Improving life for osteoarthritis sufferers
Almost two million Australians suffer from the debilitating disease osteoarthritis. Clinical rheumatologist Dr Anita Wluka is leading pioneering research into the condition and has two critical outcomes in sight. The first is to identify how to delay the onset of osteoarthritis. The second is to make the disease easier for patients to manage.
Current treatment strategies for the disease rely almost solely on losing weight. “We’re looking to find something to limit the spread of the problem and slow down the pain and joint damage,” Anita says.
Recognised as a world-leader in osteoarthritis research, Anita is based at The Alfred hospital where she combines research with clinical practice as a physician. She is passionate about her research, but says spending time with patients is what really inspires her work.
“My research is strongly influenced by my clinical work, examining the relationship between what is happening in the joint and pain. There are many different patterns of osteoarthritis. For example, everyone has a different joint shape. By defining this we may be able to work out whether lifestyle factors, such as exercise, may be good or bad for your joints.”
She says even a small delay in the progress of the disease when it is first diagnosed would make a significant difference to the wellbeing of patients and to public health costs in terms of joint replacements. “Only a small reduction in risk across the country would make a big difference to society.”
The National Health and Medical Research Council, the Shepherd Foundation and Monash and La Trobe Universities are supporting her investigations and she expects to have some findings within the next two years.
Understanding osteoarthritis has been a focus of Anita’s ground-breaking work since 1999. Her previous research has examined risk factors for osteoarthritis and developed methods for measuring the disease.
Methods used to assess earlier studies on the effects of hormone replacement therapy and obesity on cartilage had proved too difficult to be used consistently. Anita focused on developing and validating measurements of disease severity. This was extended to the use of magnetic resonance imaging to track the progress of the disease.
Anita credits colleague Professor Flavia Cicuttini, head of The Alfred’s Rheumatology Unit and the musculoskeletal unit at Monash University’s Department of Epidemiology and Preventative with kick-starting her interest in analysing and measuring arthritis risk factors.
Her work has contributed to guidelines for managing hip and knee osteoarthritis developed through the Royal Australasian College of General Practitioners National Health and Medical Research Council.
In her latest projects, Anita is using a combination of research tools. One study involves a group of twins, looking at the genetics of bunions to determine whether they are hereditary. She expects to present findings by mid-2011. A randomised controlled trial is also underway investigating whether vitamin D may protect against knee osteoarthritis and consequently other forms of musculoskeletal disease.
osteoarthritis, epidemiology and rheumatology
Tanamas, S.K., Wluka, A.E., Davies-Tuck, M.L., Wang, Y., Strauss, B.J.G., Proietto, J., Dixon, J., Jones, G., Forbes, A.B., Cicuttini, F.M., 2013, Association of weight gain with incident knee pain, stiffness and functional difficulties: a longitudinal study, Arthritis Care and Research [P], vol 65, issue 1, John Wiley & Sons Inc, United States, pp. 34-43.
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Brennan, S.L., Stanford, T., Wluka, A.E., Henry, M.J., Page, R., Graves, S., Kotowicz, M., Nicholson, G.C., Pasco, J.A., 2012, Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006 to 2007: Australian Orthopaedic Association National Joint Replacement Registry, BMC Musculoskeletal Disorders [P], vol 13, issue 63, BioMed Central Ltd, United Kingdom, pp. 1-7.
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Teichtahl, A., Wang, Y., Wluka, A.E., Szramka, M., English, D.R., Giles, G.G., O'Sullivan, R.M., Cicuttini, F.M., 2008, The longitudinal relationship between body composition and patella cartilage in healthy adults, Obesity, vol 16, issue 2, Nature Publishing Group, United States, pp. 421-427.
Davies-Tuck, M., Wluka, A.E., Wang, Y., English, D.R., Giles, G.G., Cicuttini, F.M., 2008, The natural history of bone marrow lesions in community based adults with no clinical knee osteoarthritis, Annals of the Rheumatic Diseases, vol E-Pub, BMJ Group, United Kingdom, pp. 1-5.
