Pitches of our Early-Stage Researchers 

Our early-stage researchers had the great opportunity to participate in a communication workshop organized by our partner ReumaNederland.

Here, we proudly present the results: the pitches of our talented young researchers!

Marieke Meteling is a PostDoctoral reasearcher at the University of Twente
Did you ever have pain in your knee(s) and wondered what type of exercise would be best? This is a question that many people suffering from osteoarthritis (OA) ask themselves. To help them find an answer, I am studying how cartilage cells respond to their physical environment, including physical forces, to understand why osteoarthritic cartilage degenerates over time. As OA advances, the physical properties of cartilage change significantly. For example, the environment surrounding each cell changes in firmness. This environment, the substance surrounding each cell, is known as matrix. While it is known that the matrix changes, we don’t fully understand how these changes affect the cellular function yet. The main focus of my research is to investigate how the physical properties of cartilage affect cell behavior at rest and when subjected to physical forces mimicking exercise.
Using specialized equipment we can assess the physical properties of healthy and degenerated cartilage at cellular scale. This is important to get an understanding of how cells experience their physical environment. To study cell behavior, we use specialized machines and microfluidic technology. Microfluidics is an innovative field that focuses on manipulating and controlling small amounts of fluids. Using microfluidic technology, I can create tiny droplets that simulate the matrix surrounding the cells.This allows me to study how cartilage cells behave in conditions that closely resemble their natural environment. Importantly, the physical properties of the droplets can be tuned, and I can subject the cells inside the droplets to physical forces. In this way, I can explore whether physical forces encourage a degenerative behavior in the cells, or help to prevent it. This research could provide new insights into OA progression and its relation to physical stress at the cellular level. As such it provides a missing piece to the puzzle of what type of exercise routine would be best for a patient with OA. Additionally, we hope to discover new targets for treatments that focus on the changing physical properties of cartilage, and how well the cells can detect these changes. Ultimately, these findings could empower doctors to offer more personalized exercise advice, helping patients manage their osteoarthritis and improve their quality of life.
Elke Warmerdam is a PostDoctoral researcher at the University of Twente
Imagine getting out of bed with a stiff and painful knee every morning. This is reality for three quarters of a million of people living with knee osteoarthritis in the Netherlands. These people have wear and tear of the knee joint. Managing their symptoms is difficult, as they can change day by day. That is why we are developing an easy to use tool, think of it as an app, that will help people with osteoarthritis to take more control of their condition – right from their phone. We want to show these people how much force they put on their knee joint and warn them when they are putting too much force on the knee. This way they can adjust their activities accordingly in time and prevent pain and other symptoms.

Exploring the challenges
We want the tool on the phone to be as helpful and easy to use as possible. That’s why we are involving people with osteoarthritis right from the start. Through workshops, we will explore the challenges they face and how the tool can best support them.
We will discuss what should be in the tool, how they want to interact with the tool and how we can personalize it to the wishes of the different people. We are also in contact with different healthcare professionals to learn how they think their patients can be helped best and how our tool can complement their care.

