Calgarians to benefit from innovative doc

By Valerie Berenyi
The Calgary Herald

Three years ago on holiday in Mexico, Eric Gould landed badly while playing beach volleyball, tearing some cartilage in his knee.
"I had it looked at, but there wasn't much they could do for a torn meniscus," says Gould, 54.

The swelling went down, but knee osteoarthritis, or OA, set in. It got progressively more painful, especially in winter, and his knee clicked going up and down stairs.
"I wanted to play with my grandkids, so I began researching what I could do," says the retired Calgarian. His Google searches kept turning up Dr. John Esdaile, an internationally acclaimed rheumatologist from Vancouver, B.C., and scientific director of the Arthritis Research Centre of Canada, (ARC).

Gould was contemplating knee surgery, but when he read Esdaile's articles on arthritisresearch.ca and saw a video about OA featuring the late actor Leslie Neilsen, he quickly changed his mind. Following advice from the website, he lost weight and exercised more, which helped relieve his pain.

Esdaile hopes the 10 per cent of Albertans with OA will experience a similar kind of aha! moment now that he's joined the McCaig Institute for Bone and Joint Health at the University of Calgary. He's also the first recipient of the Arthur J.E. Child Chair in Rheumatology Research at the U of C.

"Dr. Esdaile is very innovative, has lots of energy and is very well respected. He's a great addition for us," says Dr. Dianne Mosher, division chief of rheumatology in the U of C's faculty of medicine.

He'll see patients in Calgary and continue his arthritis research and education. He's also building a partnership between Alberta and B.C. through ARC, which does "practical research for everyday living," says Esdaile.

One of his current projects is researching why people develop hip osteoarthritis. "The cause is unknown, but it's basically 90 per cent of hip problems." And his team at ARC is anticipating the forthcoming publication of their research about using a blood test to diagnose early OA.

Like Gould, many patients search the web and need good information, says Esdaile. He used to travel at lot, giving lectures to family doctors so they in turn could inform their patients, a process he calls "laborious and time-consuming." Now he's harnessing the power of the Internet to educate the public about arthritis with the latest scientific knowledge.

"It's like Eric (Gould) said, 'Oh, I've sent that video to 30 of my friends.' And those friends will send it to other people. He's done more than I could, going somewhere to give a lecture to doctors."

And the word needs to get out. Take knee OA -often described as a "wear and-tear" deterioration of the knee. Esdaile believes the disease starts much, much earlier and affects many people who don't realize they have it.

In one ARC study, a large sampling of people showed that when they reported having had pain, aching or discomfort in and around the knee -at any time in the past year, even for one day -they had a 90 per cent chance of having osteoarthritis of the knee. Magnetic resonance imaging confirmed cartilage damage.

But Esdaile doesn't think our knees just wear out with age, "because you have lots of people who do lots of wear and tear to the knees and never get OA."

Trauma, like Gould's injury, can cause knee OA. So does excess weight gain. Genetics may play a role.

And, while symptoms may not show up until middle age, current thinking holds that up to 25 per cent of knee OA is caused by sport injuries that happened in adolescence.

"They're playing soccer or basketball and they get a minor injury, but are sent back in to play too soon," says Esdaile.

To prevent teen knee injuries, he's worked with a soccer organization in B.C., counselling proper warmups, the removal of obstructions on the field and holding off on returning to sport until an injured knee is fully rehabilitated.

Interestingly, women are twice as likely to develop knee OA as men. Hormones, but also a disproportionate share of household work, may play a role, he says.
Early diagnosis is key, says Esdaile, and exercise is vital. In a study published in 2010, he and his colleagues found that pain and function in those with knee OA significantly improved with exercise. It even slowed the progression of the disease. Why?

"It works though two mechanisms: losing weight impacts the pressure across the knee. Every time you step on your knee it's five times your weight. So, if you lose five pounds, you've taken 25 pounds off your knee with every step. Ten pounds of weight loss takes off 50 pounds. That's huge.

"Exercise also strengthens your thigh muscles. Really, our knees are just one bone sitting on top of another bone and they are totally stabilized by our powerful thigh muscles. If you strengthen them, even a little bit, it will help the pain."

Don't aim for "heroic" exercise. Bicycling, using an elliptical trainer and weight training are good, but swimming "is the best." Tennis and running on pavement and concrete -not so much.

Gould remains very active, snowshoeing in winter and water-skiing in summer.

"We all want the quick fix, When something hurts it's just 'give me a pill,' " he says.

"When Dr. Esdaile talks, you realize there is no quick fix, there is no pill. The deterioration may keep going to the stage where I'm going to have replace the knees, but with some exercise and smart eating I'm going to put that off for a long time."

John Esdaile is professor of medicine at the University of British Columbia and scientific director of the Arthritis Research Centre of Canada.

Material reprinted with the express permission of: The Calgary Herald
First published May 5, 2011