Davies-Tuck, M., Wluka, A.E., Wang, Y., Teichtahl, A., Jones, G., Ding, C., Cicuttini, F.M., 2008, The natural history of cartilage defects in people with knee osteoarthritis, Osteoarthritis and Cartilage, vol 16, issue 3, WB Saunders Co. Ltd., United Kingdom, pp. 337-342.
Berry, P., Hanna, F., Teichtahl, A., Wluka, A.E., Urquhart, D.M., Bell, R.J., Davis, S.R., Cicuttini, F.M., 2008, Vastus medialis cross-sectional area is associated with patella cartilage defects and bone volume in healthy women, Osteoarthritis and Cartilage, vol 16, issue 8, WB Saunders Co. Ltd., United Kingdom, pp. 956-960.
Berry, P., Teichtahl, A., Galevska-Dimitrovska, A., Hanna, F., Wluka, A.E., Wang, Y., Urquhart, D.M., English, D.R., Giles, G.G., Cicuttini, F.M., 2008, Vastus medialis cross-sectional area is positively associated with patella cartilage and bone volumes in a pain-free community-based population, Arthritis Research and Therapy [P], vol 10, issue 6, Biomed Central Ltd, London UK, pp. 1-6.
Grainger, R., Stuckey, S., O'Sullivan, R.M., Davis, S.R., Ebeling, P.P.R., Wluka, A., 2008, What is the clinical and ethical importance of incidental abnormalities found by knee MRI?, Arthritis Research & Therapy, vol 10, issue 1, BioMed Central Ltd, UK, pp. 1-6.
Racunica, T., Szramka, M., Wluka, A.E., Wang, Y., English, D.R., Giles, G., O'Sullivan, R.M., Cicuttini, F.M., 2007, A positive association of smoking and articular knee joint cartilage in healthy people, Osteoarthritis and Cartilage, vol 15, issue 5, WB Saunders Co Ltd, UK, pp. 587-590.
Guymer, E.K., Baranyay, F., Wluka, A.E., Hanna, F., Bell, R.J., Davis, S.R., Wang, Y., Cicuttini, F.M., 2007, A study of the prevalence and associations of subchondral bone marrow lesions in the knees of healthy, middle-aged women, Osteosrthritis and Cartilage, vol 15, issue 12, W B Saunders Co Ltd, United Kingdom, pp. 1437-1442.
Baranyay, F.J., Wang, Y., Wluka, A.E., English, D.R., Giles, G.G., Sullivan, R.O., Cicuttini, F.M., 2007, Association of bone marrow lesions with knee structures and risk factors for bone marrow lesions in the knees of clinically healthy, community-based adults, Seminars in Arthritis and Rheumatism, vol 37, issue 2, WB Saunders Co., United States, pp. 112-118.
Wang, Y., Wluka, A.E., English, D.R., Teichtahl, A., Giles, G.G., O'Sullivan, R.M., Cicuttini, F.M., 2007, Body composition and knee cartilage properties in healthy, community-based adults, Annals of Rheumatic Diseases, vol 66, issue 9, BMJ Publishing Group, United Kingdom, pp. 1244-1248.
Wang, Y., Hodge, A.M., Wluka, A.E., English, D.R., Giles, G., O'Sullivan, R.M., Forbes, A.B., Cicuttini, F.M., 2007, Effect of antioxidants on knee cartilage and bone in healthy, middle-aged subjects: A cross-sectional study, Arthritis Research & Therapy, vol 9, issue 4, BioMed Central Ltd, UK, pp. 1-9.
Racunica, T., Teichtahl, A., Wang, Y., Wluka, A.E., English, D., Giles, G., O'Sullivan, R.M., Cicuttini, F.M., 2007, Effect of physical activity on articular knee joint structures in community-based adults, Arthritis Care and Research, vol 57, issue 7, Wiley-Liss Div John Wiley and Sons Inc, USA, pp. 1261-1268.
Hanna, F., Bell, R.J., Davis, S.R., Wluka, A.E., Teichtahl, A., O'Sullivan, R.M., Cicuttini, F.M., 2007, Factors affecting patella cartilage and bone in middle-aged women., Arthritis Care and Research, vol 57, issue 2, John Wiley and Sons, USA, pp. 272-278.
