Osteoarthritis
Why is it painful?
Dr Sara Kelly
Arthritis Research UK Pain Centre,
School of Biosciences
University of Nottingham
Overview
• What is osteoarthritis (OA)?
• Why is it painful?
• How can we develop better treatments for osteoarthritis pain?
Some facts and figures
• 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
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
A sobering message
• 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.
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”
Lynda Tainton, 49, has
osteoarthritis of the knees.
She had one knee replaced in July
2011 and is registered disabled.
“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”
What does OA look like?
What does OA look like?
Knee MRI scan
Eroded cartilage
Which joints get OA?
Nerves and OA
Dye et al., 1998
Nerves and OA
Normal
OA
Lowered pain thresholds in patients
with painful knee OA
PAIN
Arthritis Research UK
Pain Centre
Mission:
internationally leading, multidisciplinary,
translational research centre aiming to
enhance understanding of arthritic pain
and to improve its treatment
Close collaboration
City Hospital
Queens Medical
Centre
OA knee pain
Multidimensional
Sensory: aching, burning, sharp, shooting
Affect: frustrating, depressing, distracting
Function: walking, standing, sleeping
Different problems in different people at different times
Mechanistically complex
Weak associations between radiology, symptoms and treatment response
Peripheral and central sensitisation
Multiple sources of pain with different mechanisms
Accessible
Strong knowledge base on which to build
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
An integrated approach to
a complex pathway
Context
Processing
Pathology
Outcome
The Arthritis Research UK Pain Centre