June 2007 | Back to Table of Contents
Pulse
Teaming Up for Orthopedics
They run, they bike, they ski, they raise money for orthopedic research. They’re physicians, nurses, and other health care providers, and their patients, friends, and family members who participate in Team Ortho.
Created by two Hennepin County Medical Center (HCMC) orthopedic surgeons, Richard Kyle, M.D., and Thomas Varecka, M.D., and incorporated as a nonprofit foundation in 2004, Team Ortho raises money by coordinating races and other fitness-related events in Minnesota and around the country, many in conjunction with orthopedic meetings. “At the American Academy of Orthopedic Surgeons in Chicago, we had 400 people sign up for our race, and they were from 26 countries,” says John Larson, executive director.
Altogether, 4,500 people have participated in Team Ortho events during the last two years. “We’ve had people with prosthetic limbs, people who are 100 pounds overweight, athletes from every level,” says Larson, who claims he couldn’t run a mile before starting to work with Team Ortho and has since dropped 70 pounds and completed two Ironman competitions.
“This came out of the idea that it makes sense to get people active on every level of health, whether for musculoskeletal health, bone density, joint health, or prevention of cancer, diabetes, obesity, or cardiovascular disease,” he says.
Larson explains that orthopedics doesn’t capture donations for research in the same way more high-profile diseases such as cancer and heart disease do. “Part of that is because orthopedics is so successful at addressing acute problems. But people who are in pain, whether it’s joint pain or bone pain, all they can think about is how to relieve the pain.”
Last year, Team Ortho donated $18,000 to the Orthopedic Trauma Association’s research fund, the Orthopedic Research and Education Foundation, and the Minneapolis Medical Research Foundation, the research arm of HCMC.
“Our mission is to raise money and to get people active,” Larson says.—Kim Kiser
Light Up, Lose Cartilage?
A Mayo Clinic rheumatologist has found one more reason for people to kick the smoking habit: their knees.
Shreyasee Amin, M.D., led a study that found smokers had more knee pain and less cartilage than nonsmokers. Researchers monitored 159 men with osteoarthritis of the knee. Nineteen (12 percent) were current smokers.
MRI scans of the more symptomatic knee were done at the beginning of the study and after 15 and 30 months. Researchers measured cartilage loss at the tibiofemoral and patellofemoral joints and used a scoring tool to assess pain.
After adjustments for age and weight (the smokers in the study were younger and leaner than the nonsmokers), smokers had a 2.3-fold increased risk of cartilage loss at the medial tibiofemoral joint and a 2.5-fold greater risk of loss at the patellofemoral joint compared with nonsmokers. They also had higher pain scores than the nonsmokers.
The researchers speculated that the association between smoking and cartilage loss may be the result of smoking inhibiting the proliferation of knee cartilage cells; increasing oxidant stress, which contributes to cartilage loss; or raising carbon monoxide levels in arterial blood, which would contribute to tissue hypoxia and, thus, inhibit cartilage repair.
The study was published in the January 2007 Annals of Rheumatic Diseases.
Joint Ventures
Botox can not only erase cruel frown lines that mark our faces as we age, it may also be a remedy for arthritis pain.
Researchers from the Minneapolis Veterans Affairs (VA) Medical Center, University of Minnesota, and Mayo Clinic are testing the effectiveness of botulinum toxin for treating patients with rheumatoid and osteoarthritis.
Maren Mahowald, M.D., rheumatology section chief at the Minneapolis VA and a professor of medicine at the University of Minnesota, got the idea after hearing about a physician in Boston who had used botulinum toxin to treat patients with cervical dystonia. “He noticed that when they injected the neck muscles to stop the movement, the patients’ pain decreased before the movement disorder decreased,” she says. “He then got the idea that this might work for joint pain due to arthritis.”
Mahowald says additional mouse studies of Botox (botulinum toxin type A) and Myobloc (botulinum toxin type B) suggested that the drugs did indeed decrease pain. Mahowald and fellow investigators from the VA and the university, Jasvinder Singh, M.D., Hollis Krug, M.D., and Dennis Dykstra, M.D., conducted their own open-label pilot. They injected botulinum toxin type A into the arthritic knee, ankle, and shoulder joints of 11 patients and followed them for a year. About half of the participants reported a 50 percent or greater reduction in their pain.
The researchers’ next step was to conduct a double-blind randomized controlled trial testing botulinum toxin type A versus a placebo in 42 persons with osteoarthritis and rheumatoid arthritis. Thirty five participants with moderate to severe osteoarthritis of the knee received 100 units of the drug with lidocaine or a saline/lidocaine placebo. Preliminary findings showed that one month after treatment, the osteoarthritis patients with severe knee pain who received botulinum toxin reported a significant decrease in pain and improvement in physical function; those who received the placebo showed no significant improvements. Patients with moderate pain saw little improvement. Mahowald’s team recently concluded the study and thus far have found that participants reported a significant decrease in pain three months after receiving botulinum toxin type A injections.
Andrea Boon, M.D., an assistant professor of physical medicine and rehabilitation at Mayo Clinic, is also enrolling patients with moderate-to-severe osteoarthritis of the knee in a randomized, double-blind study comparing the effect of botulinum toxin with that of cortisone for pain. Participants will receive 100 or 200 units of botulinum toxin type A or 40 mg of cortisone and be evaluated for pain and function six months later.
“If this is effective, it’s pretty exciting,” Boon says. “A lot of joints like the ankle, wrist, and facet joints in the spine are not amenable to joint replacement surgery. For many people, cortisone does not provide lasting relief or stops working altogether after the first one or two shots. This is something to potentially offer those patients. It may be a great second-line treatment.”—Kim Kiser