Creating the best possible tool
Based on these insights, we will create a first version of the tool and test it with a small group of people with knee osteoarthritis. Their feedback will help us to improve the tool, whereafter we will test it again with a small group of people. We will repeat this process until their needs are met. At this moment the tool is ready for further testing. We will launch a larger study to confirm that the tool really helps people taking control of their knee osteoarthritis.  Our goal is simple: to give people with knee osteoarthritis a practical tool that helps them manage their symptoms, stay active, and improve their quality of life. And all of that just from their phone.
Reimer Wolff is a PhD student at Erasmus MC
Have you ever heard someone say their knee or hip is ‘worn out’? It can be a real pain, both physically and mentally. Often, this discomfort is caused by a medical condition called osteoarthritis (OA). Osteoarthritis is a common disease of the joints, where the smooth cartilage layer covering the bones wears away. Cartilage acts like a cushion, reducing friction and absorbing shocks. If it is gone, cartilage cannot be regenerated, and movements can become painful or stiff, making it harder to enjoy the things you love to do. Currently, we (doctors and researchers) do not fully understand yet why cartilage is lost. Among other involved factors, inflammation of the entire joint plays an important role in the progression of OA. What triggers this inflammation, and why OA progresses faster in some people, remains unknown. For now, the best way to keep your joints healthy is to keep exercising throughout your life. But what if you have a painful or swollen knee because of this inflammation? Is exercise even beneficial in these circumstances?
How cells in cartilage react to stress and exercise
Our research focusses on how inflammation in cartilage changes the response to exercise. We want to understand how the cells in the cartilage – the chondrocytes – react to different levels of inflammation and different levels of exercise like walking or running. This could give us new insights for when and what physical activity is beneficial for patients with OA. Since it’s not possible to get both healthy and diseased cartilage from humans, we’ll be using bovine cartilage, which is ‘waste material’ from cows used for food production. By adding specific substances (called cytokines) to the cartilage, we can mimic an inflammatory environment in the laboratory. Next, we place the cartilage in a device that applies gentle, controlled pressure – similar to the pressure cartilage ‘feels’ during walking, cycling or running. Then we measure how the cells in the cartilage reacted, giving insight into what and how much exercise is best for an inflamed joint.
Towards a more personal approach for OA
Our goal is to provide better guidance and recommendations for patients living with OA, especially for when inflammation is present. We aim to find how an inflamed joint reacts to different intensities of exercises, so we can create personalized treatment plans working closely with physical therapists. A personalized plan helps patients stay active, reduce pain, and possibly delay or even avoid joint replacement surgery. This way, you can get back to enjoying the activities you love, with less pain holding you back.
Anne Flier is a PhD student at Erasmus MC Do you remember the last time you visited a friend, your parents, or neighbor for coffee? Picture them getting up to grab a cookie or refill your cup. Did you notice them moving stiffly, slowly, or mentioning sore knees or hips? These are common signs of osteoarthritis, a joint disease that becomes more prevalent with age. By midlife, your chances of developing it are 50%, and currently, there is no cure. The Balance between Activity and Joint Health Osteoarthritis occurs when the cartilage in joints breaks down. Cartilage is maintained by cells called chondrocytes, which balance creating new cartilage and removing old, worn-out cartilage. Healthy movement transfers forces to these cells, stimulating them to regulate this process.
This is why doctors advise their patients with osteoarthritis to stay active: to prevent a total halt of cartilage production. However, both too much and too little movement can lead to a shift in the balance increasing cartilage breakdown. Yet, some lifelong runners will never suffer from osteoarthritis, while others develop it by age 40. So, what level of activity do you need to maintain your balance?
How do Your Genes Handle Activity? My research aims to uncover why people’s joints respond differently to the same level of activity. Specifically, I am investigating if differences in the genetic code, the DNA, influence how chondrocytes react to forces experienced during movement. To study this, I use stem cells from different people and turn them into cells resembling chondrocytes. By applying forces to these cells and observing their responses, I can identify links between, for example, harmful reactions and specific genetic codes.
Future Cookies My goal is to use this knowledge to create personalized movement advice for osteoarthritis patients, helping them maintain the activity level that is best for their joints. One day, this could help you stay mobile and pain-free, so you can grab that cookie with ease when your family comes to visit.

Emmanuel Chukwu is a PhD Student at Eindhoven University of Technology

Imagine a world where healthcare decisions are driven by advanced AI technology that you can trust because it is transparent, above all, completely tailored to your individual needs. This is the vision behind our research project, which aims to enhance AI in healthcare by making it more understandable and accessible. Our goal is not only to predict health outcomes but also to explain
the reasoning behind these predictions.

We focus on knee osteoarthritis (OA), a condition that affects millions of people worldwide by causing pain and limiting movement. In the Netherlands, one in ten people is expected to develop OA by 2040. The pressing question is: How can we prevent this growing health crisis?

To address this, we are developing a personalized recommender system that empowers people to reduce their risk of developing OA. This system will offer actionable, easy-to-understand insights tailored to each person’s unique situation. For example, it could suggest real-time lifestyle adjustments, such as modifying daily activities to better distribute weight on the knees or providing personalized exercise tips that fit your lifestyles.

A key feature of our system is the use of an innovative technique that delivers ‘what if’ explanations. It means that it can show what might happen if you make certain changes in your daily life. Picture it as having a conversation with your doctor, who explains how small adjustments, like walking for just ten minutes each day, could lead to significant improvements in your health and help avoid joint pain in the future. This approach not only improves understanding, but also builds trust, encouraging people to follow the advice provided.

