Stem Cells and Arthritis: Fact or Folly
Osteoarthritis (OA) of the knee is one of the most prevalent diseases in the United States, and is a common condition associated with pain and significantly impaired quality of life (1).In addition to aging, an increase in sporting and physical activity across all age groups has contributed to an increased incidence of articular cartilage pathology (2).Although OA is becoming a more widespread problem, there remains a lack of recommended non-surgical treatment options. A variety of oral medications are currently available which appear to be effective in the early disease stages, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). However, these do not prevent or reverse the underlying cartilage damage nor do they provide lasting effects. Other options include injection therapies, which are usually reserved for patients not responding to oral medications. One popular choice of injection that has been widely used for the management of symptomatic knee OA is corticosteroids. Despite their popularity, they have limited proven longterm effectiveness and can have adverse reactions for the patient (3).Additionally, if changes in activity level, weight loss, pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and corticosteroid injections become ineffective viscosupplementation injections with hyaluronic acid maybe an option. The most recent research, however, has not found viscosupplementation to be effective at significantly reducing pain or improving function. Although some patients report pain relief with the procedure, some people are not helped by the injections.
Currently, various efforts to regenerate articular cartilage are being investigated, including cell therapy and tissue engineering. Developments in biologic research have highlighted the importance of growth factors in maintenance of normal tissue structure and tissue lesion repair. Advances in the field of tissue engineering have promoted a new age of injectable therapies called biologics that may suppress inflammation and promote regenerative pathways. Biologics refer to natural products that are harvested and used to supplement a medical process and/or the biology of healing. While these may hold promise for the treatment of knee OA, more high quality and consistent studies are necessary. The three main categories of therapy currently are growth factors (contained in commercial available platelet rich plasma products), cells (mesenchymal stem cells derived from bone marrow and adipose tissue); and amniotic/placental-derived tissues. Research is currently being performed to determine whether these treatments are effective. Unfortunately, biologic therapies continue to not be covered by insurance companies. Regardless, these alternative therapies can be considered when traditional first line treatments as described above fail. PRP appears to have some longer lasting benefits compared to traditional cortisone and lubricant injections.
- Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58(1):26-35.
- Gormeli G, Gormeli CA, Ataoglu B, Colak C, Aslanturk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2015.
- MacMahon PJ, Eustace SJ, Kavanagh EC. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. Radiology. 2009;252(3):647-61.
- David Jevsevar M, MBA, Chair, Gregory Alexander Brown M, PhD, Co-Chair, Dina L. Jones P, PhD, Elizabeth G. Matzin M, Paul Manner M, FRCSC, Pekka Mooar M, et al. Treatment of Osteoarthritis of the Knee (2nd edition) 2013 [Available from: http://www.orthoguidelines.org/topic?id=1005.
- Hall MP, Band PA, Meislin RJ, Jazrawi LM, Cardone DA. Platelet-rich plasma: current concepts and application in sports medicine. J Am Acad Orthop Surg. 2009;17(10):602-8.