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Championing precision medicine for children living with arthritis

The largest study in Australia into the treatment of juvenile arthritis may pave the way for a unique approach to care for those with the disabling condition and dramatically improve outcomes.

The Medical Research Future Fund will invest $2.5 million in the A3BC for Kids project which will involve researchers from the Kolling Institute and the University of Sydney in collaboration with the Australian Paediatric Rheumatology Group.

Kolling researcher and RNSH Head of Rheumatology Professor Lyn March said the centrepiece of the project, a large-scale clinical trial represents an important step towards improved care and more efficient use of medicines.

“Juvenile idiopathic arthritis affects over two million children worldwide. It is the most common chronic inflammatory musculoskeletal condition in children, and can lead to blindness and life-long disability,” she said.

“The condition is more common in girls than boys and may affect a child’s bone development and overall growth. Sadly, there is no known cause or cure.”

Current treatments involve the use of disease modifying and biologic medications which target particular immune pathways.

Professor March said these medications help, but they come with risks as they dampen the immune system, leaving some children vulnerable to infection, which can be very serious.

“International clinical and research experts agree we need to use these medications more effectively, but there is no high-quality data indicating when or how to take children off these drugs when their condition is under control,” she said.

The CHAMPION clinical trial will recruit more than 300 children from every major paediatric rheumatology treatment centre across Australia. It will involve tapering the medications to determine who can come off these drugs and how best to withdraw them once the disease is controlled.

A broad range of biological, environmental and health information will be collected from participants throughout the study. These data and biospecimens will form part of the Australian Arthritis and Autoimmune Biobank Collaborative (A3BC) biobank-registry collection.

Paediatric rheumatologist Professor Davinder Singh-Grewal from the University of Sydney said this body of work will pave the way for the development of new living treatment guidelines and clinical decision support tools to truly personalise medicine for the individual.

“This could be a global game changer for the management of children living with juvenile idiopathic arthritis, improving health outcomes and reducing uncertainty for clinicians, patients and their families,” he said.

For the first time, researchers led by the Kolling Institute’s Dr Manasi Mittinty, will also investigate how children and their families navigate the mental health impact of juvenile idiopathic arthritis. This research will assess coping mechanisms, treatment responses and children’s well-being.

Researchers are excited to launch the project and begin work with the wealth of partners, including the Sydney Children’s Hospitals Network, Arthritis Australia, Musculoskeletal Australia, Juvenile Arthritis Foundation Australia, CLEARbridge Foundation, Dragon Claw, Murdoch Children’s Research Institute, Arthritis & Osteoporosis Western Australia, the Australian Rheumatology Association, NSW Health Statewide Biobank, ANZMUSC CRE Living Guidelines team, and the A3BC NHMRC CRE Better Outcomes for Inflammatory Arthritis collaborators and patient partners advisory group.

Exciting job opportunities

A range of great employment and research opportunities, including PhD scholarships, will be available through the A3BC grants program. For more information, please contact info@a3bc.org.au

1 June 2022
Back pain treatments shouldn’t neglect the mind

ysiotherapy treatments with those focusing on the mind.

The study, involving Emma Ho, Professor Manuela Ferreira and Lingxiao Chen, analysed evidence from almost 100 trials worldwide involving over 13,000 patients.

It found a combination of physiotherapy alongside psychological interventions, like behavioural therapy and pain education, produced the best outcomes for physical function and pain intensity.

The researchers say these results could help improve the clarity of guidelines to better support patients and clinicians in making treatment decisions.

Lead author Emma Ho said we know that adults with chronic low back pain not only experience physical disability, but often also suffer psychological distress including anxiety, depression or fear of pain from movement.

“Clinical guidelines recommend a combination of exercise and psychosocial therapies for managing chronic low back pain, however very little is actually known about the different types of psychological therapies available and their effectiveness,” she said.

“This often leaves doctors and patients unclear about the best choice of treatment.

“This uncertainty motivated us to conduct the study and we are pleased to say we now have a clearer picture of the most effective psychological interventions for people with chronic low back pain.

“Our in-depth analysis looked at a broad range of interventions such as counselling and cognitive programs, and we found behavioural therapy and pain education alongside traditional physiotherapy offered the best results and reduction in pain,” she said.

Researchers from Australia and Canada were involved in the collaborative research project, with the results to inform healthcare guidelines not just in Australia but internationally as well.

