Osteoarthritic Joint Pain: Novartis Foundation Symposium 260 PDF
Preview Osteoarthritic Joint Pain: Novartis Foundation Symposium 260
Osteoarthritic Joint Pain: Novartis Foundation Symposium 260. Volume 260 EditedbyDerekJ.ChadwickandJamieGoode Copyright(cid:182) Novartis Foundation 2004. ISBN: 0-470-86763-9 OSTEOARTHRITIC JOINT PAIN TheNovartisFoundationisaninternationalscienti¢candeducational charity(UKRegisteredCharityNo.313574).KnownuntilSeptember1997 astheCibaFoundation,itwasestablishedin1947bytheCIBAcompany ofBasle,whichmergedwithSandozin1996,toformNovartis.The FoundationoperatesindependentlyinLondonunderEnglishtrust law.Itwasformallyopenedon22June1949. 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Contents SymposiumonOsteoarthriticjointpain,heldattheNovartisFoundation,London,1^3July2003 Editors:DerekJ.Chadwick(Organizer)andJamieGoode ThissymposiumisbasedonaproposalbyStuartBevanandJohnRediske DavidFelson Chair’sintroduction 1 Hans-GeorgSchaible Spinalmechanismscontributingtojointpain 4 Discussion 22 BlairD.Grubb Activationofsensoryneuronsinthearthriticjoint 28 Discussion 36 KennethD.Brandt Neuromuscularaspectsofosteoarthritis:aperspective 49 Discussion 58 PaulCreamer Currentperspectivesontheclinicalpresentationofjointpainin humanOA 64 Discussion 74 WalterHerzog,AndreaClarkandDavidLongino Jointmechanicsin osteoarthritis 79 Discussion 95 GeneraldiscussionI DevelopinganimalmodelsofRA 100 GunnarOrdeberg CharacterizationofjointpaininhumanOA 105 Discussion 115 BruceL.Kidd,AndrewPhotiouandJuliaJ.Inglis Theroleofin£ammatory mediatorsonnociceptionandpaininarthritis 122 Discussion 133 JamesL.Henry Moleculareventsofchronicpain:fromneurontowholeanimalin ananimalmodelofosteoarthritis 139 Discussion 145 v vi CONTENTS C.S.McCabe,R.C.Haigh,N.G.Shenker,J.LewisandD.R.Blake Phantomsinrheumatology 154 Discussion 174 PeterA.Simkin Bonepainandpressureinosteoarthriticjoints 179 Discussion 186 PhilipG.ConaghanandDavidT.Felson Structuralassociationsofosteoarthritis pain:lessonsfrommagneticresonanceimaging 191 Discussion 201 MartinKoltzenburg TheroleofTRPchannelsinsensoryneurons 206 Discussion 213 PatrickW.MantyhandStephenP.Hunt Mechanismsthatgenerateandmaintain bonecancerpain 221 Discussion 238 N.G.Shenker,D.R.Blake,C.S.McCabe,R.HaighandP.I.Mapp Symmetry, Tcellsandneurogenicarthritis 241 Discussion 252 LaurenceA.Bradley,BrianC.Kersh,JenniferJ.DeBerry,GeorgDeutsch, GracielaA.Alarco¤nandDavidA.McLain Lessonsfrom¢bromyalgia: abnormalpainsensitivityinkneeosteoarthritis 258 Discussion 270 DavidFelson Chair’ssummingup 277 Indexofcontributors 280 Subjectindex 282 Participants DavidR.Blake TheRoyalNationalHospitalforRheumaticDiseases,Upper BoroughWalls,inconjunctionwithTheDepartmentofMedicalSciencesand TheDepartmentofPharmacyandPharmacology,UniversityofBath,Bath BA11RL,UK LaurenceA.Bradley DivisionofClinicalImmunologyandRheumatology, UniversityofAlabamaatBirmingham,805FacultyO⁄ceTower,51020thstreet south,Birmingham,AL35294,USA KennethD.Brandt IndianaUniversitySchoolofMedicine, IndianaUniversity