Wijayaratne, S.P., Teichtahl, A., Wluka, A.E., Hanna, F., Cicuttini, F.M., 2007, Patelofemoral Osteoarthritis: New Insights into a Neglected Disease, Future Rheumatology, vol 2, issue 2, Future Medicine, UK, pp. 193-202.
Hanna, F., Teichtahl, A., Bell, R.J., Davis, S.R., Wluka, A.E., O'Sullivan, R.M., Cicuttini, F.M., 2007, The Cross-Sectional Relationship Between Fortnightly Exercise and Knee Cartilage Properties in Healthy Adult Women in Midlife, Menopause, vol 14, issue 5, Lippincott Williams and Wilkins, USA, pp. 830-834.
Urquhart, D.M., Wluka, A.E., Teichtahl, A., Cicuttini, F.M., 2007, The Effect of Physical Activity on the Knee Joint is it Good or Bad?, British Journal of Sports Medicine, vol 41, issue 9, BMJ Publishing Group, UK, pp. 546-547.
Hanna, F., Bell, R.J., Cicuttini, F.M., Davison, S.L., Wluka, A.E., Davis, S.R., 2007, The Relationship between Endogenous Testosterone, Preandrogens, and Sex Hormone Binding Globulin and Knee Joint Structure in Women at Midlife, Seminars in Arthritis and Rheumatism, vol 37, issue 1, W.B. Saunders Co., United States, pp. 56-62.
Teichtahl, A., Parkins, K., Hanna, F., Wluka, A., Urquhart, D.M., English, D.R., Giles, G.G., Cicuttini, F.M., 2007, The relationship between the angle of the trochlear groove and patella cartilage and bone morphology - a cross-sectional study of healthy adults, Osteoathritis and Cartilage, vol 15, issue 10, W B Saunders Co Ltd, UK, pp. 1158-1162.
Berry, P., Teichtahl, A., Wluka, A., Cicuttini, F.M., 2007, The role of biomechanical factors on patellofemoral osteoarthritis, Current Rheumatology Reviews, vol 3, issue 2, Bentham Science Publishers Ltd, Netherlands, pp. 123-127.
Hanna, F., Wluka, A., Ebeling, P.R., Davis, S.R., Cicuttini, F.M., O'Sullivan, R.M., 2006, Determinants of change in patella cartilage volume in healthy subjects, Journal of Rheumatology, vol 33, issue 8, Journal of Rheumatology Publishing, Canada, pp. 1658-1661.
Wang, Y., Ding, C., Wluka, A.E., Davis, S.R., Ebeling, P.R., Jones, G., Cicuttini, F.M., 2006, Factors affecting progression of knee cartilage defects in normal subjects over 2 years, Rheumatology, vol 45, issue 1, Oxford University Press, Oxford England, pp. 79-84.
Wang, Y., Wluka, A.E., Davis, S.R., Cicuttini, F.M., 2006, Factors affecting tibial plateau expansion in healthy women over 2.5 years: a longitudinal study, Osteoarthritis and Cartilage, vol 14, issue 12, WB Saunders Co. Ltd, UK, pp. 1258-1264.
Teichtahl, A.J., Morris, M.E., Wluka, A.E., Baker, R.I., Wolfe, R.S.J., Davis, S.R., Cicuttini, F.M., 2006, Foot rotation-A potential target to modify the knee adduction moment, Journal of Science and Medicine in Sport, vol 9, issue 1-2, Elsevier Australia, Australia, pp. 67-71.
Teichtahl, A., Cicuttini, F.M., Wluka, A., 2006, Imaging modalities in the outcome assessment of knee osteoarthritis, Current Rheumatology Reviews, vol 2, Bentham Science Publishers Ltd, Netherlands, pp. 131-136.
Wluka, A.E., Forbes, A.B., Wang, Y., Hanna, F., Jones, G., Cicuttini, F.M., 2006, Knee cartilage loss in symptomatic knee osteoarthritis over 4.5 years, Arthritis Research & Therapy, vol 8, issue 4, BioMed Central Ltd, UK, pp. 1-9.
