CHANCIE KNIGHTS BVetMed PhD
Chancie qualified from the Royal Veterinary College, London in 2006. After a year spent working in small animal practice in the South East of England, she completed a small animal rotating internship at the Ontario Veterinary College, University of Guelph in Canada. She returned to the UK to obtain her PhD at Kings College, London studying the pathophysiology of osteoarthritis pain. In 2011, Chancie returned to Canada where she is currently the Veterinary Services Manager for Zoetis Canada providing training advice to veterinary health care teams across Canada.
Chancie has written a number of published scientific articles on osteoarthritis pain and is passionate about furthering the understanding of osteoarthritis in both people and pets.
Chancie kindly agreed to answer the following questions:
Why is the pain in osteoarthritis so difficult to manage effectively?
While osteoarthritis (OA) is the most common cause of persistent musculoskeletal pain and can be a serious disabling disease, there is much that we don’t understand. The lack of sensory neurons within the joint cartilage and poor correlation between the radiological signs of OA and the occurrence of joint pain has led to much discussion as to the site and nature of OA pain. OA symptoms of joint pain, swelling and stiffness are suggestive of some local inflammation and episodic synovitis can coincide with occurrences of increased pain. However, OA is not considered a classical inflammatory disease and anti-inflammatories provide incomplete relief.
There are currently no disease modifying agents or effective preventative strategies for OA. Therapies are therefore targeted towards controlling symptoms, maintaining function and reducing further joint damage. The management of OA is symptomatic up to the point of serious joint dysfunction, when surgical approaches are used. Joint replacement, however, is an invasive procedure with a substantial recovery period and modest options for revision when needed. Also persistent pain has been reported in human joint replacement patients following surgery. For example, up to 8% of total hip replacement patients complain of persistent moderate to severe pain 2 years postoperatively which may be due to sensitisation of the peripheral or central nervous system. Abnormalities in central pain processing may explain why so many patients with osteoarthritis have residual pain that is not effectively treated with drugs targeting peripheral or inflammatory pathways. It is a very complex condition!
How did your research help to advance our knowledge of OA pain?
My PhD examined the role of specific pain receptors using genetically modified mice, novel analgesics, and calcium imaging leading to the identification of several targets for potential new therapeutics (including trkA, NGF and bradykinin). My research also showed that fluctuations in the degree of pain behaviours in animals with osteoarthritis could be attributed to varying levels of endorphins. This highlights the important of activities which encourage the production of endorphins such as exercise, in pain management.
How do you see treatment options for arthritis progressing over the next ten years?
I hope to see a reduction in the reliance of NSAIDs and opioids and an increase in the availability of targeted therapies that act on specific pain receptors upregulated in arthritis. This may potentially provide a greater reduction in pain with fewer side effects. Currently, monoclonal antibodies offer the greatest promise for achieving this and several are currently in development in both human and veterinary medicine.
If you could have the opportunity to give one tip/ piece of advice to an owner with a dog suffering from arthritis what would it be?
Maintain your pet’s active lifestyle with consistent exercise that maintains muscle and produces the body’s natural pain killers – endorphins. Maintain a record that tracks the pet’s weight, exercise and quality of life indicators so that medication, diet and physiotherapy/exercise can be tailored to meet their needs.