Drs. Jordan, Callahan, and Loeser awarded 5 year, $6.7 million grant from NIAMS for a pragmatic clinical trial of Weight loss and Exercise for Communities with Arthritis in North Carolina (“WE-CAN”)
Drs. Jordan, Callahan, and Loeser awarded 5 year, $6.7 million grant from NIAMS for a pragmatic clinical trial of Weight loss and Exercise for Communities with Arthritis in North Carolina (“WE-CAN”).
NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases announced that UNC will be part of a multi-center U01 study including Wake Forest University and Brigham and Women’s Hospital and will receive a 5 year, $6.7 million dollar grant, beginning September 1, 2015. The research study, “Weight loss and exercise for communities with arthritis in North Carolina (WE-CAN),” will implement and test the effectiveness and cost-effectiveness of an evidence-based practical, diet-induced weight loss and exercise intervention that communities can implement to reduce pain and improve other clinical outcomes in people with knee osteoarthritis (OA).
Joanne M. Jordan, MD, MPH, Joseph P. Archie Eminent Professor of Medicine, Director of the Thurston Arthritis Research Center and Chief, Division of Rheumatology, Allergy and Immunology at UNC is the Co-Principal Investigator with Dr. Stephen Messier of Wake Forest University. The UNC site leader and Co-Investigator is Leigh Callahan, PhD, Mary Link Briggs Distinguished Professor of Medicine, Director of Epidemiology and Outcomes Research at the Thurston Arthritis Research Center and Director of the Osteoarthritis Action Alliance. Richard Loeser, MD, Herman and Louise Smith Distinguished Professor of Medicine and Director of Basic and Translational Science at Thurston is co-investigator. Adjunct Professor of Medicine Kate T. Queen, MD, will lead the effort in Haywood County.
Drs. Jordan, Callahan, Loeser, and Queen will supervise and execute a diet and exercise intervention program, working closely with community partners in Johnston and Haywood counties. Their goals will be to determine whether an evidence-based diet and moderate exercise intervention can be implemented successfully in community-based settings in North Carolina with diverse residential (from urban to rural) and socioeconomic patterns to decrease knee pain in overweight and obese adults with knee OA, relative to a physician advice comparator group. The study will also ascertain the cost-effectiveness of the pragmatic community-based multimodal program, and conduct a budgetary impact analysis to facilitate implementation of such a program in community settings across the United States.
In addition to the Exceptional Patient Service Award, our Allergy/Immunology Clinic was also presented with the "The Good Guy Award" for exceptional courtesy based on having the highest score over all the clinics in nursing, business staff, physician and team work categories. Please join us in celebrating their amazing hard work and dedication to our patients!
Osteoarthritis (OA) is a leading cause of pain and disability among adults in general, but African Americans experience a disproportionate burden, including greater prevalence and more severe symptoms and functional limitations. Emerging data suggest that pain Coping Skills Training (CST) programs may help to reduce racial disparities in OA symptom severity. A new study, led by Dr. Kelli Allen and her research team at the Thurston Arthritis Research Center, will evaluate the effectiveness of a culturally enhanced pain CST program among African Americans with OA.
This three-year project is funded by the Patient-Centered Outcomes Research Institute and involves collaborations with investigators at Duke University Medical Center, the Durham VA Medical Center, and East Carolina University. The study will involve 248 African Americans with symptomatic hip or knee OA. Half of the study participants will be patients within the UNC healthcare system and half will be patients at the Durham VA Medical Center. This randomized controlled trial will test a 12-session, telephone-based pain CST program that is based on previous studies but enhanced through input from African Americans with OA and other stakeholders involved in the study.
Portsia Latta, NA, with the UNC Rheumatology Clinic, received a Plus People Award from UNC Healthcare. This honor is presented to UNC Healthcare employees for their outstanding performance and service. The Plus People Awards were established to recognize those who exemplify the characteristics of one or more of the pillars of Commitment to Caring. The award is a tribute to the positive attitude she brings to her job, the high quality of her work and her concern for all the people she serves. Ms. Latta has been a member of the UNC Rheumatology Clinic Nursing Team for four years and enjoys “interacting with patients and their families.”
Dr. Loeser’s team seeks to define the role of the gut microbiome in the pathogenesis of osteoarthritis (OA). OA is the most common form of arthritis, affecting over 27 million Americans, and is the #1 cause of chronic disability in adults. Management of OA is limited by the lack of interventions that slow disease progression. A better mechanistic understanding of OA is needed to develop new interventions that target mechanisms driving the disease process. Mounting evidence suggests that metabolic alterations, a systemic low grade pro-inflammatory state, and activation of the innate immune system play key roles in OA. These same factors have also been associated with altered composition of the gut microbiota (dysbiosis), which in turn is influenced by diet, in particular a high fat diet that contributes to obesity. We propose that dysbiosis of the gut microbiota, by promoting a chronic systemic pro-inflammatory state, can accelerate or worsen the development of OA when other risk factors, such as obesity or joint injury, are also present.
The unique multidisciplinary team of outstanding investigators will test the hypothesis that components of the gut microbiome contribute to the development of OA through activating innate immunity and promoting an inflammatory state. The success of these novel studies will have major public health implications. Defining a contribution of the gut microbiome to OA would indicate the use of microbiota profiling as a novel approach to identify individuals at risk of progressive OA and aid in the design of novel dietary, antibiotic, probiotic or prebiotic interventions to alter the specific components of the microbiome that contribute to OA progression.