MultipurposeArthritisandMusculoskeletalDiseasesCenter,1110West MichiganStreet,Room545,Indianapolis,IN46202-5100,USA PhilipG.Conaghan AcademicUnitofMusculoskeletalDisease,Universityof Leeds&DepartmentofRheumatology,LeedsGeneralIn¢rmary,GreatGeorge Street,LeedsLS13EX,UK PaulCreamer SouthmeadHospital,WestburyonTrym,BristolBS105NB,UK PaulDieppe DepartmentofSocialMedicine,UniversityofBristol,Canynge Hall,WhiteladiesRoad,BristolBS82PR,UK ChristopherH.Evans CenterforMolecularOrthopaedics,HarvardMedical School,221LongwoodAvenue,BL-152,Boston,MA02115,USA DavidT.Felson(Chair) BostonUniversitySchoolofMedicine,715Albany Street,A203,Boston,MA02118,USA JanetK.Fernihough NovartisInstituteforMedicalSciences,5GowerPlace, LondonWC1E6BN,UK AlysonFox NovartisInstituteforMedicalSciences,5GowerPlace,London WC1E6BN,UK vii viii PARTICIPANTS BlairD.Grubb DepartmentofCellPhysiologyandPharmacology,University ofLeicester,POBox138,LeicesterLE19HN,UK JamesL.Henry DepartmentofPhysiologyandPharmacology,Universityof WesternOntario,MedicalSciencesBuilding,M221,London,Ontario, N6A5C1,Canada WalterHerzog HumanPerformanceLaboratory,FacultyofKinesiology, DepartmentofMechanicalEngineering,FacultyofEngineering, TheUniversityofCalgary,2500UniversityDriveNWB205,Calgary,AB, CanadaT2N1N4 StephenHunt DepartmentofAnatomyandDevelopmentalBiology,Anatomy Building,GowerStreet,LondonWC1E6BT,UK DavidJ.Hunter ClinicalEpidemiologyResearchandTrainingUnit,Boston MedicalCenter,715AlbanyStreet,RoomA-203,Boston,MA02118-2526,USA BruceL.Kidd BoneandJointUnit,Bart’sandTheLondonSchoolofMedicine, CharterhouseSquare,LondonEC1M6BQ,UK MartinKoltzenburg NeuralPlasticityUnit,NeuralPlasticity,InstituteofChild Health,30GuilfordStreet,LondonWC1N1EH,UK KlausE.Kuettner DepartmentofBiochemistry,RushMedicalCollege,Rush- Presbyterian-StLuke’sMedicalCenter,1653W.CongressParkway,Chicago, IL60612,USA StefanLohmander DepartmentofOrthopaedics,UniversityHospitalLund, 22185Lund,Sweden AndrewMackenzie NovartisPharmaAG,WSJ-386.10.35,CH-4002,Basel, Switzerland MarziaMalcangio ChronicPainProgramme,NovartisInstituteforMedical Science,UniversityCollegeLondon,GowerStreet,LondonWC1E6BT,UK AnthonyM.Manning RocheBioscience,3401HillviewAvenue,PaloAlto,CA 94304-1397,USA PARTICIPANTS ix GunnarOrdeberg DivisionofOrthopaedicSurgery,KarolinskaInstitutet, DanderydHospital,Stockholm,SE-18288,Sweden DavidS.Pisetsky DukeUniversityMedicalSchool,151GDurhamVAHospital, 509FultonStreet,Durham,NorthCarolina,27705,USA JohnRediske Research,ArthritisandBoneMetabolismTherapeuticArea, NovartisPharmaceuticalsCorporation,556MorrisAvenue,Summit,NJ07901, USA Hans-GeorgSchaible InstitutfˇrPhysiologie1/Neurophysiologie, Teichgraben8,07740Jena,Germany HuaShen(NovartisFoundationBursar) CenterofExperimentalRheumatology, andWHOCollaboratingCenterforMolecularBiology,andNovelTherapeutic StrategiesforRheumaticDiseases,UniversityHospitalZu«rich,Gloriastrasse23, CH-8091Zu«rich,Switzerland PeterA.Simkin DepartmentofMedicine,UniversityofWashington,Box 356428,Seattle,WA98195,USA