Drs' Notes: Can your joints repair themselves?

Professor Tonya Vincent made a courageous career decision as a rheumatology registrar to focus on osteoarthritis research when it was considered the most unfashionable disease in the field. While her colleagues pursued research on rheumatoid arthritis, which had exciting new biologic treatments being developed, Vincent recognized osteoarthritis as a massive unmet clinical need that was poorly understood. At the time, patients with OA were essentially sent home with no treatment options, making it a risky choice for a researcher's career.

• Vincent was a registrar when new biologic treatments for rheumatoid arthritis (anti-TNFs like infliximab and Humira) were being developed
• She chose to research osteoarthritis despite it being unfunded and 'unsexy' because it represented a huge unmet clinical need
• Osteoarthritis was considered the most unfashionable disease in rheumatology at the time
• Patients with OA were simply sent back to their GPs with no treatment options

Vincent's research challenged two prevailing theories about osteoarthritis—that it was simply mechanical wear-and-tear like a tire, or a low-grade inflammatory disease similar to rheumatoid arthritis. Clinical trials proved neither theory was correct. Instead, her team discovered that cartilage cells are exquisitely mechanosensitive and respond directly to mechanical stress through hundreds of activated pathways. This finding suggested the disease mechanism was fundamentally different from what had been assumed.

• Orthopedic surgeons believed OA was just mechanical wearing down of joint surfaces, while rheumatologists thought it was low-grade inflammation
• Clinical trials showed treatments effective for rheumatoid arthritis did not work for osteoarthritis
• Vincent's research revealed that cartilage cells activate hundreds of pathways when mechanically stressed
• Chondrocytes (cartilage cells) are exquisitely mechanosensitive, contradicting the belief they were quiescent cells