David Felson, MD, MPH

My main contributions to science are in the areas of osteoarthritis and rheumatoid arthritis outcomes. Osteoarthritis (OA) is the most common form of arthritis and a highly prevalent disabling disease for which there is no known structure modifying treatment and science has focused on articular cartilage biology. I started the Framingham Osteoarthritis Study which was the first modern day study to characterize the prevalence of disease and was the first to obtain MRI’s on a community sample. These have shown that structural changes of OA including meniscal tears were common even in those without joint pain. Using longitudinal data from Framingham, we were the first to show that obesity preceded knee OA and probably caused it and the first to show that weight loss could prevent disease. I also started the MOST cohort study to examine risk factors that could be modified in osteoarthritis and the Beijing Osteoarthritis Study which confirmed the extremely low rate of hip osteoarthritis in China and showed that the remarkably spherical hips of Chinese provided an explanation.

My work has been to document that articular structures outside of cartilage generate pain in those with disease, especially bone marrow lesions and synovitis and that these structures may be good therapeutic targets. We have demonstrated the association of bone marrow lesions with pain, that their fluctuation relates directly to pain fluctuation, and that treatment of these lesions in the knee can both shrink the lesions on MRI and reduce knee pain. For synovitis, we have demonstrated an association with pain and that pain fluctuation and synovitis fluctuation are directly related. In recent work of ours, we have shown that preventing cartilage loss, a focus on treatmen development, is unlikely to have a major effect on pain reduction. For both bone marrow lesions and synovitis, my group has documented that their presence increases the risk of disease progression and cartilage loss. In recent work, we have documented that visceral adiposity products enhance musculo-skeletal pain.

For rheumatoid arthritis, my group created the idea of a core set of outcomes, a concept that has now been adopted in multiple diseases. We then led international efforts to standardize outcome measurement in rheumatoid arthritis, efforts that helped catalyze the dramatic improvements in treatment for this disease.

I have also dedicated myself to training and mentoring clinical scientists and many of the clinical researchers in musculoskeletal diseases in the US have trained in my group.

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