Arthritis Treatment

In the early part of December, the Vatican issued a pronouncement, again condemning the use of embryonic stem cells for medical research and medical treatment.

While this proclamation will hinder the development of some therapies in medicine, it should not be a major stumbling block in the management of osteoarthritis.

The reason?

Current approaches using stem cells for osteoarthritis are able to make use of autologous stem cells. These are stem cells obtained from the iliac crest (hip) of the patient using a special biopsy needle.

Stem cells are located within the bone marrow. The iliac crest is an ideal site for harvesting bone marrow. Since the procedure is done using local anesthetic, the risks of the procedure are minimal.

Autologous stem cells have the ability to differentiate into other tissue cells. Previously, it was felt this trait was not possible for adult stem cells; however, it has been confirmed that stem cells harvested from an adult are capable of differentiation.

Once the stem cells are harvested, they are concentrated using a special technique. In addition, platelet rich plasma which is derived from a patients whole blood is also obtained. Platelets are cells that contain numerous growth and healing properties. These growth factors have the ability to fire off tyrosine kinase receptors on the surface of stem cells and accelerate differentiation and multiplication.

The knee (or hip) is then prepared by irritating the cartilage using a special biopsy needle. After this, stem cells and platelet rich plasma are introduced into the joint.

Calcium chloride and thrombin are also used to create a scaffold for the stem cells to locate themselves.

Diagnostic ultrasound is used throughout to ensure the proper location for harvesting the stem cells as well as the best location for introducing the stem cells into the target joint. The use of ultrasound is mandatory for proper anatomic placement!

So who might be a candidate for this procedure?

First, its important to realize that a patient must have some cartilage remaining in the knee for stem cells to do their job.

Osteoarthritis is currently graded in clinical trials using standing knee x-rays to quantify the amount of cartilage present within the knee.

The Kellgren-Lawrence classification is used. Grade 1 means the amount of cartilage is relatively normal. Stage 4 means that the patient is bone on bone. Patients who are Kellgren- Lawrence stage 4 are not considered candidates for stem cell treatment. Patients who are grades 1-3 are acceptable.

Patients who are grade 3 must be at or near ideal weight.

Age also plays a role. It appears that as people get older, their stem cells respond less to stem cell stimulation. At our center, we generally use 75 as the cutoff. Even then the patient must be vigorous and active.

The ideal patient is between the ages of 30-70 and is at or near ideal weight. Healthy Baby Boomers who are athletic and active are felt to be the best candidates.

What measures are assessed?

We are currently evaluating both subjective as well as objective parameters. These include a visual analogue scale of pain, a Health Assessment Questionnaire (WOMAC), 50 foot walking time, knee x-rays done using special angulation to allow precise measurements of cartilage thickness, and ultrasound measurements of cartilage thickness.

The length of recovery is highly variable depending on factors such as age, general physical condition, Kellgren-Lawrence stage, and amount of irritation required to prepare the cartilage.

For more information regarding stem cells for osteoarthritis, call the Arthritis and Osteoporosis Center of Maryland at (301) 694-5800.

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Osteoarthritis (OA) is a joint disease which causes the cartilage to breakdown. Cartilage is a smooth shiny material that covers joints allowing them to glide easily as you move. It is a type of resilient connective tissue that covers and protects the ends of bones in joints. Although, OA can affect any joint in the body it more frequently affects the hips, knees, hands, feet and spine.

Arthritis is the leading cause of disability in Canada. OA is the most common form of arthritis. It affects one out of every ten people in this country. Statistics show that men and women are affected in equal numbers. OA usually occurs after the age of 45, but it can occur earlier in life.

Causes of Osteoarthritis

As you move or put pressure on a joint, cartilage allows bones to slide over one another and acts as a shock absorber. Cartilage itself does not have any nerve cells and therefore cannot sense pain. OA results when the cartilage becomes worn out, allowing the bones underneath to rub against each other causing pain and swelling. As the condition progresses, the joint may become disfigured and small growths called osteophytes begin to grow inside the joints. Osteophytes are small, irregular, bony growths that are also called bone spurs. Bits of broken-off cartilage or bone are also found floating inside the joint. This causes even more pain, swelling and immobility of the joint.