21 April 2022
Kolling researcher to join prestigious Harvard Medical School program

Congratulations to Kolling Institute researcher Dr Manasi Mittinty who has been selected for the Advanced Global Clinical Scholar Research training at Harvard Medical School.

Dr Mittinty is a medical trained researcher with the Pain Management and Research Centre and a University of Sydney lecturer. She has a keen interest in translation research and the connections between musculoskeletal conditions, pain science and neuropsychology.

The one-year training program provides clinicians and clinician-scientists with advanced training in health care research. One of its key aims is to help participants develop cutting-edge translational research on a global scale.

Places in the program are highly competitive with only established academics and leaders in their field selected. The program has previously attracted participants from more than 40 countries in high profile positions such as chief physicians, medical directors, fellows, scientists and medical specialists.

Manasi has welcomed the opportunity to join the program.

“I feel very excited and privileged to be selected from a global pool of scholars for this training. I look forward to learning from the distinguished faculty at Harvard Medical School,” she said.

“This training will help me develop and lead transformative research to promote enhanced wellbeing for people living with arthritis and their families.”

Manasi has received several prestigious awards including the Australian Post-graduate award and the Commonwealth funded Endeavour Post-doctoral Research Fellowship, and can now add this opportunity to her list of achievements.

28 January 2022
Research identifies swallowing problems following whiplash

Research conducted by a team from Kolling Institute has found that swallowing difficulties after a whiplash injury appear to be an under-recognised consequence of the injury.

The study investigated a group of 60 patients with low-grade whiplash, finding 50 per cent of patients reported swallowing problems within 12 months of their whiplash injury.

In 31 of these patients, there was a statistically significant worsening of their swallowing problems between three and 12 months post injury.

Clinical specialist speech pathologist and PhD student Danielle Stone said the study was the first of its kind to use a standard patient-reported outcome measure to investigate whether swallowing issues were an under-recognised condition following whiplash.

“Before our study, there was a small amount of literature suggesting swallowing difficulties were a possible consequence of whiplash, but following our work, we now have additional data linking the two conditions.

“Further research is needed, but this information will help in the treatment of whiplash by encouraging clinicians to consider a broader range of symptoms following a whiplash injury.”

The study also investigated whether swallowing changes were related to a change in volume of the pharynx (throat) as prior studies demonstrated a narrowing of the pharyngeal lumen in people presenting with persisting disability.

“Contrary to what we thought, there was no change in the volume of the pharynx in our cohort and therefore, no association with swallowing problems.

“Our investigations have played an important part in raising awareness of the conditions.

“As our study was the first to explicitly look at swallowing and whiplash using a well-accepted outcome measure, we now have more confidence that swallowing may be a feature of whiplash that warrants further investigation.”

The research has been published in the medical journal, Dysphagia.

6 December 2021
Researchers reject the use of plasma injections for knee joint osteoarthritis

In what will be disappointing news for many, a large-scale clinical trial has found platelet-rich plasma injections for those with osteoarthritis knee pain are no better than a placebo.

This type of injection has become an increasingly popular form of treatment for knee joint arthritis, despite its prohibitive cost at around $2,000 per injection.

Plasma from a patient’s own blood is injected directly into the joint in the hope it will reduce pain and improve joint cartilage.

But a trial conducted by researchers from the universities of Sydney and Melbourne and Monash University has found that while participants who had the plasma injections did have a significant improvement in their knee pain over 12 months, the level of improvement was the same as for those in the placebo group.

There were also no differences in the MRI scans across both groups.

Kolling Institute and University of Sydney researcher Professor David Hunter concedes the findings will disappoint some people who had hoped these injections would offer long-term relief.

“With more than two million Australians affected by knee joint arthritis, there is clearly a need for new therapies to reduce symptoms and improve the structure of the knee,” he said.

“Unfortunately, the particular treatment trialled in this study, whilst widely used and typically expensive, appears to be ineffective.

“Our research however has added to our understanding of this type of treatment and will ensure the latest recommendations are backed by high-quality evidence.

“Our current advice encourages people with knee osteoarthritis to adopt a consistent exercise program and lose weight if they are above a healthy weight range.

“We know that by reducing your body weight by just 10 per cent, you can reduce your knee pain by a remarkable 50 per cent.”

The research paper has been published in one of the world’s leading medical journals, the Journal of the American Medical Association.

