| irst treatments for osteoarthritis, better known as | | | | on. |
| “rheumatism” in the old days were | | | | Scientists have tried to develop disease modifying |
| balms which consisted of menthol and other herbal | | | | osteoarthritis drugs (DMOADS). However, clinical |
| concoctions. These were applied topically and helped | | | | experience using drugs such as diacerin, tetracycline |
| soothe some of the aches and pains. | | | | derivatives, hydroxychloroquine and the like have been |
| Variations probably included immersion in hot springs, | | | | disappointing. |
| mineral baths, or other forms of hydrotherapy. | | | | The end result of our inability to find treatments that will |
| In the Far East acupuncture was being used to | | | | slow down and reverse cartilage loss, has been the |
| alleviate rheumatic symptoms. | | | | explosion in the number of joint replacement surgeries |
| Some authorities state that around 500 BC, willow | | | | performed annually. |
| bark was discovered as having pain relieving | | | | While joint replacement surgery for osteoarthritis of |
| properties. It wasn’t until 1897 when Felix | | | | the hip and knee is generally effective, almost 30 |
| Hoffman, an employee of Bayer Company, isolated | | | | percent of patients have a complication of some |
| the active ingredient, acetylsalicylic acid… better | | | | type… most are minor but some are major |
| known as aspirin. | | | | including blood clots to the lungs, infection, and |
| In the late 1940’s and early 1950’s | | | | unexpected death. After all, it is major surgery. |
| cortisone was discovered and used in arthritis patients. | | | | The use of cartilage cell transplants, microfracture |
| Other non-steroidal-anti-inflammatory drugs were | | | | surgery, and mosaicplasty (cartilage plug surgery) have |
| developed with the idea that they could be an | | | | met with mixed reviews… successful for some |
| improvement upon aspirin in both efficacy as well as | | | | athletes but uniformly disappointing in patients with |
| safety. | | | | osteoarthritis, |
| In the late 20th century, viscosupplements began to be | | | | So what can be done? |
| used extensively for osteoarthritis of the knee. | | | | In recent years, there has been increasing interest in |
| More recently, nutritional supplements such as | | | | the use of tissue regenerative techniques incorporating |
| glucosamine and chondroitin have been scrutinized. | | | | platelet-rich plasma (PRP) as well as autologous (a |
| So what to do all these remedies have in common. | | | | patient’s own) stem cells. While anecdotal |
| Basically, they are used for symptom control. Now | | | | reports have been encouraging, there have been no |
| there’s nothing wrong with controlling | | | | double-blind-randomized controlled clinical trials. |
| symptoms since symptoms are what bring arthritis | | | | Fortunately, attempts at measuring efficacy are being |
| patients to the physician. | | | | conducted at our center and we hope to have early |
| However, treating symptoms does not have any | | | | data available shortly. |
| effect on the underlying disease process. | | | | The major question that needs to be answered is not |
| Osteoarthritis is a condition that is due to the gradual | | | | whether the use of autologous stem stems cells |
| wearing away of articular cartilage, the | | | | work- they appear to be effective short term… |
| “gristle’ that caps the ends of long | | | | but the length of time one can expect them to be |
| bones. It is the end result of a biomechanical process | | | | effective and what the length of time a procedure |
| that involves local inflammation as well as the | | | | should expected to last. This is another parameter we |
| production of protein messengers that cause the | | | | are measuring. |
| hyperproduction of destructive enzymes. | | | | Other questions...Which method is best for delivering |
| The pain of osteoarthritis is due to factors other than | | | | the stem cells? What is the best framework material |
| cartilage damage since cartilage itself has no nerve | | | | should be used? Only through careful scientific scrutiny |
| fibers. Theories include the irritation of the joint capsule, | | | | can we be assured that stem cell procedures have |
| mechanical stretching of ligaments and tendons, and so | | | | lasting benefits. |