In submitting publications, presentations and grant applications using data from your Phase I award, please remember to acknowledge the SOM Office of Research and TraCS Translational Team Science Award.
Collins Mbonu and Shahmeer Lateef join UNC TARC under the guidance of Dr. Leigh Callahan and Dr. Amanda Nelson, respectively. The purpose of the preceptorship program is to introduce medical and graduate students to rheumatology-related health care by supporting a full-time clinical or research experience in the broad area of rheumatic disease.
Jeffrey Brow and Nicolas Ashur are both MSTAR students who will work with Dr. Jordan this summer on a projects related to arthritis.
Jeffrey will work on a project looking at the role of obesity, diabetes mellitus, and cardiovascular disease as modulators of pain threshold in patients with symptomatic knee and hip osteoarthritis and Nicolas's project will explore the effect modification of co-morbidities on physical function in osteoarthritis.
Richard Loeser receives the OARSI Basic Science Research Award for "Aging and Osteoarthritis: What’s the Link?”
DELETION OF MACROPHAGE MIGRATION INHIBITORY FACTOR REDUCES SEVERITY OF OSTEOARTHRITIS IN MICE
Amanda Nelson and Yvonne Golightly:
VARIATIONS IN HIP SHAPE ARE ASSOCIATED WITH PREVALENT RADIOGRAPHIC KNEE OA: THE JOHNSTON COUNTY OSTEOARTHRITIS PROJECT
Antoine Baldassari and Leigh Callahan:
ASSOCIATIONS BETWEEN SOCIOECONOMIC STATUS AND RADIOGRAPHIC AND SYMPTOMATIC KNEE OSTEOARTHRITIS: DATA FROM THE OSTEOARTHRITIS INITIATIVE
Becki Cleveland and Leigh Callahan:
ASSOCIATION OF LARGE JOINT OSTEOARTHRITIS WITH ALL-CAUSE DEATH: THE JOHNSTON COUNTY OSTEOARTHRITIS PROJECT
PROGRESSION OF DISABILITY IS ASSOCIATED WITH SOCIOECONOMIC MEASURES IN THE JOHNSTON COUNTY OSTEOARTHRITIS PROJECT
Joanne M. Jordan:
A GENOME WIDE ASSOCIATION STUDY OF PRESSURE PAIN THRESHOLD IN THE JOHNSTON COUNTY OSTEOARTHRITIS PROJECT
Dr. Allen's abstract;
Knee osteoarthritis (OA) is a leading cause of pain and disability among veterans, and Department of Veterans Affairs health care users are the most severely affected. There is ample evidence that exercise improves pain, function, and other outcomes among patients with knee OA. However, the vast majority of individuals with knee OA are physically inactive. There is clearly a need to develop and implement programs that efficiently and effectively foster regular physical activity and improve key patient-centered outcomes among veterans with knee OA. This objective of this study is to evaluate the effectiveness a novel STepped Exercise Program for Knee OsteoArthritis (STEP-KOA).
This will be a randomized controlled trial of n=345 veterans with symptomatic knee OA in two VISN 6 sites, with participants assigned to two study arms: STEP-KOA and Arthritis Education Control (AE). STEP-KOA will begin with three months of access to a low-resource internet-based exercise training program that uses patient-specific information to determine and deliver an appropriate personalized exercise plan (Step 1). Participants who do not meet response criteria for clinically meaningful improvement in pain and function after three months of Step 1 will additionally receive telephone calls from an exercise counselor for three months, to facilitate adherence and address barriers to physical activity (Step 2). Participants who still fail to meet response criteria after Step 2 will receive in-person physical therapy visits, which address specific functional impairments and further tailor exercise recommendations (Step 3). Outcomes will be assessed at baseline, 3-months, 6-months, and 9 months (primary outcome time point). Veterans in the AE group will be offered participation in STEP-KOA after completing study assessments. The primary outcome will be the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), a measure of lower extremity pain, stiffness and function. The secondary outcomes will be objective measures of physical function. The main study analyses will compare the STEP-KOA intervention to the AE control condition at follow-up time points. We will also evaluate patient characteristics associated with the need for progression to each Step and will conduct a cost-effectiveness analysis of STEP-KOA. This stepped exercise intervention is matched with patient needs, and it also provides the VA with a potential approach for focusing limited physical therapy resources toward patients who do not respond adequately to initial, less resource intensive and costly strategies to improve physical activity and related outcomes.
Dr. Jordan will retain her current appointments as Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief, Division of Rheumatology, Allergy and Immunology, and Director, Thurston Arthritis Research Center.
In her new role, Jordan will be charged with:
- Supervision of 5-year reviews of tenured faculty, department chairs and center directors
- Oversight of Appointment, Promotion and Tenure committees
- Faculty Pipeline Programs, the Simmons Scholar Program and the Scientific Integrity Office
- Coordination of searches for chairs and center directors
- Oversight of faculty leadership development activities in the School of Medicine
In her role as Executive Associate Dean, Jordan will report to Wesley Burks, MD, Executive Dean of the School of Medicine.
Jordan has served on the faculty of the UNC School of Medicine since 1987. The outstanding communications skills and leadership abilities she has displayed in her 27 years at UNC make her well suited for success in her new, expanded role. Jordan replaces Paul Godley, MD, PhD, who was recently appointed as the School’s Vice Dean for Finance and Administration.
All of us at UNC TARC and UNC RAI are so proud of Dr. Jordan!