Cartilage cell transplantation procedure for arthritis approved by NHS (published on 19 February 2018 )

Patients with a certain form of arthritis have a new preventative treatment option available to them, following the recent NHS approval of a cutting-edge cartilage cell transplantation procedure.

Autologous chondrocyte implantation (ACI) has won approval to be funded across the NHS thanks to a growing body of clinical evidence - supported by Versus Arthritis and others - that has conclusively demonstrated the considerable benefits the technique offers.

How the procedure works

ACI is designed to help patients who have small areas of cartilage damage or early osteoarthritis of the knee. These conditions can often affect younger people in their 20s and 30s, sometimes as the result of a sporting injury.

The procedure sees a sample of cartilage removed from the knee, allowing doctors to grow a fresh supply of healthy cells that are native to the patient's body in a laboratory, a process that takes around three weeks. These chondrocyte cells can then be returned to the affected area in a second surgical procedure.

Following this process, the cells anchor themselves to the bone within 24 hours, resulting in fresh cartilage growth at the damaged site. Patients can expect to resume everyday use of the joint in three months and full activities including sports after 12 months, making this a much better option for younger patients than knee replacement, which was previously the only alternative treatment.

A growing body of supporting evidence

Before the recent decision to approve this treatment for full NHS funding, ACI was only available at the Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry, Shropshire.

However, further studies of the procedure have been ongoing in numerous locations in recent years to prove the considerable benefits that ACI can offer.

Research carried out by the Arthritis Research UK Tissue Engineering Centre and the ASCOT clinical trial, led by Professor Sally Roberts and also funded by Versus Arthritis, have contributed evidence that helped to secure the eventual approval.

Their research highlighted a number of factors - including age, gender, location and number of defects, and the number of previous operations - that can all affect the chances of ACI succeeding, giving doctors valuable guidance in determining which patients are most likely to benefit.

As such, ACI has now been approved for the treatment of patients who have not had previous surgery to repair articular cartilage defects, with minimal osteoarthritic damage to the knee, and defects that measure over two square cm.

The experts' view

Professor James Richardson, an experienced consultant orthopaedic surgeon performing this procedure at the Robert Jones and Agnes Hunt Orthopaedic Hospital, said: "The patients are usually only in hospital for two days postoperatively, though there is a lot of rehabilitation and physiotherapy to follow after that. The results we have seen have been positive, particularly if the patient has not had prior microfracture."

Dr Stephen Simpson, director of research at Versus Arthritis, said: "It is certainly positive news that, thanks to the valuable research in this area, ACI is being made available on the NHS. This means that more people with this type of cartilage damage or early osteoarthritis will be able to access and potentially benefit from this treatment.

Osteoarthritis affects over eight million people in the UK and can have a devastating impact on daily life, making things like getting dressed or going to work difficult. We're determined to prevent people from experiencing these challenges and this development is a fantastic example of how our funded research can deliver clinical advances and help more people to live the pain-free life they deserve."

Published on 19 February 2018

Future pain therapies 'could be tailored to different kinds of pain' (published on 21 November 2016)

Pain-sensing nerves in the body may function in more specific ways than previously thought, according to new Versus Arthritis-funded research.

Carried out by University College London, the study indicated that different nerves may respond to specific types of pain - opening the door for the development of new treatments that are tailored to meet the needs of chronic pain sufferers more precisely.

How pain sensors offer specialised functions

It is often assumed that pain-sensing nerves respond to all types of pain in the same way, but this new study - conducted using lab mice and published in the journal Science Advances - found that the majority of these neurons are actually sensitive to specific types of painful stimulus.

For this research, pain-sensing neurons in mice were genetically marked to emit a fluorescent glow when activated, before the animals were exposed to either a small pinch, cold water or hot water stimulus on one of their paws to see which neurons were activated.

It was revealed that more than 85 per cent of pain-sensing neurons were specific to one type of pain - whether it be heat, cold or mechanical pain - and did not react to others.

Although most of the neurons were specific to one type of pain, it is believed that they can become universal pain sensors when the tissue is damaged - explaining why this discovery was not made when more invasive approaches have been used.

