Hip replacements for junior rheumatoid arthritis patients

(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 years or younger

Rheumatoid arthritis in adults is persistent, chronic, and lifelong, while 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. When she was two, she was diagnosed with juvenile rheumatoid arthritis. When she was 10, she was sitting bone to 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 to school.”

Medications and steroids worked for a short time, but flare-ups stopped Wegmann during childhood.

“It was very hard to watch my friends go out and that I was trying to keep up with them,” Wegmann recalls.

“Her arthritis was so aggressive it damaged her acetabulum on her hip socket,” said Craig J. Della Valle, a Midwestern orthopedic surgeon at Rush.

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

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

So far, five years later, her right hip is still doing well. And she had her left hip replaced the summer before starting her freshman year of college.

“Since then, I’ve been able to live like a normal teenager would,” Wegmann said.

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

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

His team has genetically engineered cells that, when implanted in mice, release a biological 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 get osteoarthritis from sports injuries and the increasing prevalence of obesity.

“Our thought was, can we develop a system with living cells and get the cells to make these drugs in the body? That way the cells can continuously make and deliver biological drugs that are used to fight arthritis,” said Dr. Guilak.

A major 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 of some cancers. The research team created a small disk about a quarter inch in diameter and about a millimeter thick that they can tuck under the skin. It stays there until it feels inflammation, then it turns on the medicine that fights arthritis.

dr. Guilak says, “…we have some work to do, but we’ve got all the pieces in place, and hopefully we’ll get to that eventually.”

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