WimvandenBerg CenterofRheumatologyResearchandAdvanced Therapeutics,NijmegenCenterofMolecularLifeSciences,GeertGrooteplein 26-28,6500HBNijmegen,TheNetherlands ThasiaG.Woodworth Arthritis/Bone,NovartisPharmaAG,CH-4002,Basel, Switzerland KiranYashpal DepartmentofPhysiologyandPharmacology,Universityof WesternOntario,MedicalSciencesBuilding,M221,London,Ontario, N6A5C1,Canada Osteoarthritic Joint Pain: Novartis Foundation Symposium 260. Volume 260 EditedbyDerekJ.ChadwickandJamieGoode Copyright(cid:182) Novartis Foundation 2004. ISBN: 0-470-86763-9 Osteoarthritic Joint Pain: Novartis Foundation Symposium 260. Volume 260 EditedbyDerekJ.ChadwickandJamieGoode Copyright(cid:182) Novartis Foundation 2004. ISBN: 0-470-86763-9 Chair’s introduction DavidFelson Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 715AlbanyStreet,A203,Boston,MA02118-2526,USA Tobeginwith,I’dliketomentionsomeresultsfromLoisVerbrugge,whogavea group of people in Detroit a diary to take home to record their daily health symptoms (Verbrugge 1979). In people aged 65 and over she tallied the most commondailyhealthsymptom.Inwomenover65,itwaskneetrouble;inmenit wasbackachefollowedbykneetrouble.Themostcommoncategoryofsymptoms in older people was musculoskeletal problems. Is this just older people? No. In women aged 45^64 the second most common daily symptom was knee trouble. Thus, pain in knees, often due to osteoarthritis (OA), is a remarkably prevalent problem. Osteoarthritis is the most common form of arthritis. In elderly subjects the prevalenceofeachofhandandhipOAisaround2^3%ofthepopulationaged65 andover.Prevalenceinthiscaseisde¢nedassymptomsonmostdaysandevidence ofstructuralOAasacauseofthesesymptoms.KneeOA(seebelow)isevenmore common.Intheelderly,OAisamorecommoncauseoflowerextremitydisability thananyotherdisease.Itcauses1in8daysofrestrictedactivityinUSeldersandis thereasonwhymostpeoplehavekneeandhipreplacements.Theburdenofthis diseaseonsocietyistrulyremarkable. I’dalsoliketomentiondataonkneeOAfromavarietyofrecentstudiesinthe UK (Peat et al 2001). Of 10000 people aged 55 and over, about 25% have radiographic OA, but not necessarily symptoms. Irrespective of radiographs, about25%ofpeopleinthisover-55agegrouphavehadanepisodeofkneepain lastingatleast4weeks.AbouthalfofthesehaveradiographicOA.This12.5%of the population would be the group that we would categorize as having symptomaticOA. Theotherthingtonoteisthatarthritisisnotgoingtodecreaseinprevalencein western societies. Because of the demographics, it is only going to increase in prevalence. We are getting older, but we are also getting more overweight, which is a major risk factor for OA in weight-bearing joints. Add to this the increasingnumberof sportsinjuries.The estimateisthat the current levelof 20 milliona¡ectedintheUSAwillriseto40millionby2020. InthepastthefocusofOAresearchwasonhyalinearticularcartilageloss.Iam notgoingtosuggestthatcartilagelossisnotpivotal;ratherthatthewholejointis 1
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