Thurston Today the newsletter for the thurston arthritis research center and the division of rheumatology, allergy and immunology at the unc school of medicine Fall 2008 Studies Show Efficacy of Exercise Programs Ongoing Research Shows Exercise Improves Quality of Life Among People With Arthritis For years, doctors believed that exercise could aggravate arthritis, but recent research conducted at the UNC Thurston Arthritis Research Center shows otherwise. Leigh F. Callahan, PhD, Associate Professor of Medicine, Orthopaedics, and Social Medicine, and her team have been working throughout the state of North Carolina conducting trials of different exercise programs in people with arthritis. The results of all three studies have been very encouraging. “Many people believe the myth that exercise might make their arthritis symp- toms worse,” said Callahan, “The truth revealed in the three studies we have conducted is that symptoms actually improve with exercise.There are arthritis exercise programs suitable for every fitness level, even inactive older adults.” Clinical trials have involved people with self-reported arthritis in three major exercise programs: Arthritis Foundation Exercise Program (AFEP—formerly PACE) is an 8-week community-based exercise program designed by the Arthritis Foundation specifically for people with rheumatic diseases, with special consideration toward pain, fatigue, and loss of strength and motion that are usually associated with those conditions. Activities are designed to increase benefited from the program, and found being encouraged to exercise “bit endurance and joint mobility. by bit” and receiving social support from other adults with arthritis to be particularly helpful. ALED was found to be appropriate for people with Active Living Every Day (ALED) was developed by Cooper Institute arthritis but could be enhanced with some modifications. (Preventing at Brown University and Human Kinetics. The 20-week program was Chronic Disease, Jul 2007) originally developed for the general population. It has been previously shown to be effective at improving cardiovascular disease risk factors and The WWE study is still on-going, but preliminary results from pilot cardiorespiratory fitness. Callahan’s group is the first to study its effects programs show similar results. The Callahan group has recruited almost among people with arthritis to determine if it is appropriate for this group. four hundred participants in over twenty-five sites across North Carolina. The study has recruited participants among the elderly as well as a number Walk With Ease (WWE) is a community-based walking program for of middle-aged working adults at their worksites. people with arthritis, also designed by the Arthritis Foundation. It is offered in two formats: group-led and self-instructed. Walking may be one of “This research confirms what we have long suspected,” said Dr. Joanne the most feasible activities for people with arthritis, as it is low cost, low Jordan, Director of the UNC Thurston Arthritis Research Center and impact, and can be done almost anywhere. Chief of the Division of Rheumatology, Allergy, and Immunology, “At Thurston, we’re excited to be able to do this type of community outreach Results of the AFEP study, recently published in Arthritis Care & Research research, as benefits can be seen immediately throughout the state.” (Jan 2008), showed that regular exercise improves strength, flexibility, levels of pain and fatigue, and participants felt as though they could better cope For more information on the results of these studies, contact Leigh Callahan with their arthritis. The ALED study showed that people with arthritis (866-396-6240) Center Director/Division Chief Dear Friends, Joanne M. Jordan, MD, MPH It is with great pleasure that I introduce this inaugural issue of Thurston Today, the newsletter of the UNC Thurston Arthritis Research Center and Rheumatology Fellowship the Division of Rheumatology, Allergy, and Immunology at the University of Program Director North Carolina School of Medicine. This issue is dedicated to our patients, all Beth Jonas, MD the people who have participated in our research studies, our faculty and staff, and our generous supporters and volunteers. Director of Development At Thurston, we strive to bring arthritis care to those who need it most. In Randy Mounce this issue of Thurston Today, we focus on the work of Dr. Leigh Callahan, an Associate Professor of Medicine, Orthopaedics, and Social Medicine, whose Board of Advisors research has demonstrated that exercise programs for arthritis are effective Hugh O’ Neil, Ph.D, Chair in relieving pain and reducing disability. Dr. Callahan has studied several Stuart Bondurant, MD arthritis programs and brought these programs to over 1,200 people across John Fraley, Jr. North Carolina. Working with family physicians, rheumatologists, community Robert Gaskin agencies on aging, community colleges and universities throughout the state, Grace T. Grasty her work has touched people in rural areas and cities, in the mountains, the Gene Marx Piedmont, and the coast, and has made a difference in many lives. Charlie Meyer Edwina Shaw Thurston has also reached around the globe to gain insights about a particular Doc Thurston III kind of arthritis in China that is associated with low selenium in the soil, Diana Tufts Meyer among other things. This condition, called Kashin-Beck Disease, has prompted Lane VanderHoek us to investigate whether low selenium is related to other forms of arthritis, John A.Young, MD including osteoarthritis, the most common form of arthritis in the