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!
Two of our very own clinical faculty, Dr. Maya Jerath and Dr. Bill Yount are two of only 22 doctors who are being awarded the 2015 UNC Health Care and Faculty Physicians Award for Carolina Care Excellence. Dr. Jerath and Dr. Yount are outstanding physicians who each achieved 100% satisfaction with their patients!
For those of us who know and love them, this comes as no surprise, but it is lovely that their excellent care is appreciated and recognized!
An R01 is a grant awarded by the NIH to support a large research project and they are hard to get. Dr. Golightly's RO1 is a four-year grant titled “The Role of Joint Hypermobility in Lower Body Osteoarthritis”, and her UNC TARC team includes Drs. Jordan, Nelson, Cleveland, Schwartz, and Renner; as well as Patrick Gale and Betsy Hackney. The project also has four researchers from other institutions; Duke, Harvard, and Hospital for Special Surgery.
Joint hypermobility is a condition in which range of motion at the joints is greater than normal and is commonly referred to as being “double-jointed.” Joint hypermobility is a lifelong condition that is common in youth and declines with age (joints tend to stiffen with age). As many as 25% of adults may have joint hypermobility, it is more common in women than men and may increase the risk for osteoarthritis (OA).
In the United States, the number of people diagnosed with OA is rapidly increasing each year, resulting in rising health care costs and more people experiencing disability.
We will be conducting the largest study to date of over 7,000 people from three large studies of participants with and without OA: the Johnston County Osteoarthritis Project, Genetics of Generalized Osteoarthritis study, and Genetics of Osteoarthritis study. This study will help us understand the role of joint hypermobility in lower body OA. Results of this study will lead to interventions, like shoes, bracing, or specialized exercises, that may promote good joint function to help prevent or treat OA.
“It is uncommon to get the award on the first try, and I feel very fortunate.”
UNC was well-represented at the North Carolina Rheumatology Association (NCRA) meeting March 21-22. Dr. Slavin did a fantastic case presentation sparking much discussion (photo). Dr. Jimmy Ford from pulmonary gave an excellent talk on pulmonary hypertension. Also in attendance were our fellows Drs. Adhikari and Ritt and Dr. Nelson who serves as the academic representative to the NCRA board.
Dr. Richard Loeser in the Division of Rheumatology, Allergy and Immunology and the UNC Thurston Arthritis Research Center has received a National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) research grant called a BIRT award for “Building Interdisciplinary Research Teams”. The purpose of this competitively reviewed award is for investigators holding a current NIAMS RO1 research project grant to form a new interdisciplinary team that will add a novel and innovative approach to the ongoing project. The new team members are Dr. Keith Burridge in the Department of Cell Biology and Physiology and Dr. Elizabeth Loboa in the Department of Biomedical Engineering. The team will study how cell receptors called integrins transmit signals that control the response of cartilage cells to mechanical forces. Cartilage is the tissue that coats the ends of bones providing a smooth and slippery surface that allows for normal joint motion. Maintenance of healthy cartilage is supported by a certain level of mechanical stimulation that occurs during normal joint use. However, abnormal and excessive forces on the cartilage, for example after a joint injury or in obese individuals, stimulate the cartilage cells to breakdown the cartilage, resulting in development of osteoarthritis, the most common form of arthritis and the number one cause of pain and disability in older adults. By better understanding the signals produced in response to various levels of force placed on cartilage cells, new therapies can be designed which would block the response seen with abnormal joint loading and promote the healthy responses needed for maintenance and repair.
Aubrey received her B.S. degree from Elon University in Biology, with minors in Chemistry and Psychology in May 2008. She graduated with a Masters Degree in Physician Assistant Studies from Methodist University in 2011. Since graduation, she has worked as a Physician's Assistant at Edgewater Medical Center in Lillington, NC and at Lafayette Rheumatology in Fayetteville, NC. Thanks to her experience at Lafayette Rheumatology, she brings to our practice valuable experience in evaluation, diagnosis and management of a broad range of our chronic rheumatic diseases. She also co-founded the Lafayette Gout and Osteoporosis clinics during her employment there. Aubrey is also a trained and certified EMT and worked at Emerald Isle Emergency Medical Services prior to enrolling in her PA program.
Please join us in welcoming Aubrey!
Jaime Brozowski, M.S. is a third year Ph.D. Candidate, HHMI Translational Medicine Trainee and Women in Science at UNC Chair.
Business and nursing staff on opening day of the Therapeutic Infusion Center
UNC Hospitals and the Division of Rheumatology, Allergy and Immunology are excited to announce the opening of the UNC Hospitals Therapeutic Infusion Center at Carolina Pointe II!
The new twenty-two seat Infusion Center is located on the second floor of 6013 Farrington Road in Chapel Hill. Here, a skilled team of nurses, led by Lana Amend, RN and Suzanne Francart, PharmD, will perform non-oncologic infusions for patients from numerous specialties including - but not limited to - Rheumatology, Gastroenterology, Neurology, and Benign Hematology. The Infusion Center is led by two clinical faculty of the Division of Rheumatology, Allergy and Immunology and the UNC Thurston Arthritis Research Center; Dr. Alfredo Rivadeneira will serve as Director and Dr. Bill Yount as Associate Director.
If you would like to inquire about utilizing infusion services for your patients – please contact Alex Nance at Alexander.Nance@unchealth.unc.edu
Check out this great article about our center! Drs. Jordan, Tarrant, Callahan, Loeser and Sheikh were all contributors.