Title: Improving prevention and treatment for patients with musculoskeletal conditions
Funder: Medical Research Council

Abstract: The aim of the programme is to improve prevention and treatment for patients with musculoskeletal conditions. These are a major problem both nationally and internationally with a high burden of disability, and will become increasingly important as a consequence of the ageing population.||Arthritis Research UK is one of the largest medical research charities in the UK, funding research into the causes, consequences and treatment of musculoskeletal conditions. In 2008 Arthritis Research UK launched their clinical studies initiative to develop a comprehensive research programme in partnership with the UK Clinical Research Network (CRN), industry and other funders (such as NIHR) that would permit the testing of both new and existing interventions, based on a nationally agreed and scientifically robust research agenda, across the major disease areas of the charitys interests. In achieving this, there would be a transformation of clinical practice in areas of relevance which would drive both knowledge advance and quality of care. All their UK funded trials will be conducted by UKCRC registered trials units. The charity has funded a senior statistician post at the CTU since 2001 to advise researchers developing proposals for these clinical studies.||Osteoarthritis is a common disorder, and at present there are no effective treatments that alter disease pathology. Management of osteoarthritis is primarily aimed at symptom control with the aim to retain or improve joint function. Epidemiological data suggest that low dietary intake of vitamin D and low serum 25-hydroxyvitamin D3 levels are associated with radiological progression in knee osteoarthritis. VIDEO is a three year randomised, double-blind, placebo controlled trial funded by Arthritis Research UK to determine whether vitamin D supplementation of cholecalciferol 800 IU daily can reduce the rate of disease progression and improve symptoms in participants with knee osteoarthritis. The primary outcome measure is radiological progression with secondary endpoints being symptoms and quality of life assessments. As Vitamin D supplementation is safe and cheap, any proven benefit in the management of osteoarthritis will have important relevance to healthcare in the elderly.||Since 2007 the Royal National Orthopaedic Hospital have funded a statistician post to at the CTU to work on orthopaedic studies. A strong research theme of the Royal National Orthopaedic Hospital is a regenerative approach to lesions of cartilage, bone and tendon using cell-based therapies. If such an approach can be made to work this would reduce the need for reconstructive surgery and improve quality of life by reducing the amount of time the patient has to spend with their leg in a metal frame. RNOH have secured MRC funding to conduct a trial (PACINO) of autologous mesenchymal stem cells in fracture non-union. At the end of the trial we will use proteomics to correlate clinical response with cell phenotype. This should enable us to refine cell culture processes, and hence to develop more effective treatments for future trials.||A Phase II trial (SCARAB) of autologous bone marrow derived mesenchymal stem cells mixed with bone stock to improve the regeneration of bone adjacent to the implant in revision hip surgery is being planned. The failure rate of revision hip surgery is high, 25-50% of revision procedures fail, and increasing the regeneration of bone within the impacted graft is crucial for a successful outcome.


Research activity codes: 6.2 CELLULAR AND GENE THERAPIES;6.9 RESOURCES AND INFRASTRUCTURE (TREATMENT EVALUATION);5.9 RESOURCES AND INFRASTRUCTURE (TREATMENT DEVELOPMENT);6.1 PHARMACEUTICALS
Health categories: MUSCULOSKELETAL