We hope to pave the way for a future where AI serves as a reliable partner in helping improve knee health. Ultimately, our success will contribute to smarter and more personalized medical decision making, leading to better health outcomes for everyone.

Steven Lankheet is a Juniour Researcher at Medische Spectrum Twente

The Problem with a “One Size Fits All” Approach Imagine wearing the same size pants as everyone else—it wouldn’t fit right, would it? Yet, many e-health treatments for people with knee complaints take this one-size-fits-all approach. They are offering identical exercises and advice to all patients. Unsurprisingly, these solutions don’t work for everyone. Fortunately, as technology advances and we better understand patient behavior, interventions are becoming smarter and more tailored to individual needs. Personalized care in other areas of healthcare has already delivered promising results. The key question is: How can we effectively personalize treatment for knee osteoarthritis (KOA) and integrate these strategies into a digital coaching buddy?
Fine-Tuning Coaching Strategies
To answer this, we’ll begin by analyzing all published digital interventions for KOA to see how personalization is implemented. Next, we’ll gather real-world data by following patients with KOA, capturing details about their condition and experiences. This will help us pinpoint factors that can guide tailored treatments. For example, some patients might need extra encouragement (“The Underachievers”), while others may thrive with a more moderate approach (“The Overachievers”). There could be other factors as well, such as pain levels lor lifestyle habits, that we can use to fine-tune coaching strategies.

Developing a Personalized Coaching Buddy
With the insights from previous studies and real-life data, we’ll develop a personalized digital coaching buddy. This system will adapt to each patient’s needs. Some may be encouraged to try more advanced exercises, while others will follow a gentler routine. Break times will vary, with some requiring longer rests and others benefiting from shorter intervals. Additionally, the format of instructions will be customizable—video tutorials for visual learners, or written guides for those who prefer to read. Once developed, we’ll test this coaching buddy with around 15 patients to evaluate its practical application.

Taking Control
By making e-health solutions more personalized, we aim to deliver support that fits each patient as perfectly as a well-tailored outfit. Like wearing clothes that are designed for you, personalized care ensures comfort, confidence, and effectiveness.
Famke Janssens is a PhD Student at the Radboud University Medical Center

Imagine you enjoy staying active, whether it’s a daily run, a walk with your dog, or simply moving throughout your day without discomfort. Now, imagine that suddenly even a short walk becomes a challenge because every step you take is painful. For millions of people worldwide, this is the daily reality of knee osteoarthritis, one of the leading causes of joint pain and loss of mobility. In the Netherlands alone, the numbers are staggering, and the problem is growing.

Knee osteoarthritis occurs when the cartilage, the soft tissue inside your knee, gets damaged. This tissue acts as a cushion, absorbing the forces of daily movements.
At the Radboudumc, our research dives deep into understanding how everyday movements impact this soft tissue. Using advanced computer models, we simulate everyday activities, like walking, running, or cycling. We make use of real patient data to simulate these activities and predict how different forces impact the knee cartilage. For example, with each step we take, pressure is applied to our knee. Our models show where the most pressure is placed on the knee and cartilage, how high these pressures are, and where the risk of damage is thus the highest.

Think of it as creating a 3D map of stress over the cartilage. This visualization allows us to see inside the knee during these activities. This way we kind of make the ‘invisible’ visible. Because the models use real patient data, they can be customized to specific individuals. This allows us to run multiple virtual scenarios to explore how different activities affect the knee within one person, something that would be nearly impossible with physical tests alone. For instance, we can directly compare the effects of walking versus running for that specific patient.

Gaining deep understanding of how the daily activities impact the knee joint and the cartilage inside, can help inform personalized exercise advice and new strategies for joint protection. In the long term, integrating this work with biological research could transform knee health, leading to more effective treatments and prevention strategies. By understanding knee cartilage stress in such detail, we are moving closer to a future where joint injuries can be predicted and prevented, keeping people active and pain-free longer.

Sabrina Hörmann is a PhD Student at Technical University Delft

Have you ever heard someone complaining about knee pain during long walks? If so, keep reading we want to help these people with our research. Knee pain is often caused by osteoarthritis, a condition in which the cartilage in the joint wears down over time. Around 654 million people worldwide suffered from knee osteoarthritis in 2020. Unfortunately, there is no cure yet.

