Duration: 01 September 2025 - 31 August 2030
Funder: Arthritis UK
Chief investigators: Dr Rosemary Hollick (University of Aberdeen), Professor Cosimo De Bari (University of Edinburgh)
Co-investigators: Professor Gary Macfarlane, Professor Graeme MacLennan, Dr James Ross, Dr Anke Roelofs (University of Edinburgh), Dr Benjamin Winter (NHS Grampian)
Study Co-ordinator: Dr Rebecca Parr
Assistant Study Co-ordinator: Jonathan Lock
Osteoarthritis is a common condition caused by joint damage, most often affecting the knees. It is a major cause of pain, disability, and reduced quality of life. Current treatments focus on lifestyle changes, pain relief, and joint replacement when there is significant joint damage, but there are no drugs currently available that can slow or stop joint damage. This is partly because osteoarthritis is usually detected only once damage is visible on x-rays, by which time it is often too advanced for treatments to be effective. There is also no accurate way to measure whether new treatments are working. Detecting early changes in the knee and tracking them over time is therefore crucial and has been identified by our patient partners as a key priority.
Further information
- What is the study about?
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The PIOKNEER study is designed to develop new ways to detect and monitor early knee OA using innovative imaging and biological methods. The study builds on a successful pilot study (FRESKO), which showed that these methods are safe and acceptable to participants.
We will follow 300 people aged 35–70 with early knee pain but no visible osteoarthritis changes on x-ray, using cutting-edge Field-Cycling Imaging (FCI). FCI uses much lower magnetic fields than standard MRI that can be rapidly changed while the person is being scanned. This provides more detailed information and can detect subtle and early cartilage changes that cannot be seen with standard X-rays or MRI scans.
The team will also analyse blood and urine samples to measure biological indicators of joint damage. Some participants will be invited to have a sample of tissue (biopsy) taken from the lining of their knee joint (synovium) to study how changes in the synovium may drive early damage.
We will also recruit 100 patients with more established knee osteoarthritis to undertake FCI investigation as a comparison and to help us understand what additional information can be gained from FCI in people with established osteoarthritis
In addition, we will explore people’s experiences and needs to improve early care. Working closely with patients, PIOKNEER will deliver new knowledge, tools, and guidance to support earlier diagnosis and treatment of knee osteoarthritis.
- Why is this research important?
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Currently, there are no treatments that can slow or stop osteoarthritis once joint damage is visible. Detecting changes earlier could open the door to effective new therapies and prevent progression. The project addresses a major gap identified by people living with osteoarthritis and aligns with global efforts to improve early diagnosis of osteoarthritis.
- What are the aims and methods of the study?
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- Survey people living in Aberdeen City and Aberdeenshire using the open electoral register to identify those with knee pain who have not had major knee injury or surgery and invite them for a knee x-ray at local community hospitals
- Recruit 300 people with knee pain but no osteoarthritis changes visible on X-ray.
- Track symptoms, and changes in the knee joint with FCI, x-rays and blood and urine samples over four years.
- Analyse knee biopsy samples (using single-cell RNA sequencing) in a small group of participants with stable or rapidly worsening knee OA
- Recruit 100 patients with X-ray changes of osteoarthritis who will undergo FCI once only as a comparison
- Explore people’s experiences of living with early-stage KOA using interviews, focus groups and workshops, to identify gaps in care, and co-produce guidance to support timely access to services, and evaluate the feasibility of FCI in practice.
- Survey people living in Aberdeen City and Aberdeenshire using the open electoral register to identify those with knee pain who have not had major knee injury or surgery and invite them for a knee x-ray at local community hospitals
- What has the study found so far?
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Recruitment will begin in 2026.
- How can I get involved?
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People aged 35–70 living in the Aberdeen/Aberdeenshire area who experience knee pain and have not had major knee injury or surgery may be eligible to take part. Recruitment will open in 2026 – some people will receive an invitation to take part by post, but we will also be advertising via social media and local NHS networks.
- Study team
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Chief investigators
- Dr Rosemary Hollick
- Professor Cosimo De Bari (University of Edinburgh)
Co-investigators:
- Professor Gary Macfarlane
- Professor Graeme MacLennan
- Dr James Ross
- Dr Anke Roelofs
- Dr Benjamin Winter (NHS Grampian)
Study Co-ordinator
Patient partners
- The project will involve patient partners throughout. Find out more about our Patient and Public Involvement and Engagement work to be notified of opportunities to get involved in this project.
- Study locations
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The study is based at the University of Aberdeen although study x-rays will be able to be performed at community locations within Aberdeen and Aberdeenshire.
- Information for participants
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Participants will attend annual visits at the Foresterhill Health Complex, including questionnaires, X-rays, and knee scans using FCI technology. Some will be invited for optional knee biopsies. Some participants will be invited for a single visit to undertake imaging. All data are handled in line with strict confidentiality and ethical standards.
- Privacy notice
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All personal information will be kept secure and confidential in accordance with UK data protection law. Data will be anonymised for analysis and shared only in aggregated form for research purposes.
- Contact details
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For further information, please contact:
Dr. Rebecca Parr
PIOKNEER Study Coordinator
University of Aberdeen
Email: piokneer@abdn.ac.uk