Sita Bierma-Zeinstra is professor of Osteoarthritis and Related Disorders and specialises in the causes, prevention and treatment of the condition. She leads the Osteoarthritis research group at the Department of General Practice and is also affiliated with the Department of Orthopaedics and Sports Medicine at Erasmus MC, as well as the Department of Biomechanical Engineering at TU Delft.
The wonder
“Well, I’ll be damned”, I thought, when my patient said he got rid of his tinnitus after my treatment. I’d simply tried a novel approach! As a physiotherapist in the 1980s, I’d treated this patient with some stretch relaxation exercises for the muscle attachments behind his ears. The fact that it worked was good news for him. But something kept gnawing at me. What was known about this condition? What was the treatment based on? Physiotherapy wasn’t evidence-based. That’s not how I wanted to work.
“I went back to studying and then doing research, with a focus on osteoarthritis. It was absurd how little was known about osteoarthritis back then when it’s so common. I can’t say I’ve had a single major eureka moment since. I have those eureka moments all the time. For example, after reading a study on shoulder injections, which said that injections into the gluteal muscle also gave good results, I thought: ‘Hey, maybe this approach will work for osteoarthritis of the hip as well, so GPs can inject patients themselves and reduce the need for referrals.’
“Also, I’d been thinking for some time about the phenomenon that the incidence of osteoarthritis increases much faster in women after the age of fifty than in men of the same age. People used to think this had something to do with the menopause, but nobody knew exactly why.”
The eureka moment
“It was then that a rheumatologist in her late fifties told me she’d stopped taking the pill. Within three weeks, she spotted Heberden’s nodes – bony swellings on her fingers. These are signs of osteoarthritis of the hand.
“I was surprised that the woman was still on the pill at her age. I talked about it with a GP and he didn’t think it was that crazy. He explained that many women of that age are still on the pill and that GPs advise them to stop around the age of 53.
“That’s when I really had a eureka moment. At that age, the pill keeps hormone levels artificially high, even though the woman has already entered menopause. Going off the pill at that point causes a sharp drop in hormone levels. I saw opportunities to study the emergence of disorders due to the menopause.”
The research
“I started a pilot study with other departments and made a call to pharmacies. When women aged between fifty and sixty picked up a new pill strip, the pharmacy gave them information about my research on the development of osteoarthritis, among other things, and a request to sign up.
“In no time, I had enough participants. We followed fifty women for two years, gathering many data points: questionnaires, MRIs, DXA and UTC scans, blood levels of hormones and proteins, and so forth. All of them have now completed the follow-up study after the two-year period.”
The result
“The study is still ongoing. We’re busy analysing the data. I’ve already seen signs of an abrupt change in proteins six weeks after stopping the pill. Using statistical analyses, we’ll examine whether this is also related to the occurrence of certain diseases, and whether it makes sense to start a larger study. This research really is at the cutting edge. I enjoy that very much.”
