a major, 16-center study on the usefulness of the dietary supplements glucosamine and chondroitin sulfate, which previous studies have suggested may be useful for osteoarthritis. (See "Nutritional Supplements" for more details about this trial.)

Some genetic and behavioral studies are focusing on factors that may cause osteoarthritis to develop. Among behavioral risk factors, excessive weight and lack of exercise have been identified as contributing to knee and hip disability.

Researchers are working to understand the role certain enzymes play in the breakdown of joint cartilage in osteoarthritis. They also are testing drugs that block the action of these enzymes and looking at new ways to administer drugs.

Studies show that young adults 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. They are also prompting scientists to look for ways to prevent joint cartilage breakdown after injury.


Rheumatoid Arthritis

Researchers are trying to identify the cause of rheumatoid arthritis so they can develop better and more specific treatments. They are examining the roles 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, genetic therapies, and biologic agents that selectively block certain immune system activities associated with inflammation. In recent years, several biologic agents have been approved. These include etanercept (Enbrel) and infliximab (Remicade), which block a cytokine, or chemical messenger, called tumor necrosis factor (TNF); anakinra (Kineret), which blocks the cytokine interleukin-1 (IL-1); and abatacept (Orencia), which interferes with function of some cells such as T-lymphocytes. These cells are important in rheumatoid arthritis. Followup studies of biologics have shown that they not only relieve signs and symptoms of rheumatoid arthritis, but also block the joint destruction it causes. Studies for additional new drugs targeting other cytokines and inflammation pathways continue.

Recently, scientists discovered that the presence of proteins called anti-citrulline antibodies can help identify people with early rheumatoid arthritis who are likely to have aggressive disease. This enables doctors to begin aggressive treatment early and help prevent damage. Researchers continue to search for biomarkers that identify people at risk of aggressive disease as well as those most likely to respond to a particular treatment.

Researchers are also studying non-medication treatments for rheumatoid arthritis, such as green tea, fish oil, borage seed oil, and relaxation techniques.


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 a number of studies, researchers have found evidence of fetal cells within the blood and skin lesions of women who had been pregnant years before developing scleroderma. These studies suggest that fetal cells may somehow play a role in scleroderma. Scientists are continuing to study the implications of this finding.

Scientists are also trying to better understand the organ complications that can occur in people with scleroderma and to find factors that predict who is at greatest risk for these complications.

Treatment studies are under way as well. One study in particular has looked at the effectiveness of ultraviolet light in softening the thickened skin of people with scleroderma, and others have shown that drugs affecting the circulation can improve symptoms of scleroderma.


Spondyloarthropathies

Researchers are working to understand the genetic and environmental causes of spondyloarthropathies, which include ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and arthritis associated with inflammatory bowel disease. They are also looking at genetic determinants of disease severity, the development of associated eye problems, and potential new treatments for the diseases and their complications.


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 or more severe 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 marrow transplants to correct immune abnormalities. Contrary to the widely held belief that estrogens can make the disease worse, a major NIAMS-supported study has shown that it may be safe to use estrogens for hormone replacement therapy and birth control in women with lupus.


The Health Partnership Program: A Local Diversity Outreach Initiative for Treating Rheumatic Diseases

In the winter of 2000, 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 also have the opportunity to participate in clinical studies. More information about the HPP is available at www.niams.nih.gov/hi/outreach/index.htm.

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