Wluka, A., Wang, Y., Giles, G., Giles, G.G., English, D., Cicuttini, F.M., 2006, Muscle mass explains the gender difference in knee cartilage volume, Arthritis and Rheumatism, vol 54, issue 9, pp. 157-158.
Teichtahl, A.J., Jackson, B.D., Morris, M.E., Wluka, A.E., Baker, R., Davis, S.R., Cicuttini, F.M., 2006, Sagittal plane movement at the tibiofemoral joint influences patellofemoral joint structure in healthy adult women, Osteoarthritis and Cartilage, vol 14, issue 4, Elsevier, UK, pp. 331-336.
Teichtahl, A., Cicuttini, F.M., Janakiramanan, N., Davis, S.R., Wluka, A.E., 2006, Static knee alignment and its association with radiographic knee osteoarthritis, OsteoArthritis and Cartilage, vol 14, issue 9, WB Saunders Co. Ltd, UK, pp. 958-962.
Teichtahl, A.J., Wluka, A.E., Morris, M.E., Davis, S.R., Cicuttini, F.M., 2006, The relationship between the knee adduction moment and knee pain in middle-aged women without radiographic osteoarthritis, Journal of Rheumatology, vol 33, issue 9, Journal of Rheumatology Publishing Co. Ltd, Canada, pp. 1845-1848.
Wang, Y., Wang, Y., Cicuttini, F.M., Vitetta, L., Wluka, A., 2006, What effect do dietary antioxidants have on the symptoms and structural progression of knee osteoarthritis over two years?, Clinical and Experimental Rheumatology, vol 24, issue 2, pp. 213-214.
Cicuttini, F., Ding, C., Wluka, A., Davis, S., Ebeling, P., Jones, G., 2005, Association of Cartilage Defects With Loss of Knee Cartilage in Healthy, Middle-Age Adults, Arthritis and Rheumatism [E], vol 52, issue 7, Wiley-Blackwell, United States, pp. 2033-2039.
Cicuttini, F.M., Ding, C., Wluka, A., Davis, S., Ebeling, P., Jones, G., 2005, Association of cartilage defects with loss of knee cartilage in healthy, middle-age adults: A prospective study, Arthritis & Rheumatism, vol 52, issue 7, John Wiley & Sons, Inc., USA, pp. 2033-2039.
Cicuttini, F.M., Hankin, J., Jones, G., Wluka, A., 2005, Comparison of conventional standing knee radiographs and magnetic resonance imaging in assessing progression of tibiofemoral joint osteoarthritis, Osteoarthritis and Cartilage, vol 13, issue 8, WB Saunders Co Ltd, UK, pp. 722-727.
Brooks, S., Cicuttini, F.M., Lim, S., Taylor, D.M., Stuckey, S.L., Wluka, A.E., 2005, Cost effectiveness of adding magnetic resonance imaging to the usual management of suspected scaphoid fractures, British Journal of Sports Medicine, vol 39, issue 2, BMJ Publishing Group, UK, pp. 75-79.
Hanna, F., Ebeling, P.R., Wang, Y., O'Sullivan, R.M., Davis, S., Wluka, A.E., Cicuttini, F.M., 2005, Factors Influencing longitudinal change in knee cartilage volume measured from magnetic resonance imaging in healthy men, Annals of the Rheumatic Diseases, vol 64, issue 7, BMJ Publishing Group, The Netherland, pp. 1038-1042.
Teichtahl, A.J., Wluka, A.E., Proietto, J., Cicuttini, F.M., 2005, Obesity and the female sex, risk factors for knee osteoarthritis that may be attributable to systemic or local leptin biosynthesis and its cellular effects, Medical Hypotheses, vol 65, issue 2, Churchill Livingstone, UK, pp. 312-315.
Powell, A., Teichtahl, A.J., Wluka, A.E., 2005, Obesity: a preventable risk factor for large joint osteoarthritis which may act through biomechanical factors, British Journal of Sports Medicine, vol 39, issue 1, BMJ Publishing Group, London England, pp. 4-5.
