Postdoctoral scholar looks to ease pain of millions

Paul Mayne // Western News

Amanda Ali is the inaugural Kirkley Postdoctoral Fellow in Musculoskeletal Health Research and Innovation.

Amanda Ali doesn’t mince words when it comes to her work within the Faculty of Health Sciences.

“The goal is to reduce the burden of osteoarthritis.”

Part of Western’s Bone and Joint Institute and the Collaborative Training Program in Musculoskeletal Health Research, Ali is the inaugural recipient of the Kirkley Postdoctoral Fellowship in Musculoskeletal Health Research and Innovation.

With a focus on improving pain management in osteoarthritis, she comes to Western from the Institute of Medical Science at the University of Toronto, to complete her postdoctoral project, Improving pain management in osteoarthritis: A senior-friendly peer-led community education and mentoring approach. This work is being conducted in the Sam Katz Community Health and Aging Research Unit at Western, under the supervision of Health Studies professor Marita Kloseck and Orthopaedic Surgery professor Joy MacDermid.

Ali’s research aims to develop a novel ‘peer-mentor-based program’ to get osteoarthritis pain management information into the hands of seniors in London retirement communities. The project looks to identify mentorship models to reduce health-care costs, the demand on specialized care providers and the overall burden of osteoarthritis on this at-risk community.

Her present battle, however, is getting the word out on what is often a misunderstood disease.

Arthritis is a disorder that involves pain and inflammation in one or more joints. However, there are more than 100 forms of arthritis – and not all are understood by the general public despite their prevalence in millions of people.

“Osteoarthritis is the most common type of arthritis, but rheumatoid arthritis is better understood,” Ali said. “Usually, when you get any kind of information related to arthritis, the focus is on rheumatoid.”

Simply stated, osteoarthritis occurs when the protective cartilage on the ends of your bones wears down over time. Although osteoarthritis can occur in any joint, the disorder most commonly affects your hands, knees, hips, shoulders and spine. Osteoarthritis often gradually worsens. No cure exists.

Rheumatoid arthritis, however, is a chronic inflammatory disorder affecting small joints in your hands and feet. Unlike the progressive damage of osteoarthritis, rheumatoid arthritis occurs acutely, causing a painful swelling and joint deformity. An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your body’s tissues.

“There is also good information about management strategies for osteoarthritis, but part of the struggle is making people aware that they exist, and can help,” Ali said. “There’s not a magic-bullet treatment for arthritis; the subtypes shouldn’t be treated the same. There are nuances. Part of my work is raising awareness about this, using a community-management approach.”

Among its many parts, Ali’s research looks to create a unique pain management program for osteoarthritis.

Ali continued, “What we’re hoping to do is build resources specific to osteoarthritis, and create a community network of support for accessing and implementing specific pain-management strategies to reduce the daily burden of this disease.”

While half of people over 65 years old will get some form of osteoarthritis, that means half will not, leading osteoarthritis researchers to believe it is not just ‘a normal part of aging.’

“Part of the challenge is the complexity of the disease. There can be so many contributing factors – genetics, activity level, injury,” she said. “The disease doesn’t develop the same way in all people. X-rays may show osteoarthritis, but the patient experiences no pain, and the reverse is true, a patient may have pain, but show no radiographic signs of osteoarthritis.”

Ali hopes to target patients who are just starting to experience pain and address their situation before the need for joint-replacement surgery.

“Let’s say you’re experiencing symptoms of osteoarthritis in your mid-50s. What can we do in terms of lifestyle factors to manage the disease and prevent progression? Plenty, according to emerging research,” she said. “The current option for advanced osteoarthritis is joint replacement. To me, that’s not an ideal solution. It’s an invasive procedure and it’s not always beneficial for people, especially for osteoarthritis, that can affect multiple joints in the body.”

While there were opportunities for Ali to take her research to the University of British Columbia or Duke University, she saw Western as the best fit for taking her work to the next level.

In May, Western further buoyed its leadership in musculoskeletal health research with the formation of The Bone and Joint Institute. The institute builds on a $5-million investment the university made into the Western Cluster of Research Excellence in Musculoskeletal Heath in November 2014. That program will fund more than 70 researchers from several faculties, including the Schulich School of Medicine & Dentistry, Health Sciences, Engineering, Science and Social Science to study conditions such as arthritis, osteoporosis, trauma and work-, sport- and exercise-related injuries.

Ali’s appointment coincided with the institute announcement.

“I chose Western because this fellowship is an amazing opportunity to work with the Bone and Joint Institute. Also, the Sam Katz Community Health and Aging Research lab is one of the best for community research,” she said. “More work is needed for implementation and knowledge-translation in the musculoskeletal field. The critical component is to engage the end user in the research process.

“Our approach does this, using participatory-action research. Community-dwelling seniors will be involved in developing the pain-management program for osteoarthritis, because ultimately, they’ll be the ones to use it.”

The interdisciplinary approach Ali has experienced in her initial two months has been “exactly the reason for coming to Western,” as she has already spoken with eight principal investigators who will contribute to this work.

As she moves forward, Ali said community engagement and education will be front and centre. With that, she will be working with The Arthritis Society to create sustainable strategies for London and other communities.

“I don’t want a study that just exists within itself. I want something that can be sustained and implemented right across Canada,” she said. “There are strategies to help manage and, therefore, prevent progression of osteoarthritis. I think the real challenge is getting that information to the people who can benefit from it – and the earlier the better.”