UNC project digs into arthritis

Data gathered in Johnston

Staff WriterAugust 25, 2011 

  • As the project has created changes in the way arthritis is diagnosed and treated, it also has produced a lasting community of technicians, doctors, researchers, participants and family members.

    Anne Cogdell, participant

    "The program does a lot for people if they are willing to participate," said Cogdell, 78, who, like all participants, lives in Johnston County.

    The project sends people door to door in Johnston neighborhoods to enlist participants, who receive small fees in addition to the detailed exams and follow-up. After Cogdell was recruited for the project, she became an interviewer herself.

    As a result of what she has learned from the project, Cogdell has been exercising regularly, getting on her stationary bike for 30 minutes each morning. She also practiced tai chi as part of study that showed the Asian martial art's beneficial effects on arthritis.

    "Old folks can't stay in bed; They get to where they can't move," she said.

    Joanne Jordan, project leader

    Jordan, who has headed the study since the beginning, was just getting her degree in epidemiology in the early 1990s, when UNC's Thurston Arthritis Center was setting up a partnership in Johnston County. Researchers wanted to change the usual protocol for such tests, in which people are recruited, then have to travel to research facilities, often in large cities, for relatively short-term trials.

    "We know that people that make it to the doctor, particularly to Chapel Hill, are very different from people who don't go to the doctor," Jordan said. "We knew that really the way to find out what was going on was to go to the communities themselves. We enrolled about 3,200 people in the early '90s."

    Johnston was selected for its demographics that included a mix of races and rural and suburban residents.

    Participants weren't asked whether they had arthritis. But they have answered dozens of questions about their lifestyles, backgrounds and family histories. They have been given bone density and blood pressure tests and even have had clippings from their toenails taken. The study is unusual in the number of rural and African-American people who have taken part.

    "There was more arthritis in this rural population than in other populations around the country," Jordan said.

    The doctors and staffers involved in the study don't treat participants whose health problems are revealed through their workups, but refer the information to their own physicians.

    "We have had incidents where we discovered things that people had no idea about," Jordan said.

    Spencer and Beverley Braswell, participants

    Smithfield retiree Spencer Braswell, 76, discovered in 2002 that he had osteoporosis because of the bone density scan he received as a participant in the project. He and his wife, Beverley, 72, signed up after hearing from a friend at church about the study.

    "It's pretty neat to know that something you're involved in could help somebody else 20 years from now," Beverley Braswell said. "The byproduct was that Spencer got this help."

    Tipped off by the bone density scan, Spencer Braswell started therapy involving the drug Fosamax and regular exercise. His bone density has increased, putting him at significantly less risk for the fractures and bone weakness that come with osteoporosis.

    Spencer Braswell has a farm background and had a long career in manufacturing. His wife worked in a doctor's office for 35 years. They continue to give back to the community that they have made their home for decades.

    "In the past five or six years, I have started helping transport people who are having cancer treatments," he said.

    Lynn Joyner and Georgene Capps, clinical workers

    At the clinic where participants get their thorough going-over, Joyner and Capps have spent more than a decade as clinical workers, increasing their technical skills as time progresses. By design, everyone who works for the project is from Johnston County.

    Joyner and Capps spend time every week, in addition to their clinic hours, going into the community to interview possible participants.

    "You establish a relationship with these people," Capps said. "Even though they only get a follow-up every four or five years, you see them at the grocery store, you seem them at church."

    Some participants also come back for specific studies on subjects such as whether tai chi benefits older people with arthritis. (It does.) That led to a therapist associated with the center offering tai chi courses to the community.

    "We understand our data goes all over the world," Joyner said. "We're amazed when we see an article somebody wrote on the other side of the country and it will say, 'Information from the Johnston County Osteoarthritis Project.' "

A joint effort between UNC-Chapel Hill's medical school and thousands of Johnston County residents has produced a one-of-a-kind data mine that is benefiting patients, scientists and doctors all over the world.

For the past two decades, the Johnston County Osteo arthritis Project has studied randomly selected Johnston County residents over 45 who agreed to extensive interviews and head-to-toe X-rays, physical exams and bone density scans. Scientists have documented the progress of thousands of the Johnston residents as some developed osteoarthritis, a degenerative joint disease.

The huge database arising out of the project, as well as thousands of blood and tissue samples kept in subzero freezers in Chapel Hill, has provided fodder for more than 100 peer-reviewed studies. It has led to significant discoveries about the ways in which heredity, lifestyle, occupation and ethnic backgrounds intertwine. For instance:

The association between fatigue and arthritis is so strong that some people can be treated simply with more sleep at night.

"Sometimes the best thing we do for people is getting them sleep," said UNC's Dr. Joanne Jordan, director of the project. "They didn't need another big drug, or knee injection; they might not have just been sleeping enough."

People with high levels of exposure to lead, experienced by anyone who was alive before the introduction of unleaded gas in 1972, are more likely to develop osteoarthritis.

Routine environmental exposure to a broad variety of products such as mercury and other metals - all more common in low-income groups - could predispose people to autoimmune disease such as arthritis.

People who have legs of different length are more likely to develop osteoarthritis of the hip and knee.

Results of the project have included the identification of biomarkers - substances present in blood or urine - that can diagnose or predict the development of osteoarthritis.

Researchers also have looked at the ways that people from different ethnic and economic backgrounds deal with the pain and depression that accompanies the disease.

And most recently, data have been used to study the presence of genes that indicate a predisposition to arthritis. The various markers are being studied for potential use in treating and even preventing the development of osteoarthritis.

thomas.goldsmith@newsobserver.com or 919-829-8929

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