Wluka, A.E., Ding, C., Jones, G., Cicuttini, F.M., 2005, The clinical correlates of articular cartilage defects in symptomatic knee osteoarthritis: a prospective study, Rheumatology, vol 44, issue 10, Oxford University Press, UK, pp. 1311-1316.
Wang, Y., Wluka, A.E., Cicuttini, F.M., 2005, The determinants of change in tibial plateau bone area in osteoarthritic knees: a cohort study., Arthritis Research & Therapy, vol 7, issue 3, BioMed Ltd, UK, pp. R687-R693.
Brooks, S., Wluka, A.E., Stuckey, S., Cicuttini, F.M., 2005, The management of scaphoid fractures, Journal of Science and Medicine in Sport, vol 8, issue 2, Sports Medicine Australia, Dickson ACT Australia, pp. 181-189.
Cicuttini, F.M., Teichtahl, A.J., Wluka, A.E., Davis, S.R., Strauss, B.J.G., Ebeling, P.R., 2005, The relationship between body composition and knee cartilage volume in healthy, middle-aged subjects, Arthritis & Rheumatism, vol 52, issue 2, John Wiley & Sons, Inc., USA, pp. 461-467.
Wluka, A.E., Wang, Y., Davis, S.R., Cicuttini, F.M., 2005, Tibial plateau size is related to grade of joint space narrowing and osteophytes in healthy women and in women with osteoarthritis, Annals of Rheumatic Diseases, vol 64, issue 7, BMJ Publishing Group, London England, pp. 1033-1037.
Cicuttini, F.M., Wluka, A., Davis, S.R., Strauss, B.J.G., Yeung, S., Ebeling, P.R., 2004, Association between knee cartilage volume and bone mineral density in older adults without osteoarthritis, Rheumatology, vol 43, issue 6, Oxford University Press, Oxford UK, pp. 765-769.
Cicuttini, F.M., Wluka, A.E., Hankin, J., Stuckey, S., 2004, Comparison of patella cartilage volume and radiography in the assessment of longitudinal joint change at the patellofemoral joint, The Journal of Rheumatology, vol 31, issue 7, Journal of Rheumatology Publishing Co. Ltd, Canada, pp. 1369-1372.
Wluka, A., Wolfe, R.S.J., Stuckey, S., Cicuttini, F.M., 2004, How does tibial cartilage volume relate to symptoms in subjects with knee osteoarthritis?, Annals of the Rheumatic Diseases, vol 63, issue 3, BMJ Group, United Kingdom, pp. 264-268.
Cicuttini, F.M., Wluka, A.E., Wang, Y., Stuckey, S.L., 2004, Longitudinal study of changes in tibial and femoral cartilage in knee osteoarthritis, Arthritis & Rheumatism, vol 50, issue 1, John Wiley & Sons, Inc., USA, pp. 94-97.
Cicuttini, F.M., Wluka, A., Hankin, J., Wang, Y., 2004, Longitudinal study of the relationship between knee angle and tibiofemoral cartilage volume in subjects with knee osteoarthritis, Rheumatology, vol 43, issue 3, Oxford University Press, UK, pp. 321-324.
Hanna, F.S., Wluka, A.E., Bell, R.J., Davis, S.R., Cicuttini, F.M., 2004, Osteoarthritis and the postmenopausal woman: epidemiological, magnetic resonance imaging, and radiological findings, Seminars in Arthritis and Rheumatism, vol 34, issue 3, WB Saunders Co., Philadelphia USA, pp. 631-636.
Cicuttini, F.M., Jones, G., Forbes, A.B., Wluka, A., 2004, Rate of cartilage loss at two years predicts subsequent total knee arthroplasty: a prospective study, Annals of Rheumatic Diseases, vol 63, issue 9, BMJ Publishing Group, UK, pp. 1124-1127.
Dashti, M., Wluka, A., Geso, M., Davis, S.R., Stuckey, S., Cicuttini, F.M., 2004, Relationship between the area of cartilage shown on the magnetic resonance imaging middle-slice image of the medial and lateral tibial cartilages with cartilage volume and grade of osteoarthritis over time, Scandanavian Journal of Rheumatology, vol 33, issue 2, Taylor & Francis AS, Norway, pp. 87-93.
