Portrait and video Sita Bierma-Zeinstra: "I hope this leads to even more cooperation"

In the Netherlands, osteoarthritis causes pain and physical limitations in one and a half million people. Despite this high number, very little is known about this condition and only treating symptoms is possible. Prof. dr. Sita Bierma-Zeinstra focuses her research work on early detection and better treatment of osteoarthritis. "I want to find out why something is the way it is and how we can change it," she said.

Professor Sita Bierma-Zeinstra leads the osteoarthritis research group at Erasmus MC and is one of the Scientific Leaders of the program Medical Delta: Improving Mobility with Technology. She was recently appointed Medical Delta professor with a dual appointment at TU Delft.

"This appointment validates my collaboration with TU Delft," Bierma-Zeinstra says. "There are already some very nice projects we are doing together, this Medical Delta professorship confirms that and makes it more visible. I hope it will lead to even more collaboration. With my current collaboration partners, I know very well what we have to gain from each other, but there are also opportunities beyond that. For example, with Artificial Intelligence."

Can you briefly tell us what your expertise is?

"My expertise is in the musculoskeletal field. I have a background in physical therapy. I studied biomedical sciences in Nijmegen. After my PhD, I focused entirely on osteoarthritis, both diagnostics and therapy. I lead many clinical studies as well as epidemiological research. I also collaborate a lot to do translational research. I try to be the link between different departments and between clinical and basic research. I also often ask questions of basic researchers, because many things you see in patients, they don't always have in mind. I notice in patients where they suffer the most. If we can reduce those issues, we've already come a long way. For example, by investigating not only how the cartilage changes, but also how the pain arises."

What motivates you to work on this?

"I've always been intrigued by research and driven by curiosity. I want to find out why something is the way it is and how we can change it. After my doctoral research, I discovered that very little is known about osteoarthritis, even though I encountered it so often in practice. How can that be? Osteoarthritis is becoming the largest chronic condition within the population, while there is still no treatment to influence the disease. We now do symptom control or else just give a new hip or knee. But that doesn't always work either and is an expensive and temporary solution. We can still learn so much about osteoarthritis and treat it better or even prevent symptoms."

In what way does technology help your research?

"My collaboration with TU Delft is now focused on making computer models of joint growth or an osteoarthritic joint. These models are based on the data we collect. In the growth model, we can examine how such a joint grows and which interventions affect that growth. The load model shows the situation of a patient who has damaged cartilage in a certain way. With those models, you can artificially test treatments and see in what way the cartilage can be loaded. That way we hope to learn more about how to put together interventions."

What is it like to start collaborating with someone from a completely different discipline?

"For the research on knee loading, Medical Delta professor Jaap Harlaar from TU Delft joined me. We worked out the research together and wrote an application. For the other application on joint growth, I approached Amir Zadpoor of TU Delft. One challenge here is that you don't always speak the same language. First I have to read the pieces Amir writes at least twice. To get it in focus for myself, I ask a lot. What do you mean by that? Is this really that? It's OK to ask silly questions."

Is that also your tip for good collaboration?

"Yes. Then don't pretend to be better than you are, dare to ask questions. How can that be? How about that? So that you really help each other."

What do you hope to have accomplished for the patient in five years?

"In any case, we will then be able to determine for a number of cases with osteoarthritis what load would be good for that type of patient. Now people ask, 'can I still do this or do that,' and the doctor's answer is, 'if it hurts you can't do it.' That can be done much better, much more accurately. In five years we will hopefully be able to advise much better what can or cannot be done.

Results on prevention is another story. That's a long-term view. We should do much more on prevention. In all major population diseases that is happening, but not at all yet in osteoarthritis. In a few years we will have much more knowledge about this, but the patient will not notice anything about it then."

What will caregivers notice?

"My whole research, broader than what I'm doing with TU Delft, is aimed at detecting osteoarthritis early and treating it. Now we start treatment too late and by then too much has already been destroyed. The patient is then already in a pain process and it is then very difficult to intervene or get someone to adopt a different lifestyle. When we change that, the caregiver also gets a lot more options."

What other researcher are you inspired by?

"I can name several in a moment. A good example is Annette van der Helm of the LUMC. She does a lot of research on early recognition of rheumatoid arthritis. That is also very interesting for osteoarthritis. I have an appointment with her soon to discuss this further and see how we can help each other further."

This article is part of a series in which we highlight the eight new Medical Delta professors. Click here for the other portraits published so far.