OsteoarthritisWhy is it painful?

Dr Sara KellyArthritis Research UK Pain Centre,

School of BiosciencesUniversity of Nottingham

• What is osteoarthritis (OA)?

• Why is it painful?

• How can we develop better treatments for osteoarthritis pain?

Overview

• Millions of people in the UK live with arthritis

• The major cause of lower limb disability in older people worldwide

• 10% of men and 18% of women aged ≥60 years

• Arthritis affects young and old alike, and many parts of the body. 

Some facts and figures

• Pain is the major symptom and impacts upon lives 

• People with arthritis live with severe pain

• Everyday tasks can be an agonising ordeal

• Severely impacts on quality of life 

• We are still not sure how best to manage the pain

• Joint replacement provides relief, but 15% of postoperative patients still report pain

Some facts and figures

Joint replacement

160,000 total hip and knee replacements are performed per year in the UK at a cost to the NHS of almost £1bn

• Our ageing population and rising obesity will see an increase in arthritis over the next 10 to 20 years.

• The need to better understand the pain of arthritis and improve the lives of people who suffer from it has never been more pressing.

A sobering message

Dean Collier is 45 and has suffered from painful

osteoarthritis for around seven years

“I lost my engineering job as my employer said I wasn’t safe to do the job anymore. Osteoarthritis affects everything I do. I can’t go back into engineering; I need to think about another career really. There’s more than just pain killers to help you through and I’d like to get that message across. Don’t get me wrong, I have my bad days, when nothing I’ve tried works and I’m in such pain – that’s when I take painkillers, as a last resort”

“I’d got to the stage where I couldn’t stand in the shower, and I was crawling up the stairs. Within three weeks (of the op), I could feel the difference – the grating pain is gone. This is a real turning point – I’m going to get my life back and take control”

Lynda Tainton, 49, has osteoarthritis of the knees.

She had one knee replaced in July 2011 and is registered disabled.

What does OA look like?

Knee MRI scan

Eroded cartilage

What does OA look like?

Which joints get OA?

Dye et al., 1998

Nerves and OA

Normal OA

Lowered pain thresholds in patients with painful knee OA

Nerves and OA

PAIN

Mission:internationally leading, multidisciplinary,translational research centre aiming toenhance understanding of arthritic painand to improve its treatment

Arthritis Research UK Pain Centre

Close collaboration

City Hospital

Queens MedicalCentre

Sensory: aching, burning, sharp, shootingAffect: frustrating, depressing, distractingFunction: walking, standing, sleepingDifferent problems in different people at different times

Multidimensional

Mechanistically complexWeak associations between radiology, symptoms and treatment responsePeripheral and central sensitisationMultiple sources of pain with different mechanisms

AccessibleStrong knowledge base on which to build

OA knee pain

OA knee pain

•Common

•Disabling

•Distressing

•Current treatments partially effective

Our impact

• Better understanding of why arthritis causes pain• Identify new drug targets for the treatment of pain• Test new treatments for people suffering from arthritis

Pathology

Processing

Context Outcome

An integrated approach toa complex pathway

The Arthritis Research UK Pain Centre