Jackson, B.D., Wluka, A., Teichtahl, A., Morris, M.E., Cicuttini, F.M., 2004, Reviewing knee osteoarthritis - a biomechanical perspective, Journal of Science and Medicine in Sport, vol 7, issue 3, Elsevier Australia, Australia, pp. 347-357.
Cicuttini, F.M., Morris, K., Glisson, M., Wluka, A., 2004, Slice thickness in the assessment of medical and lateral tibial cartilage volume and accuracy for the measurement of change in a longitudinal study, The Journal of Rheumatology, vol 31, issue 12, Journal of Rheumatology Publishing Co. Ltd., Canada, pp. 2444-2448.
Wang, Y., Prentice, L.F., Vitetta, L., Wluka, A., Cicuttini, F.M., 2004, The effect of nutritional supplements on osteoarthritis, Alternative Medicine Review, vol 9, issue 3, Thorne Research Inc., USA, pp. 275-296.
Jackson, B.D., Teichtahl, A.J., Morris, M.E., Wluka, A.E., Davis, S.R., Cicuttini, F.M., 2004, The effect of the knee adduction moment on tibial cartilage volume and bone size in healthy women, Rheumatology, vol 43, issue 3, Oxford University Press, UK, pp. 311-314.
Wluka, A., Wolfe, R.S.J., Davis, S.R., Stuckey, S., Cicuttini, F.M., 2004, Tibial cartilage volume change in healthy postmenopausal women: A longitudinal study, Annals of the Rheumatic Diseases, vol 63, issue 4, BMJ Group, United Kingdom, pp. 444-449.
Teichtahl, A.J., Morris, M.E., Wluka, A., Bach, T.M., Cicuttini, F.M., 2003, A comparison of gait patterns between the offspring of people with medial tibiofemoral osteoarthritis and normal controls, Clinical and Experimental Rheumatology, vol 21, issue 9-11, Pacini Editore, Italy, pp. 489-494.
Teichtahl, A., Wluka, A., Cicuttini, F.M., 2003, Abnormal biomechanics: a precursor or result of knee osteoarthritis?, British Journal of Sports Medicine, vol 37, issue 4, BMJ Publishing Group, London England, pp. 289-290.
Cicuttini, F.M., Wang, Y.Y., Forbes, A.B., Wluka, A.E., Glisson, M., 2003, Comparison between patella cartilage volume and radiological assessment of the patellofemoral joint, Clinical and Experimental Rheumatology, vol 21, issue 3, Clinical and Experimental Rheumatology, Italy, pp. 321-326.
Cicuttini, F.M., Wluka, A.E., Forbes, A.B., Wolfe, R.S., 2003, Comparison of tibial cartilage volume and radiologic grade of the tibiofemoral joint, Arthritis and Rheumatism, vol 48, issue 3, John Wiley & Sons, Inc., New York USA, pp. 682-688.
Cicuttini, F.M., Wluka, A.E., Wang, Y., Stuckey, S., Davis, S.R., 2003, Effect of estrogen replacement therapy on patella cartilage in healthy women, Clinical and Experimental Rheumatology, vol 21, issue 1, Clinical and Experimental Rheumatology, Italy, pp. 79-82.
Cicuttini, F.M., Wluka, A., Bailey, M.J., O'Sullivan, R.M., Poon, C., Yeung, S., Ebeling, P.R., 2003, Factors affecting knee cartilage volume in healthy men, Rheumatology, vol 42, issue 2, Oxford University Press, UK, pp. 258-262.
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Wluka, A., Stuckey, S., Brand, C., Cicuttini, F.M., 2002, Supplementary Vitamin E does not affect the loss of cartilage volume in knee Osteoarthritis: a 2 year double-blin randomised placebo controlled study, Journal of Rheumatology, vol 29, issue 12, The Journal of Rheumatology Publishing Co ltd, Canada, pp. 2585-2591.
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