hen doctors Marc Feldmann and Ravinder N. Maini demonstrated the role of TNF inhibitors to treat rheumatoid arthritis back in the 1980s, it was a game-changer for the management of the over 100 diseases we collectively call inflammatory arthritis. People who a generation ago would have been confined to a wheelchair or bedridden are instead living rewarding lives and participating fully in their families, their communities, and the economy.

Unfortunately, osteoarthritis (OA) — by far the most common form of arthritis, and one of the world’s leading causes of disability — works differently from inflammatory diseases, and does not respond to these new treatments.

With the advent of stem cell technology and other advances, we are learning how to harness the body’s own regenerative powers to repair joint damage caused by arthritis.

For people living with severe OA, the plan is pretty much the same as it was 30 years ago: deal with ever-increasing levels of pain and disability as the disease gradually deteriorates bone and cartilage in the affected joints, until the damage becomes too severe to bear. At that point they have to hope to qualify for joint replacement surgery — a highly invasive procedure that comes with significant risks and does not present a long-term solution. That’s it. But, there’s reason for hope.

The next 10 years: a revolution in OA care

The coming decade may represent as much of a watershed in OA treatment as the last 20 years have been for inflammatory forms of the disease. We stand on the cusp of breakthroughs that will forever change the way we manage OA, and Canadian researchers are leading the way in three key areas.

Regenerative medicine

With the advent of stem cell technology and other advances, we are learning how to harness the body’s own regenerative powers to repair joint damage caused by arthritis.

Dr. Sowmya Viswanathan at the University of Toronto is embarking on a study funded by The Arthritis Society to explore the role of immune cells, which are meant to help repair a damaged joint, but somehow get subverted in some people’s joints, contributing to the development of OA. The team is increasing the presence of a particular type of immune cell in human cartilage to see if it will halt further tissue degeneration, and hopefully kick-start the repair process.

Personalized medicine

We are developing treatments targeted to the unique genetic profile of the patient, significantly increasing effectiveness while reducing the likelihood of rejection and other adverse events.

The Arthritis Society is currently funding Dalhousie University’s Dr. Jason McDougall to investigate the ability of similar cannabinoid compounds sourced from medical cannabis to repair joint nerves and thereby relieve neuropathic pain from OA.

In another Society-funded project, Dr. Rita Kandel’s team at Toronto’s Mount Sinai Hospital are growing replacement cartilage from a person’s own tissue. They then layer the home-grown cartilage over a new material that can take the place of damaged bone, but is porous enough to allow actual bone to grow into and eventually replace it. This process will allow the body itself to rebuild the damaged joint from the ground up to create a kind of natural joint replacement.

A deeper understanding of pain

Pain remains the single most debilitating symptom of arthritis. A complex system of molecules and receptors in the body, collectively referred to as the endocannabinoid system, plays a role in governing the body’s pain responses — along with the immune system, appetite, and assorted other functions. The more we understand this system, the more we can target treatments that enhance the body’s own ability to regulate pain.

An emerging theory is that part of the pain of OA is neuropathic in nature — arising from damage to the nervous system rather than to the joint itself. They may explain why current therapies are only mildly effective in managing OA pain. The Arthritis Society is currently funding Dalhousie University’s Dr. Jason McDougall to investigate the ability of similar cannabinoid compounds sourced from medical cannabis to repair joint nerves and thereby relieve neuropathic pain from OA.

It’s an incredibly exciting time: projects like these are taking place in research centres across the country, and they bring the promise of better days ahead for Canadians living with osteoarthritis.

Towards a cure

Helping people live better with arthritis today is critical, but so is making progress towards a cure. More than 4.6-million Canadians live with arthritis, yet this disease receives only a small allocation of national health research funding. Research progress has therefore been dependent on the commitment and support of individual Canadians who have chosen to make joint health a priority.

Imagine what would be possible if we combined our talent, ingenuity, and dedication with the financial resources to back them! We would then be able to accelerate research breakthroughs in OA and erase the pain of arthritis for good.