United For 25 years, States. Our preliminary work in the Johnston County Osteoarthritis Project, a the UNC Thurston Editorial Board long-standing partnership between Thurston investigators and the citizens of Diana McAlister Johnston County, shows that those with very low selenium levels were indeed Arthritis Research more likely to have osteoarthritis. However, more work remains before this Randy Mounce can be tested as a possible treatment since too much selenium can be toxic. Center has Coaina Nel Carol Patterson Our focus at Thurston is on excellence in clinical care, education of the next served as the Contributors generation of clinicians and researchers, and outstanding basic laboratory and only public clinical research. For 25 years, the UNC Thurston Arthritis Research Center M. K. Farmer has served as the only public comprehensive arthritis research center for comprehensive Sara Hudson the people of North Carolina. It is a privilege that we all take very seriously. Brenda Meier Our mission is to investigate the causes, consequences, and treatments of arthritis and arthritis research Amanda Nelson autoimmune diseases and reduce their impact on patients, their families, and society. center for Britta Schoster Bonnie Shaw With each issue of Thurston Today, we will focus attention on cutting-edge the people of research and the people behind that research. Our goal is to give you an idea Phone of what we do here and our progress to improve the lives of the millions of North Carolina. people living with arthritis. We hope you find this newsletter informative and 1-866-862-8272 enjoyable. It was created with you in mind. Please tell us what you would like (1-866-UNC-TARC) to read about in future issues. We will do our best to address issues that are important to you. We welcome your comments and suggestions, directed to Website email@example.com. http://tarc.med.unc.edu Chapel Hill Clinic Ambulatory Care Center 102 Mason Farm Road Chapel Hill, NC 27599 (919) 966-9141 Sanford Clinic Sanford Specialty Clinics 1301 Central Drive Sanford, NC 27330 (919) 718-9512 Jordan Studies Arthritis-Related Diseases in China Studying Kashin-Beck Disease Could Give More Clues to the Role of Selenium in Osteorthritis 2007 saw the Thurston Arthritis Selenium is a mineral that can act as an anti-oxidant to protect tissues from Research Center go global as Dr. oxidative damage. Dr. Jordan’s work in the Johnston County Osteoarthritis Joanne Jordan, Center Director and Project in North Carolina has shown that low levels of selenium are linked Division Chief, travelled to Shaanxi with a higher likelihood of osteoarthritis. She was inspired to study selenium’s Province in China to study Kashin- relationship to osteoarthritis because of the role it plays in KBD. “We were Beck Disease (KBD). Accompanied very intrigued about these findings because no one had ever measured body by colleagues from Duke University selenium in this way in relationship to osteoarthritis,” said Dr. Jordan. and Cardiff University, and in collaboration with Dr. Junling Cao of Researchers collected toenails from study participants in the Johnston County the Institute of Endemic Diseases at Osteoarthritis Project to examine selenium levels, and did the same from people Xi’an Jiaotong University, Dr. Jordan with KBD in China. Analysis is on-going and will continue when one of Dr. saw over 125 people for clinical Cao’s graduate students travels to North Carolina later this year for a year’s study diagnosis of Kashin-Beck Disease and at Duke and UNC. collection of scientific samples. “We are eager to compare the data from China with our data from North KBD is an osteoarticular disease that Carolina,” said Dr. Jordan. “It could lead to a much better understanding of the Dr. Jordan with Sihuan Li from Xi’an affects bone and joint cartilage. It can Jiaotong University and a citizen of role of selenium in osteoarthritis, and give us clues for how we might prevent it Shaanxi Province who suffers from in the future.” manifest in children as young as five Kashin-Beck Disease. years old and increases in severity Low levels of selenium have also been linked to some types of cancer; however, as patients age. Symptoms include joint pain and restriction of movement, selenium intake is difficult to regulate, as it can be toxic at relatively low levels. and severe cases may involve stunted growth and joint deformity. One of the Supplementation is not currently recommended in well-nourished populations, underlying causes of KBD is selenium deficiency, though a range of factors such as the U.S. contribute to the severity of the disease. Ongoing Clinical Trials Thurston Arthritis Research Center frequently participates in Clinical Trials in order to help gain a better understanding of different autoimmune diseases and their treatments. For more information about any of our Did You Know? Clinical Trials, please contact the person associated with the trial below. Antiphospholipid Syndrome (APS) Study • An estimated 46 million adults in the United Who is Eligible: People with APS and one or more family members with States have some form of arthritis. APS or another autoimmune disease. Contact: Diane Bresch (919-966-0545) • By 2030, it is estimated that 67 million American CLEAR Study adults will have arthritis, in part related to the Who is Eligible: African Americans with rheumatoid arthritis (RA). aging of the population, the obesity epidemic, Contact: Diane Bresch (919-966-0545) and sedentary lifestyles. Precision Study Who is Eligible: People with rheumatoid arthritis (RA) or Osteoarthritis (OA). • Arthritis is the most common