October 23, 2000

The Musculoskeletal Signature Program, like the Health Center's other signature programs, plays off some long-standing areas of emphasis and research skill, but this program makes some bold calculations and aims assertively at the future.

The plan submitted to the Health Center strategic plan oversight committee, envisions four areas of concentration: Osteoporosis, Arthritis, Sports Medicine and a Joint Replacement Center. Moreover, the plan suggests a fifth initiative: establishment of a new program in osteoarthritis.

The Health Center's experience with osteoporosis clinically and in the lab goes back 25 years and is supported by extensive extramural funding including an NIH grant for a Center of Excellence in Research in Osteoporosis. Similarly, the Health Center once housed a federally charted Multipurpose Arthritis Center. Its faculty is still renowned for treating scleroderma, Sjogren's syndrome, Systemic Lupus Erythematosus (SLE or lupus), and other connective tissue diseases.

Where the proposal lifts its eyes to tomorrow involves the sports medicine and joint replacement centers - state-of-the-art facilities for medical care and treatment based on current research. But where it positively soars is the osteoarthritis initiative.

"This is very exciting," says Lawrence Raisz, a professor of medicine, director of the General Clinical Research Center, a founder of the Health Center' s osteoporosis program and co-chairman of the Musculoskeletal Signature Program Task Force. "The goal is to integrate our current strengths in clinical work and basic research. This initiative could result in substantial increase in clinical research and increase clinical services in an area in which we've worked long and hard - but one in which we have the capacity to improve."

His fellow task force co-chairman A. Jon Goldberg, a professor of prosthodontics and director, Center for Biomaterials, echoes Raisz's sentiments: "I think it's an excellent idea to focus on clinical initiatives tied to research strengths," he says. "By concentrating resources, clinical activity is enhanced and research initiatives are underscored."

The musculoskeletal program is one of four signature programs designed to build a stronger Health Center by closely linking areas of research excellence with areas of clinical excellence. The programs designated signature by the 2000 Strategic Plan include Genetics/Immunology and Cancer, Brain and Human Behavior, Musculoskeletal, and Connecticut Health. The programs concentrate resources to maximize results through efficiency, cohesion and faculty synergy.

Sports medicine is a growth field: the 18 to 59 age group - estimated to represent more than 50 percent of the U.S. population in 2025 - is the primary group using these clinical services. The growth in sports medicine can be demonstrated by the number of arthroscopic surgeries - one of the most prevalent procedures used to treat sports injuries: in 1980 there were 150,000; in 1995, there were 4 million.

The Health Center already has orthopaedic surgeons on the faculty who are skilled in sports medicine. These doctors provide care for a number of local teams at the high school and college levels, as well as adults of all ages.

Yet the program can be improved by coordination, the musculoskeletal task force report suggests: other specialties such as cardiology, nutrition, or physical therapy should be involved. A coordinated intake system would ensure the availability of specialists as needed and would optimize care and case outcomes.

The musculoskeletal proposal addresses just these concerns and envisions a regional facility providing comprehensive clinical care, enhanced by research initiatives and outcomes studies focused on the prevention, rehabilitation and treatment of joint and soft tissue injuries in active individuals of all ages.

Efficiency is at the core of the Joint Replacement Center proposal. Orthopaedic surgeons currently perform hundreds of hip and knee replacements at the Health Center.

An aging population coping with joint and connective tissue ailments ensures increasing numbers of potential patients.

The Joint Replacement Center would increase the number of procedures done on the Farmington campus by promoting to collaborating physicians the Health Center's physical attributes - newly renovated operating suites and the availability of beds for convenient in-patient care.

Research plays a vital role in the Joint Replacement Center, for scientists are already exploring the efficacy of tissue engineering and biomaterials, and those scientists' work will increase in importance in the future.

"Opportunities exist right now," says Raisz. "We need to seize these opportunities as they present themselves, because they may not exist forever."

Osteoarthrtitis - degenerative joint disease - is the most common type of arthritis, affecting more than 16 million people in the United States. It probably affects almost every person over age 60 to some degree, and is characterized by the loss of joint smoothness and range of motion without major joint inflammation.

Treatment of osteoarthritis has not been emphasized at the Health Center, the report states, but in order to provide full services for musculoskeletal disease and expand the research base, the institution needs to develop a program in osteoarthritis. And while basic sciences faculty are exploring a number of areas relevant to osteoarthritis and outcomes research, clinical investigator s currently are in short supply.

The committee recommends as part of its signature program recruiting clinical faculty to treat osteoarthritis. The recommendation wasn't a spur of the moment impulse. As the committee researched the idea, members contacted leading osteoarthritis clinicians and talked to them. They found that the clinicians felt existing Health Center-related research made for an appealing situation for an academic osteoarthritis specialist.

So too did the likelihood of increased osteoarthritis research support from the federal government, and the Health Center's commitment to the Total Joint Program.

"We do not have expertise in osteoarthritis," says Raisz. "But we do have scientists doing basic research as well as outcomes research, and these are very likely to contribute positively to the establishment of an osteo-arthritis program."

Program administrator Anne Horbatuck sums up the enthusiasm for the bone and musculoskeletal signature program: "We have so many clinical and research programs that are just excellent," she says. "We need to heighten awareness of the programs here and we need to do a better job of coordinating them. We need to get out and show everybody what we can do.

"Our plan addresses this; now we need to do it!"

Pat Keefe