Medical Moment: Hip replacements for junior rheumatoid arthritis patients

Published: Aug. 5, 2022 at 5:42 PM EDT
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(WNDU) - Juvenile idiopathic arthritis is a form of arthritis in children that causes joint inflammation and joint stiffness. It affects one or more joints for at least six weeks in a child aged 16 or younger

Adult rheumatoid arthritis is ongoing, chronic and lasts a lifetime, whereas children often outgrow JIA.

However, the disease can affect bone development in a growing child.

Despite her age 19-year-old Emily Wegmann knows a lot about joint pain. At two she was diagnosed with juvenile rheumatoid arthritis. By 10, she was bone-on-bone on her left hip.

“I couldn’t even get myself dressed,” Wegmann said. “I couldn’t do my hair. I couldn’t get myself to walk into school.”

Medications and steroids worked for short periods of time, but flare ups held Wegmann back during childhood.

“Seeing my friends go out and me trying to keep up with them was very hard,” Wegmann recalled.

“Her arthritis was so aggressive that it was actually damaging her acetabulum on her hip socket,” said Craig J. Della Valle, a Midwest Orthopaedics surgeon at Rush.

She developed an uneven leg length, which caused more pain in her knees, feet, and back. At 14, doctors recommended that Wegmann have a hip replacement and it worked. With new modern materials for hip replacements, her hip can last a really long time.

“It’s possible that this could last her longer than 20 years, 30, 40, 50 years and hopefully her lifetime,” Dr. Della Valle said.

So far five years in, her right hip is still going strong,. And she got her left hip replaced the summer before she started her freshman year of college.

“Ever since then, I have been able to live like a normal teenager would,” Wegmann said.

And now she can truly enjoy her college experience pain-free.

Director of Research at Shriners Children’s St. Louis, Farshid Guilak, PhD, is working towards a goal of developing rheumatoid arthritis therapies that have minimal side effects.

His team has genetically engineered cells that, when implanted in mice, deliver a biologic drug in response to inflammation. The engineered cells reduced inflammation and prevented a type of bone damage known as bone erosion.

Dr. Guilak says children are getting osteoarthritis from sports injuries as well as the increasing prevalence of obesity.

“Our thought was, can we develop a system using living cells and get the cells to create these drugs in the body? In that way, the cells could continuously make and deliver biologic drugs used to combat arthritis,” Dr. Guilak said.

A big concern with these drugs is that dosing is difficult, and if you suppress the immune system, the patients have an increased risk of infection and an increased risk for some cancers. The research team created a tiny disk about a quarter inch in diameter and about a millimeter thick that they can insert under the skin. It sits there dormant until it senses inflammation, then it turns on the drug that fights arthritis.

Dr. Guilak says, “…we have some work to do, but we have all the pieces in place, and hopefully we will get to that eventually.”

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