26 November 2021
Kolling researcher takes out coveted award

Congratulations to Kolling researcher Dr Jillian Eyles who’s been named one of the inaugural research translation fellows by Sydney Health Partners.

Facing tremendous competition from a large group of outstanding researchers, Jillian is one of just five people to have been awarded a fellowship, which means they’ll be able to dedicate a greater amount of their time to research.

Sydney Health Partners says the fellowships are aimed at building research translation capability in the workforce by supporting researchers to improve their translational skills while remaining in their substantive position. The fellowships will also involve learning support and professional development.

Sydney Health Partners Executive Director Professor Don Nutbeam says the new fellows were successful in a highly competitive process.

“We are very pleased to be able to support such able clinicians and researchers through Sydney Health Partners. The standard of applications was very high and we are disappointed not to be in a position to support several other worthy applicants,” he said.

Dr Eyles will now be able to direct her research focus to a project evaluating strategies to enhance the adoption of the Osteoarthritis Chronic Care Program (OACCP) across NSW public hospitals.

Jillian has welcomed the fellowship saying it will provide an opportunity to extend this important program focusing on evidenced-based, patient centred care to improve outcomes for people living with osteoarthritis.

“While it is a great program, the clinicians who lead the OACCP have identified important aspects that could be improved to make it even more successful. I am looking forward to collaborating with clinicians from Northern Sydney, Western Sydney and Sydney local health districts to help make this happen.”

Kolling Institute Acting Executive Director has commended Jillian on her fellowship, saying it’s a testament to her talent and her impressive track record.

“This additional support from Sydney Health Partners is welcome as the Kolling steps up its focus on research translation,” he said.

“By investing in projects like this, we can speed up the implementation of best practice, and ensure our hospital-based care is informed by the very latest developments and research.”

19 November 2021
Game-changing research partnership to ease musculoskeletal burden

An important new partnership has been formed to dramatically improve care for musculoskeletal conditions by speeding up the translation of research to clinical practice.

The Northern Sydney Local Health District has joined with the University of Sydney and Sydney Local Health District to create Sydney Musculoskeletal Health which will link researchers from across the University with clinicians, consumers, policymakers and industry.

Co-director and Kolling Institute researcher Professor David Hunter said the partnership represents a key step towards better care.

“Musculoskeletal conditions are a leading cause of disability, impacting approximately 1.7 billion people worldwide and around one-third of the Australian community. Low back pain, osteoarthritis, neck pain, rheumatoid arthritis and gout are some of the most common musculoskeletal disorders, compromising work and social opportunities,” he said.

“We know that poor musculoskeletal health contributes to fall-related injuries and physical inactivity, increasing the burden of disease globally.

“This exciting new partnership is set to transform our management of these conditions by supporting world-leading, multidisciplinary research, and rapidly translating the resulting knowledge into clinical practice and education.

“Our goal is to improve health and well being by undertaking high quality research that promotes the delivery of efficient, patient-centred, evidence-based care.

“We’ll be looking to discover new ways to prevent, manage and cure these debilitating musculoskeletal conditions and injuries, and to promote healthy ageing and physical activity.”

Professor Hunter said the breadth of expertise across the partnership will be a key factor in its success, along with a commitment to investigate all the musculoskeletal conditions.

“This will ensure that all research will be translated across all relevant applications, and the partnership between the University and the two health districts means the research can be put into practice sooner.

“This is a key distinction which will see improvements in care, new treatments and a review of the efficacy of current treatments to ensure that clinical guidelines keep pace with research.”

1 November 2021
Living with Osteoarthritis

At 16, Tom Buttel suffered a knee injury while playing rugby, and while that incident happened more than 40 years ago, it continues to impact his life today.

At 60 Tom has advanced osteoarthritis in his right knee after the debilitating condition took hold in his mid-20s.

Tom underwent several surgeries over a 15 year period and has now lived with osteoarthritis for many years.

“It has a huge impact on my life, but I have developed the skills to manage the condition and have learnt a great deal about osteoarthritis and self care,” Tom said.

“As I’m getting older, my arthritis is naturally not improving, but I’m in a better position to manage the condition and reduce its symptoms.

“The best treatment has been a chronic care program involving clinician/researchers from the Kolling Institute which focuses on losing weight and specialised exercises.

“It’s been very helpful for me in recent years and the multi-disciplinary team has been tremendously supportive.

“The program has adopted an evidenced-based approach developed through a series of research initiatives. You really are receiving the best care if it’s informed by the latest research.