Staying active, Easing pain
In the later stages of osteoarthritis, patients live with constant pain, and even everyday activities become a struggle. For these cases, replacing the knee joint with an artificial implant is often the only option to restore movement. However, surgery is not without risks, and the lifespan of the knee implant is limited. That’s why doctors first recommend conservative treatments like physiotherapy. They encourage their patients to stay active since the right movement is assumed to slow down the disease progression.
The Big Question
But which activities, and at what intensity, work best for each patient? That’s the big question we still need to answer. That’s where our research comes in.

Estimating the Knee Joint Forces
My role within the project is to determine the forces acting on the knee joint during different activities, like walking, running, and cycling. This is challenging because no direct method exists to measure the loads on the patient’s knee joint. For this reason, I will use an advanced simulation model to estimate the knee joint forces. However, one model cannot represent every patient. Just look at the people around you – everyone has a different body. I want to understand which patient-specific parameters highly impact the knee joint load. For example, one key factor is which muscles the patient uses to walk. This can vary significantly from person to person. By accounting for patient-specific differences, we can more accurately estimate the forces acting on the knee joint.

Tailored Movement Advice
Finally, our research will allow us to understand how much load the knee joint experiences for each patient during various activities. This insight will help us to give patients tailored movement advice, bringing us one step closer to the goal of helping osteoarthritis patients walk pain-free again.
Relation Between Osteoarthritis and Injury
Osteoarthritis (OA) is a very common, painful, and disabling joint disease. Despite the fact that many people suffer from OA, there is not yet a drug that can prevent or slow down the disease. OA often develops due to aging, but genetics and how we load our joints also play a big role. Our research aim is to investigate why some people develop OA after heavy use or injury, while other people don’t. In other words: we are studying how genetic differences affect the cartilage cell behavior upon stress and injury. Better understanding of this underlying process could eventually lead to the identification of new druggable targets.

Genetic Differences in Osteoarthritis
In this study, we focus on a special type of DNA changes called high-impact mutations – mutations found to play a causal role in the development of OA. We investigate how these mutations affect the way cartilage cells respond to mechanical overloading, such as injury.

Stem Cell Technology to Study Cartilage
For a deep dive into cartilage cell behavior, we use stem cell technology. This means that we use a special type of stem cells, so-called human induced pluripotent stem cells (hiPSCs), to make little cartilage constructs. We can introduce the high-impact mutations to these hiPSCs by applying a technology that is called CRISPR-Cas9. In this way, we can create and compare cartilage constructs with and without these special mutations.

Testing the Impact of Mechanical Loading
To test the impact of mechanical loading, we use a device that applies a damaging pressure to the cartilage constructs, mimicking an injury. We compare the cartilage constructs with and without the mutation to see if the cells respond different to mechanical overloading. In other words: do some mutations make it harder for the cartilage to repair itself? Does one version of a gene protect against damage while another makes it worse?

Tailored treatments
Our goal is to unlock new insights into how OA develops and identify potential drug targets that could slow down or even prevent OA. With better understanding of the genetic and mechanical triggers, future treatments can be more precise and tailored to each person’s unique biology – helping people stay active and pain-free for longer.
Picture yourself, a 50-year-old man or woman, living an active life. You have a nice, but busy job, and a nice family to take care of. So, to stay in shape you go for a run/walk/workout three times a week. You have been active all your life, and you love running. However, over the past few weeks, you haven’t been able to run. Your left knee hurts, it’s swollen, and it feels a bit unstable. After a few days, you decide to visit your general practitioner. He tells you that your symptoms are caused by knee osteoarthritis and that it might be better not to run for a while. When you ask him how long you should wait or if it would be okay to go cycling with your friends, he replies: “Sorry, I don’t know.” This is already a very realistic situation for over one and a half million people in the Netherlands and might be for you as well one day, since the amount people suffering from knee osteoarthritis will increase rapidly over the next few years. The biggest problem is that there is no cure for osteoarthritis. Scientific evidence suggests that staying physically active may help reduce symptoms, but the best way to do so and the optimal amount of activity remain unclear.
Therefore, we set up the LoaD-study. In this study, we will track 332 physically active individuals with knee osteoarthritis. Hikers, runners, cyclists, and tennis players will be followed for two years to see how their physical activity impacts their knee OA. At the start of the study, participants will undergo an MRI scan of their most painful knee and complete questionnaires about their knee complaints, lifestyle, and work. Over the next two years, participants will track their physical activity (hiking, running, cycling, or tennis) using a wearable device, such as a smartwatch or smartphone. Furthermore, they will report their knee complaints through monthly questionnaires.
After two years, the MRI and questionnaires will be repeated. With all that collected data, we hope to find out how people with knee osteoarthritis can stay physically active. So, when the time comes that your general practitioner really does get that question, he will be able to provide you with solid advice on when you can run with your friends again.

