The joint venture
Arthritis is often considered an unavoidable aspect of old age. Andrew Gimson finds out how the Masonic Samaritan Fund is helping Arthritis Research UK dispel old ideas and create new cures
Arthritis is typically seen as a gloomy disease of old age about which nothing can be done. Nearly half of the people polled by Arthritis Research UK believe that arthritis means just ‘aches and pains when you get old’, and nearly one-third assume that you cannot do anything about it and must simply live with the pain. The Masonic Samaritan Fund (MSF) is determined to help combat these pessimistic misconceptions and has given £177,606 towards the development of a groundbreaking new treatment being pioneered at the Arthritis Research UK Tissue Engineering Centre.
Professor Alan Silman, medical director at Arthritis Research UK, explains the revolutionary work that his team is engaged in. The most common condition affecting joints is osteoarthritis, which occurs when cartilage wears away. If you examine one hundred sixty-year-olds on X-ray, most will show some evidence of a problem, for as we get older we lose our capacity to repair cartilage.
As damage to the hip or knee joint becomes worse, the ability to walk, go upstairs or get into the bath becomes more and more limited, and the pain intensifies.
It is the body’s repair function that Professor Silman and his colleagues now seek to assist. Cartilage consists of cells, and his team has discovered how to take these cells and grow them ‘like mustard and cress’ in a laboratory. But this form of tissue engineering is a laborious process. It would be preferable to plant something in the joint and get the body to regrow its own cartilage.
One way of doing this is by making use of stem cells. Embryonic stem cells are produced at the very start of life and are found in profusion in the umbilical cord. But your body also contains stem cells throughout life, which can be turned into many different kinds of cells: in this case, cartilage cells. So Professor Silman’s team is investigating where to find the best stem cells in adults, what it must do ‘to tweak these cells to turn them into cartilage cells’, and what is the best material, or ‘compost’, to add to them to enable growth.
One possibility is to drill a tiny hole through the cartilage into the bone, get a little bone marrow leaking through into the cartilage, and add a substance to stimulate the bone marrow to turn into cartilage.
The ‘prize’ that the treatment offers is great as it should become possible to intervene early – when people first experience pain – and reverse the disease.
Arthritis occurs when the body loses the ability to repair cartilage between joints
Less pain, more gain
Current practice is to administer painkillers, carry out physiotherapy, and when things get too bad, operate. Hip replacement operations, of which ninety per cent are caused by osteoarthritis, have become commonplace and tend to work very well, but it would be preferable to avoid the need for them.
According to Professor Silman, the demand for operations ‘is just going to grow and grow and grow’ due to our increasingly ageing population. Last year, more stringent criteria were introduced for knee replacements, and a debate is now taking place about how much pain it is acceptable to let people suffer. Stem-cell treatment could remove that pain altogether.
When asked if orthopaedic surgeons had protested against his research, which might deprive them of their burgeoning hip-replacement work, Professor Silman replied that they had not.
A cadre of skilled clinicians will still be needed to look through a telescope at a joint and to apply the materials that would enable new cartilage to grow. Professor Silman explains that the first tests are being carried out on patients who have lost very small amounts of cartilage, rather than on those suffering from the more severe forms of osteoarthritis.
The research team is at present about eighteen months into a five-year programme. According to Professor Silman, ‘It’s early days but things are moving in the right direction.’ So many different skills are needed for this work that Arthritis Research UK has built a consortium of four universities: Newcastle University, the University of Aberdeen, Keele University/the Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, and the University of York. Each of these institutions will cover a different area of the research.
‘This research could reduce morbidity due to osteoarthritis worldwide’ Dr Simon Fellerman
‘We were really excited to receive the donation,’ says Professor Silman, keen to express his gratitude to the MSF for its support. Dr Simon Fellerman, who is a member of the MSF board, adds: ‘As far as MSF was concerned, we were fairly new to making medical grants, and we felt the most appropriate approach would be to give to charities of interest to Freemasons.’
Fellerman says that as a general practitioner, a large percentage of his patients suffer from joints that are wearing out, and it would be ‘marvellous’ to be able to prevent this: ‘It’s a groundbreaking bit of research. If they can regenerate cartilage from stem cells, they could reduce morbidity due to osteoarthritis worldwide.’
It is hard not to marvel at the ingenuity of this research and feel encouraged by the positive tone in which Professor Silman describes his team’s work. The MSF has certainly discovered a very worthy cause to support.
What is osteoarthritis?
The most common form of joint disease, osteoarthritis causes pain and stiffness in the joints and affects at least eight million people in the UK. When a joint has osteoarthritis, its surfaces become damaged and it does not move as well as it should. The cartilage becomes rough and thin, with the bone at the edge of the joint growing outwards and forming bony spurs called osteophytes.
The joint may also swell, with the capsule and ligaments slowly thickening and contracting. In severe osteoarthritis, the cartilage can become so thin that bones start to rub against each other and wear away.
The loss of cartilage, the wearing of bone and the osteophytes can alter the shape of the joint and force bones out of their normal position.
To find out more about the condition, go to www.arthritisresearchuk.org
Beating the hurdles
Although ninety per cent of arthritis sufferers are over the age of sixty, it would be quite wrong to regard this as a condition that afflicts only the older generation.
Manuel Bello-Cano, who is now forty-three, was a keen athlete from the age of twenty-two, specialising in the one-hundred-and-ten-metre hurdles. Unknown to him, he was putting his trailing leg in a position that damaged his cartilage. It became more difficult for him to do that movement, but he thought this was because he was not training enough. After experiencing an increasing level of pain in his groin, he was referred to the Freeman Hospital, Newcastle, which gave him an MRI scan and then a hip arthroscopy to reshape part of the bone in his hip. It was during this operation, carried out at the age of thirty-six, that his surgeon, Professor Andrew McCaskie, found he was also suffering from cartilage damage.
‘I was shocked that I had the earliest stages of osteoarthritis as I’ve always thought it was a disease that only affected older people,’ recalls Bello-Cano, who is hopeful that stem-cell regeneration is the solution. While there is no indication yet of when he may get stem-cell treatment, as far as Bello-Cano is concerned it cannot come quickly enough. In hospital, he has met a lot of people suffering from similar conditions. In the end, they get to a state where they have to have hip-replacement surgery, which could be avoided if stem-cell treatment works.