“I have been fortunate to have been supported by some of the Kolling’s impressive clinican/researchers including Professors Hunter, March and Little and I’ve benefitted from their expertise.

“They are leading experts in their field and that gives you a huge amount of confidence that you are receiving the best care and advice.”

Convinced of the importance of evidenced-based care, Tom has taken part in a collection of research trials and continues to support patient advocacy initiatives.

“I feel the more you give, the more you receive. I’ve met some wonderful people and they’ve inspired me as a patient to try a little harder.

“Seeing that level of care and dedication from those looking after you encourages you as a patient.

“All these years later, I’m in better shape as a result of the care and treatment I’ve received, and I’m keen to do what I can to support research and help more people benefit from evidenced-based care.

“It can dramatically improve their condition and ultimately quality of life.

“I’m keen to do what I can to support research and help more people benefit from evidenced-based care.”

18 October 2021
World Spine Day: Kolling researchers challenging old concepts to improve care

To mark World Spine Day on October 16, the Back Pain Research team at the Kolling Institute is urging those who experience the condition to adopt the latest advice and keep moving.

Spinal pain is extremely common, affecting around 800 million people globally. The condition compromises social, family and work activities, and is the main reason Australians retire involuntarily.

The lower back and neck are most commonly affected, with those over 75 suffering the most.

Head of the Kolling’s Back Pain Research team and University of Sydney researcher Professor Manuela Ferreira said that despite the impact of spinal pain, it’s rarely due to serious disease and usually gets better with time.

“Our spine is strong and old concepts like back pain is caused by poor posture or bending are no longer supported by research,” she said.

“The latest findings show that there are no right and wrong postures for the spine, as long as we keep moving and changing positions frequently.

“The current advice from researchers is to keep working, remain as active as possible and modify activities as needed. It’s important to find an exercise you can do and enjoy doing as every exercise can help the spine.

“It’s also important to limit the use of strong medications and injections, and to consider the role of surgical procedures as many have limited benefit in the long term.”

The Back Pain Research team is continuing its program to help those suffering from spinal pain, launching new research to improve our understanding of spinal conditions and how they can be prevented and treated.

“We are conducting ground-breaking studies nationally and internationally so that the community ultimately has access to high-value, evidenced based care.

“We are excited by our new research which will focus on broadening our knowledge around the efficacy and safety of the most common surgical procedures, and the development of innovative digital approaches to bring the best care to patients with spinal pain.”

13 October 2021
Talented, young Kolling researcher takes out prestigious national award

Despite a tremendously competitive field, the Kolling Institute’s Dylan Ashton has won the 2021 Cooperative Research Australia Early Career Research competition.

Dylan is part of the team investigating the effectiveness of kangaroo tendons to treat ACL injuries. He has worked on the project for several years and has welcomed the announcement.

“I am extremely thankful for Cooperative Research Australia’s efforts to link universities and industry to drive innovation and stimulate research and development,” he said.

“I have always been passionate about translatable research, and I think universities and industry have a lot to offer each other.

“I’m very grateful to have been able to compete in this year’s early career research competition and delighted to have won. This however, has always been a team effort and I could not have achieved anything without the ongoing support, encouragement and wisdom of my supervisors Associate Professor Elizabeth Clarke, Professor Christopher Little and Dr Carina Blaker.

As the Director of the Murray Maxwell Biomechanics Laboratory, Associate Professor Clarke said Dylan’s award represents a significant achievement.

“This prestigious award is a great opportunity to recognise the research achievements of our rising stars and to highlight the fantastic, industry-linked, translational musculoskeletal research underway at the Kolling Institute,” she said.

The award will also highlight the research assessing the suitability of kangaroo tendons to treat ACL injuries.

“As a sport loving country, Australia is seeing a consistent rise in the number of ACL injuries, particularly in children between 5 and 14 years, and a rise in surgical reconstructions,” Dylan said.

“If you were to rupture your ACL today, your surgeon would source a tendon from either your own leg or a tissue donor. However, each has inherent limitations which has driven research into alternative graft sources. Off-the-shelf synthetic grafts aim to address these issues but release synthetic particles which can lead to spontaneous failure.

“Our team is working with orthopaedic company Bone Ligament Tendon to develop a natural graft using kangaroo tendon which is superior, environmentally sustainable and uniquely Australian.

“We have welcomed the opportunity to discuss this important program of research.”

1 October 2021

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