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which they investigate genes that play a role in the regulation of cartilage degradation and repair. This work is critical to understanding the onset and progression of OA. Because cartilage has no blood vessels, it has little capacity to remodel in response to healthy loads across the joint or to heal when it is damaged by injury or disease. When cartilage breaks down, it cannot rebuild itself. Dr. Goldring says, “the idea is to understand the very basic cellular mechanisms that lead to problems. If we understand the basic mechanisms involved in cartilage injury and repair, we may be able to define cellular targets for treatment and develop effective therapies.” One particular challenge in OA research is that the disease begins before a patient feels any symptoms. Once new therapies are developed, patients may well need to be screened early on to fully benefit from treatment. To address this problem, skilled orthopedic radiologists and biomechanical engineers at HSS are already developing new ways to diagnose cartilage breakdown early in the disease process. Imaging and Biomechanics Hollis Potter, MD, Chief, Division of Magnetic Resonance Imaging in the Department of Radiology and Imaging and Director of Radiology and Imaging Research at HSS, specializes in musculoskeletal magnetic resonance (MR) research. She and her colleagues have developed techniques to non-invasively examine cartilage tissue. An MRI is essentially “a visual, objective, non-invasive microscope,” Dr. Potter explains. In the recent past, a surgical biopsy would have been required to diagnose disease in cartilage tissue. Now, MRI images can show if the cartilage is healthy. MR can also objectively test new therapies. The FDA is increasingly requiring drug companies to use MR as a tool to assess the outcomes of new medications. “At HSS, we do clinically relevant research that will ultimately have an impact on patients’ lives,” says Dr. Potter. With support from an NIH grant included in the American Recovery and Reinvention Act of 2009 (See In the News), Dr. Potter, her coPrincipal Investigator biomedical engineer Matthew Koff, PhD, and other scientists are exploring another important fibrocartilage tissue in the knee joint called the meniscus. By correlating MR images with the biomechanical and biochemical properties throughout the meniscus, Dr. Potter and her colleagues are building a predictive model to determine when patients will begin to lose function in this important loadcarrying structure. The ability to measure cartilage health through MRI is a boon for OA research. Cartilage damage can be detected long before symptoms are felt. Because meniscal transplants will fail if the articular cartilage is too worn, cartilage imaging helps surgeons determine when a transplant is necessary and also objectively measures when a meniscus is fully healed after surgery. In this study and others, the role of the Hospital’s biomechanical engineers, who apply the principles of engineering to study the effects of loads on the skeletal system, is integral to OA research at HSS. Working with radiologists and surgeons, HSS engineers examine how injury affects the structure and function of the skeletal system, and help figure out why injury is a risk factor for developing OA. Motion Analysis Howard Hillstrom, PhD, is a biomedical engineer and Director of the Motion Analysis Lab at HSS, whose engineers, technologists, physical therapists and physician researchers conduct a wide range of studies on OA from the perspective of structure (body alignment) and function (e.g., standing and walking). Dr. Hillstrom explains that “we’re interested in how OA affects the neuromusculoskeletal system in terms of pain and function, and how treatments aimed to conservatively (i.e., with a brace) or surgically realign limbs can improve clinical outcomes.” Physicians and physical therapists refer patients to the Motion Analysis Lab for comprehensive evaluations of how their bodies move in the context of their condition, physical limitations or disability. This information makes it possible for the medical team to devise the best, most personalized plan of treatment for each patient. The lab, filled with high-tech electronic equipment, investigates mechanical factors that may play a role in the development of OA. Researchers study anatomy by measuring what happens to the body when it moves, with the goal of understanding how the relationships between joint alignment and body weight can influence the development of OA. Translational Research While still a fellow, Lisa Mandl, MD, MPH, a rheumatologist and recipient of the Charles L. Christian Research Fellowship at HSS, noticed that many patients suffered from basal thumb arthritis, a painful condition with few existing treatment options: non-steroidal This clinical practice guideline (CPG) was developed by a physician volunteer clinical practice guideline development group based on a formal systematic review of the available scientific and clinical information and accepted approaches to treatment and/or diagnosis. This clinical practice guideline is not intended to be a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. Clinical patients may not necessarily be the same as those found in a clinical trial. Patient care and treatment should always be based on a clinician’s independent medical judgment, given
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