The possibility of better-targeted treatments

These findings could make it possible for scientists to develop new painkillers that target different pain conditions specifically.

The next step will be to look at how specific types of chronic pain affect animals to see which neurons cells are activated.

The study's senior author Professor John Wood of the University College London Wolfson Institute for Biomedical Research said: "We hope to identify the different neurons through which chronic pain can develop, so that focused treatments can be developed.
We use 'chronic pain' to describe all sorts of pain conditions with different causes, but we now need to differentiate them so that we can develop new specific treatments."

Our view

Natalie Carter, head of research liaison and evaluation at Versus Arthritis, said: "Chronic pain affects nearly half of the UK population and can have a devastating impact on a person's quality of life. We know that current pain medication just isn't working for many people, and more needs to be done to provide better pain management and find better treatments for relieving pain.

"This study is important because it helps further our understanding of how pain is detected and processed by nerves. This is essential for the development of effective pain-relieving treatments for specific conditions such as arthritis. We welcome further research into this area."

Published on 21 November 2016

Clinical trial discovers a new way to prevent children with arthritis and eye disease losing their sight (published on 27 April 2017)

A trial funded by Versus Arthritis and the National Institute for Health Research (NIHR) has discovered a drug combination that could help thousands of children with arthritis.

Over 5,000 children and adolescents with juvenile idiopathic arthritis (JIA) in the UK are likely to develop uveitis, a condition that causes inflammation in the middle layer of the eye.

The drug combination discovery will help to prevent them from serious complications, including blindness.

The trial was first of its kind in the world and the findings are a major step forward for children with JIA.

The drug therapy has already been approved for use and the study is published today in The New England Journal of Medicine.

A significant reduction in eye inflammation

The trial’s co-chief investigators, Professors A. V. Ramanan and Michael Beresford, and colleagues from across the UK, found that a drug called adalimumab, in combination with methotrexate, was an effective therapy in children and adolescents with JIA-associated uveitis.

The majority (75%) of those children treated with adalimumab experienced a significant reduction in eye inflammation. An early analysis of the data was so convincing that the trial was stopped early.

In this randomised, placebo-controlled trial on review of 90 of the target 149 patients with JIA-associated uveitis, the data and safety monitoring committee noted that the adalimumab group had evidence of a significantly lower risk of treatment failure than the placebo group.

This multi-centre trial involved extremely close collaboration between paediatric rheumatology and ophthalmology colleagues across the country and was sponsored by University Hospitals Bristol NHS Foundation Trust, and co-ordinated by the Clinical Trials Research Centre at the University of Liverpool.

The trial outcomes directly led to the changes in commissioning guidelines and resulted in NHS England approving the use of adalimumab in children with uveitis that threatens their sight, and for whom other treatments have proven ineffective.

Professor Ramanan from University Hospitals Bristol NHS Foundation Trust and University of Bristol said: "Uveitis in children is an important cause of loss of vision. This study demonstrates the benefit of adalimumab in children with uveitis. This is the first randomised trial of its kind worldwide and the results will have a major impact in children with uveitis all around the world."

Finding the best way of caring for children with arthritis and uveitis

Professor Beresford from University of Liverpool and Alder Hey Children’s NHS Foundation Trust said: "This landmark trial has demonstrated the commitment and leadership of colleagues across the UK in working closely with patients and parents in tackling a key priority of finding the very best way of caring for children with arthritis and this serious problem of uveitis.

"It has shown the UK to be extremely well placed to deliver challenging trials in children, with the support of the NIHR Clinical Research Network and other research networks that are in place across the UK."

There are 15,000 children and adolescents in the UK with the auto-immune disease JIA. One third of those are likely to develop uveitis, leading to more serious visual impairments and may be registered as blind.

Stephen Simpson, director of research and programmes at Versus Arthritis, said: "We're thrilled of the outcome of this trial and the huge promise it heralds for transforming the quality of life for the large numbers of children with JIA-associated uveitis.

"This trial is an impressive example of how investing in exceptional science can ultimately help change how treatment is delivered with direct and immediate benefit for patients."

Published on 27 April 2017