cause of disability. Contact: Diane Bresch (919-966-0545) • Arthritis is a more frequent cause of activity IFN3958f limitation than heart disease, cancer or diabetes. Who is Eligible: People with systemic lupus erythmatosus (SLE). Contact: Brenda Meier (919-843-6619) • North Carolina has a higher frequency of BLISS-76 arthritis than the US national average and has Who is Eligible: People with systemic lupus erythmatosus (SLE). one of the highest projected rates of increase for Contact: Brenda Meier (919-843-6619) the years ahead. IM101O75 Who is Eligible: People with lupus nephritis (kidney disease). Source: The Arthritis Foundation, Centers for Disease Control and Contact: Brenda Meier (919-843-6619) Prevention and NIH SL007 Who is Eligible: People with active lupus symptoms. Contact: Brenda Meier (919-843-6619) Interview with Leigh F. Callahan, PhD Q: When and how did you I have now conducted evaluations of physical activity interventions in first become interested in more than 40 counties. researching arthritis? Q: What led you to research the efficacy of the AF’s A: I stumbled into arthritis re- activity programs? search in the early 1980s while I was in graduate school at Vander- A: My work at the CDC as well as experience serving and chairing bilt University. I was working in AF committees focused on quality of life issues for people with the Division of Rheumatology and arthritis and autoimmune diseases highlighted the important role Immunology on laboratory re- physical activity plays in primary, secondary and tertiary prevention. search, and I pitched in to help out The CDC has an interest in making sure that programs that are on a long-term follow-up study delivered through the public health system are backed up by of 75 individuals with rheumatoid scientific evidence. I have been fortunate to be awarded CDC grants arthritis (RA). While assisting with to evaluate People with Arthritis Can Exercise (the AF’s Exercise that study, I became hooked on Program), Active Living Every Day (a behavioral lifestyle program), outcomes research and epidemiol- and the AF’s Walk with Ease Program. All three programs have ogy. demonstrated a benefit for patients in terms of improved symptoms, strength, and psychological measures. I have enjoyed working with Later, I began volunteering for the Arthritis Foundation (AF) and soon many collaborators across NC including the AF, the Area Agencies became active at both a local and national level. My interactions with on Aging, the state arthritis program, universities, practicing individuals with arthritis helped me put a face on my research findings rheumatologists, and industries. and also guided me to think about what issues matter most to the people who deal with the daily challenges of arthritis. In the early 1990s, I joined Q: How has TARC helped you achieve your research goals? the Arthritis Program at the Centers for Disease Control and Prevention Thurston is the ideal place to combine and nurture my numerous re- (CDC) and expanded my interests to not only include clinical outcomes, search goals which include physical activity, the role of socioeconomic but to population health and public health outcomes. I started working status on health outcomes, health literacy, patient-reported outcomes with Dr. Joanne Jordan and the Johnston County Osteoarthritis Project assessment, and complementary and alternative medicine. while I was at the CDC. We have a very collaborative environment that fosters intellectual In 1995, I was recruited to the Thurston Arthritis Research Center and I exchange and discussion among clinicians, social psychologists, was thrilled to be coming home to North Carolina. I was born in Ruther- epidemiologists, geneticists, laboratory researchers, biostatisticians, fordton, NC and did my undergraduate degree at UNC Chapel Hill, so and graduate students from Schools and other Centers across campus. it was a real privilege to join the UNC faculty. While at Thurston, I have Our Center is also a fun, exciting place to work. We all have a expanded my work to evaluating arthritis outcomes in the family practice commitment and passion about making a difference in the lives of setting and communities. Dr. Philip Sloane and I developed a practice- people with arthritis and autoimmune diseases. based research network of 25 family practices across the State in 2001 and Thurston Supports UNC Tomorrow The 17 UNC campuses have collectively engaged in responding to the future challenges of North Carolina citizens through the UNC Tomorrow Initiative. Led by UNC Board of Governors’ Jim Phillips, UNC President Erskine Bowles and the UNC Tomorrow Commission, this community, business and education partnership will address the priorities identified by North Carolina residents, faculty, students and staff members from across the state as keys for success in the 21st century. The UNC Thurston Arthritis Research Center has a long history of working with communities throughout North Carolina in both research and clinical care. Those efforts will prosper as we join the commitment of UNC Tomorrow to provide public health outreach for the citizens of North Carolina. As part of this endeavor to better serve North Carolina, UNC-Chapel Hill is launching the Community-Campus Partnership for Tomorrow. For more information: See http://www.unc.edu/pse/unctomorrow-about.php Grateful Patient: Linda Watson Thank you for supporting arthritis research! A favorite saying of mine is: The UNC Thurston Arthritis Research Center “If everything in life were gratefully acknowledges the contributions of easy, we’d never see the the