Prof. Dr. Bart Koes, Dr Sita Bierma-Zeinstra, Dr Arianne Verhagen
Musculoskeletal disorders are a major public health problem. More than 40% of the people aged 25 years or more reports at least one musculoskeletal disorder. Commonly reported musculoskeletal diseases are tendinitis or capsulitis, (osteo)arthritis and complaints as a result of a trauma. Evidence based information is needed to understand, treat and prevent musculoskeletal disorders.
MUSC (Musculoskeletal Science Center) is the multidisciplinary musculoskeletal research institute of the Erasmus MC. Within MUSC, the Erasmus MC departments of Rehabilitation Medicine, Orthopaedics, Rheumatology, Plastic and Reconstructive Surgery, Public Health, General Practice, Traumatology, and Biomedical Physics participate. Over 100 researchers carry out fundamental (basic) as well as patient oriented (applied) research. Structural research co-operation exists with, among others, the Department of Neuroscience and the Netherlands Expert Centre for Work related Musculoskeletal disorders. Musculoskeletal research questions are related to (consequences of) diseases, accidents, chronic overuse, and congenital defects. This includes chronic or chronic recurrent diseases, impairment and disabilities of the elderly, primary and secondary prevention, as well as work and health.
The three main clinical topics of MUSC are:
- Back and pelvic pain
- Hip- and knee disorders
- Upper extremity disorders
MUSC offers the participating departments a multidisciplinary environment to fruitfully address musculoskeletal research questions from fundamental to patient-related clinical research and public health issues.
The objective of the fundamental research is to identify underlying mechanism of injuries to the lower back and pelvis, hip- and knee disorders and disorders of the upper extremity. The research projects focus on questions as: which biological structures are vulnerable to overuse of high-energy impact, and which postures and movements are responsible for patient’s complaints? Patient-related research questions include the effect of a broad range of health care interventions including rehabilitation, determinants and pathogenic mechanisms of systemic bone and joint disorders such as (osteo)arthritis and osteoporosis, ambulatory recording of daily life activities, posture and movement at work, activities of pain patients and elderly, and data acquisition of true natural activities instead of laboratory measurements. Measurement instruments are developed and tested for validity and reproducibility. An important goal of the public health research is to identify the determinants of the occurrence of incident and recurrent musculoskeletal disorders and to investigate the association between work and musculoskeletal disorders.
Two examples of MUSC projects:
- In the MUSC randomised double-blinded trial ‘glucosamines and osteoarthritis’, 220 patients with hip osteoarthritis take glucosamines or placebo for a period of two years. Pain and function scores are obtained at regular intervals. X-rays, DXA scans are made at the start and the end of the study to determine joint space narrowing and bone density changes. In the clinical part of the study the effect of glucosamines on these outcomes are studies.
- In the fundamental part of the study, cartilage and subchondral bone is cultured from patients who develop severe osteoarthritis during the course of the study and undergo a total joint replacement. The effects of glucosamines on cartilage cell metabolism as well as gene expression analysis are determined in these cultures. This fundamental part of the project can elucidate the working mechanism of glucosamines and may lead to improved intervention methods and new targets to treat osteoarthritis.
In the research project ‘Magnetic Resonance Imaging (MRI) of hand, hip and knee’ different MUSC participating departments work together to:
- enhance reliable measurements with MRI of tissue changes over time in (early) osteoarthritic joints, by validation of quantitative scores that will be developed;
- quantify pathological characteristics of tendon in the hand;
- find pathological characteristics that can be used to identify the status of osteoarthritis;
- describe disease development of osteoarthritis at the structural (tissue) level and find the most essential characteristics that can predict disease progression.
MUSC participants are internationally well recognized with respect to osteoarthritis research and this research project aims to strengthen research on osteoarthritis and tendons within MUSC and it with novel MRI techniques to evaluate e.g. cartilage degeneration in osteoarthritis of hand, hip and knee and in tendon disorders of the hand. The MUSC research on osteoarthritis is connected to the ERGO cohort (Dept. of Epidemiology) that concerns a large open population cohort study among over 8000 subjects.
For a NIHES fellowship, there are suitable methodological questions available within the musculoskeletal databases at the department of General Practice. For example we combine data from different cohort studies to evaluate prognostic factors and create a prediction model. Furthermore this combined dataset will be used to evaluate the association between pain, function and recovery and to evaluate the influence and timing of dichotomising variables for selecting in a prediction model.
Theme 1: Musculoskeletal imaging (US, CT and MRI)
Principal investigator: Dr. E.H.G. Oei
The Advanced Musculoskeletal Imaging Research Erasmus MC (ADMIRE; www.erasmusmc.nl/admire) group of the Department of Radiology & Nuclear Medicine focuses on advanced imaging of musculoskeletal diseases, particularly those with a large burden for patients and society, such as osteoarthritis, osteoporosis, and sports injuries. There is a large need for sensitive and accurate imaging biomarkers in order to detect these diseases earlier, providing better understanding of their etiology and pathophysiology, and discovery of new therapies. Therefore, we develop, improve, and validate innovative CT, MRI, ultrasound and nuclear imaging techniques, and apply these in clinical studies on early osteoarthritis, sports injuries and other musculoskeletal conditions.
Many of these techniques are aimed at visualizing and quantitatively measuring changes in the structure and composition of musculoskeletal tissues such as cartilage, synovium and tendon. In this work, we collaborate closely with MRI physicists and image analysis experts from the Biomedical Imaging Group Rotterdam (BIGR). Another important research focus is on musculoskeletal population imaging. We utilize information from MRI and other imaging techniques in the large-scale population based Rotterdam Study to address the epidemiology and genetics of musculoskeletal diseases such as osteoarthritis and osteoporisis. In the Generation R cohort we apply MRI to study the development of muscuskeletal tissues and changes in body composition.