Osteoarthritis (OA) is a condition that makes everyday movements-like walking, sitting, or climbing stairs-painful and difficult, especially older adults. For millions of people, this pain only gets worse over time, making it harder to stay active and independent. A key part of the problem is the extra stress placed on the knee joint. My research is focused on developing a simple solution to measure this stress to help manage this condition. 

I’m working with a wearable system that uses small sensors and special shoe insoles to measure how people move and how much weight they put on their feet. This information helps us understand the strain on the knee during normal activities like walking around the house. Right now, doctors use complicated and expensive tests to measure this kind of knee pressure. My goal is to create something affordable and simple-something you can use at home, like putting on a pair of shoes. This system could make it much easier for doctors and patients to monitor knee stress, without needing hospital visits or high-tech equipment. 

I am conducting my research at the University of Twente, in a space called the eHealth House. This space looks like a regular home. Here I can test my system in real-life settings. People can move here naturally, just as they would in their daily lives, giving us more realistic results. My hope is that this tool will help doctors provide better care that’s customized for each patient and give people with OA a better understanding of how to manage their condition. As more people live longer and aim to stay active later in life, the need to slow down the progress of osteoarthritis is becoming more important. By monitoring knee pressure early, we may even be able to reduce the need for surgeries like knee replacements. 

My goal is helping people with osteoarthritis lead more comfortable, independent lives with a solution that’s easy to use and affordable.

Most widespread disease
Knee osteoarthritis (OA) is a long-term condition that causes pain and limits movement, leading to reduced physical ability and quality of life. As the world’s elderly population grows, along with rising rates of obesity, OA is becoming an increasingly urgent health issue. By 2040, it may become the most widespread chronic disease in the Netherlands. Despite its prevalence, we still lack a complete understanding of how OA symptoms change throughout the day, which makes it harder to manage effectively. Our goal in this study is to create a system that can monitor OA symptoms in everyday life. This system will use various types of sensors to gather information, allowing us to understand each person’s condition and offer personalized support. Ultimately, the information gathered can be used for digital coaching, human support, or even smart devices like special stockings to help manage OA symptoms.

Study Design
This study is observational, meaning we watch and gather information without making any changes to participants’ normal routines. Participants will carry out their regular physical activities for about two hours either at home or at a specially designed simulated home environment called the “eHealth House” at the University of Twente. Study Design This study is observational, meaning we watch and gather information without making any changes to participants’ normal routines. Participants will carry out their regular physical activities for about two hours either at home or at a specially designed simulated home environment called the “eHealth House” at the University of Twente.

Who Will Be Involved?
We are working with active eldly individuals—those who enjoyed running, cycling, tennis, and hiking—who experience knee OA. By focusing on these groups, we aim to gain deeper insights into healthy and optimal joint loading that can help prevent or reduce OA symptoms, benefiting a broader population in the long run. Participants will be recruited based on a larger, ongoing study, and those already involved will be invited to join this smaller study.

How We Collect Information
Data collection for each participant will take about 3.5 hours. We will gather both subjective (selfreported) and objective (sensor-measured) information. At the start of the session, participants will fill out questionnaires about their knee symptoms, pain levels, quality of life, and other health aspects. These questionnaires will be used to track changes in symptoms and provide additional context to the sensor data. Participants will then perform regular activities for two hours. These activities include getting up from a chair, walking around, climbing stairs, and other daily tasks, as well as specific exercises for their subgroup, such as running or cycling. We will collect both subjective data from questionnaires and objective data from wearable sensors. The sensors will track physical movements such as walking, standing, and climbing stairs. By analyzing these movements, we hope to uncover patterns in how different activities affect OA symptoms, helping us develop personalized management strategies for individuals.

Why Is This Important?
Our goal in this study is to develop a system that monitors OA symptoms continuously throughout daily activities, offering insights that can lead to personalized treatment and intervention options. Ultimately, we aim to use this data to improve the management and quality of life for individuals living with OA.