individuals, corporations, foundations and strength we possess.” That was put to the test when, organizations who provide vital support to our at the young age of 41, I goal to find preventions, cures and treatments for started experiencing early arthritis, allergy and autoimmune diseases. signs of arthritis. My life was always pretty Private donations are essential to our operations much normal. I was a sin- and assist basic science research, population-based gle mom raising two sons, studies, faculty enhancements, fellowship support, working 45 to 50 hours a professorships and other important initiatives. week and never missing a day of work. My work was Quite simply, the continued support and generosity physically demanding; therefore aches and pains were a part of my life. One day I began to experience a different kind of pain, one of our donors enable us to serve as the arthritis that was deep burning, and throbbing, especially in my hands and center for the people of North Carolina. feet. I tried different kinds of medicine and physical therapy, but nothing seemed to help. No one in my family ever had arthritis, so I was confused about what was happening to me. I’d be angry one minute, then sad the next. I began to look for answers. I realized an arthritis support group would not only be a good way to find answers, but also to help others and myself in the process. It was through this group that I was introduced to the UNC Thurston Arthritis Research Center and Dr. John Winfield. I knew immediately I was in good hands. I was diagnosed with rheumatoid arthritis. I found Dr. Winfield a most caring and compassionate man. At first I was able to get around only with the help of a cane, then a walker, and then for the next five years, a wheelchair. Throughout this difficult time, he often went way above the call of duty to answer my questions while giving me ample time to digest what he was saying. He never rushed or made me feel uncomfortable and, most of all, he Community Support Networks encouraged me even when I wanted to give up. Several operations Please visit our website at www.tarc.unc.edu under the and two hip replacements later, I could walk on my own again. Thanks to prayer, the research and staff at Thurston and my won- “Patients” tab to see our directory of North Carolina arthritis derful doctor, I have my life back. support groups. We are happy to add your group to our list, too! Please follow the contact information on our website Today, I am an active community volunteer. It seems strange now to think of this as a disability because it was during this time that under Community Support Networks. I discovered the joy of helping others. I hold the door for others, help them with their wheel chairs and visit rest homes. I discov- ered that taking the time to treat someone with kindness is such a blessing. I love my volunteer time at quilting and craft classes for assisted living homes, the American Red Cross and our local hos- pital and hospice. I also found strength through my support group, and they in turn seemed to get inspiration from me. I truly thank Thurston for the unsung work they do daily to find preventions and treatments for this chronic disease. Thurston Rheumatology Fellow Wins Young Investigator Award Dr. Amanda Nelson Presents Paper on Racial Differences in Multi-Joint Osteoarthritis Amanda Nelson, MD, 3rd year fellow in the Division of Rheumatology, in involvement at other joints, or in the Allergy, and Immunology, has been awarded a Young Investigator Award overall patterns of joint involvement. She from the Osteoarthritis Research Society International (OARSI), in looked at the hands, knees, hips, and spine recognition of the excellence of her abstract, entitled “Multi-Joint individually and at combinations of joints, Radiographic Osteoarthritis Phenotypes Among African to determine the frequencies of various Americans and Whites: The Johnston County Osteoarthritis patterns of OA, and identified several Project.” This award was presented at a Plenary Session at the 2008 differences that may impact how OA is OARSI World Congress on Osteoarthritis, held September 18-21, defined in future studies. This work will 2008 in Rome, Italy. Dr. Nelson is a post-doctoral awardee of UNC’s also provide the foundation for additional institutional T-32 training grant in Arthritis and Immunology and the work by Dr. Nelson, evaluating overall Hartford Center for Excellence in Geriatrics, and is a fellow in the patterns of OA with other measures UNC institutional K-30 program. Her research in the epidemiology such as pain, function, and blood of osteoarthritis has been conducted in conjunction with Dr. Joanne and urine markers of OA. Dr. Jordan, utilizing data from the Johnston County Osteoarthritis Project. Nelson would like to express her gratitude for all of the Her research project was designed to evaluate patterns of multi-joint support she has received osteoarthritis (OA), and to look for differences between White and from the Thurston Arthritis African American individuals with OA. In previous work, presented Research Center as a by Dr. Nelson at the 2007 OARSI meeting in Florida, she reported whole, and particularly that while African Americans had less radiographic hand OA from her mentor, Dr. compared to Whites, the frequency of lumbar spine OA was similar. Joanne Jordan. She was therefore interested to see if there were differences by race Chapel Hill, NC 27599-7280 3300 Thurston Bldg., CB# 7280 The University of North Carolina at Chapel Hill Thurston Arthritis Research Center permit #216 Chapel Hill, NC PAID US postage Nonprofit Org.