The exact cause of these changes is unknown. Scientists believe that the following factors play a role:

increasing age: The cartilage wears down with time

family genes: Scientists believe that osteoarthritis may be passed on through families with the symptoms appearing in middle age.

being overweight: Excess weight puts stress on the weight-bearing joints such as hips and knees, and increases the risk of cartilage breakdown

Osteoarthritis Symptoms

The symptoms of osteoarthritis usually come on slowly. Joint pain, often described as a deep ache, is the most common symptom [Table 1]. Early in the disease, the pain does not usually last longer than a couple of hours. It may occur only after physical work or exercise. The pain subsides once you rest the joint. Occasionally, pain caused by osteoarthritis occurs someplace other than in the affected jointa condition known as referred pain. For example, people with osteoarthritis of the neck often experience referred pain in the shoulder.

Pain or stiffness

The warning symptoms include steady or intermittent pain that usually worsens with activity in a joint, stiffness after getting out of bed, joint swelling or tenderness in one or more joints and a ‘crunching’ feeling or sound of bone rubbing on bone.

Aches and pains

Osteoarthritis develops slowly. Early in the disease, joints may ache after physical work or exercise. Osteoarthritis can occur in any joint, but most often occurs at the ends of the fingers, thumbs, neck, lower back, knees and hips.

Treatment

The goals of treatment are to relieve pain, maintain or improve joint movement, increase the strength of the joints, and reduce the disabling affects of the disease. The treatment depends on which joints are involved.

MEDICATIONS

The most common medications used to treat osteoarthritis are nonsteroidal anti-inflammatory drugs (NSAIDs). They are pain relievers that reduce pain and swelling. Types include aspirin, ibuprofen, and naproxen.

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Osteoarthritis, also known as degenerative arthritis or degenerative joint disease, is the most common joint disorder and has unknown causes. It is a condition that is usually seen in older people, in their larger, weight-bearing joints, such as the hips, knees, and spine. It can also affect the hands and feet, or other joints.

The smooth cartilage lining of a joint begins to flake and crack through age and general wear and tear. As the cartilage deteriorates, the underlying bone can become thickened and distorted. This can make moving the joint so painful and restricted that the associated muscles are used much less. This leads to the degeneration of the unused muscles.

Symptoms

Pain, swelling, and stiffness can occur at intervals of months or years. Although osteoarthritis often affects several joints, it rarely causes symptoms in more than one or two joints at a time. Pain may gradually become so sever that it disturbs sleep and limits everyday activities.

Swelling can vary from being hardly noticeable to making the joint appear extremely knobby and enlarged. The pain from osteoarthritis can be felt directly in the affected joint, or indirectly. That is, the pain may transmit to other parts of the body in what is known as referred pain. For example, the front of the thigh or knee may be very painful for someone with osteoarthritis in the hip.

Risks

X-rays show some degree of osteoarthritis in most people over 40, whether they have symptoms or not. There are no life-threatening risks and it seldom becomes a serious problem. Certain occupations and sports are more often associated with the development of osteoarthritis, such as ballet or football.

Treatment

There are self-help treatments to help with the pain symptoms of osteoarthritis. If a person is overweight, losing weight can help release some of the strain on weight-bearing joints. Resting frequently or using a cane can help ease pain. Heat is often an easy self-help treatment for joint pain.

Most importantly, regular exercise prevents the muscles around the affected joints from becoming weak and minimizes symptoms. Physical therapy including exercise, massage and heat treatments are often recommended. Aspirin or ibuprofen can help relieve pain, but a doctor can prescribe another painkiller.

For severe pain, an injection of a corticosteroid drug into the joint can help. However, if it is used too often it can be damaging. Joint replacement through surgery can also be common.

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