Arthritis Treatment: What Is Needed For Successful Osteoarthritis Treatment?

Arthritis is the most common cause of disability in the United States. It is also one of the most common causes of physician visits.

One major misconception is that there is just one type of arthritis. Not so.

There are more than 100 different kinds of arthritis. The most common remains osteoarthritis which affects between 28 million and forty million people in the U.S., depending on the source.

Osteoarthritis is a disease of articular cartilage, the gristle that caps the ends of long bones. There are two major types of cartilage. The "gristle" is also known as hyaline cartilage. It is responsible for cushioning, gliding, and shock absorption.

The other kind of cartilage, called fibrocartilage, also helps protect from compressive forces but is somewhat weaker. An example of fibrocartilage is the meniscus material found in the knee.

Osteoarthritis occurs as a result of cartilage degeneration. The development of osteoarthritis is a complex interplay of various factors including genetic predisposition, injury, and local inflammation.

Since cartilage does not have nerves or blood vessels, healing of cartilage injury is problematic.
To date, most of the therapies aimed at treating osteoarthritis have been essentially palliative, pain relief only.

The Holy Grail of cartilage treatment would be to find treatments that aid in symptom relief and which also slow down or reverse cartilage damage.

A variety of treatments have been used with dismal results.

Only recently have there been attempts to heal cartilage injury using a variety of techniques such as mosaicplasty, chondrocyte (cartilage cell) transplantation, and microfracture.

These procedures may be useful for small discrete lesions but apparently are not effective for the treatment of osteoarthritis.

Promising reports describing the use of autologous stem cells (a patient's own stem cells) have been published.

Upon closer scrutiny though, these various attempts at inducing cartilage healing with SCs have met with mixed results. The results appear to be highly dependent upon the following factors: age of the patient, body mass index (BMI), extent of cartilage loss, degree of anatomic deformity, and the technical expertise of the center performing the procedure.

Age appears to be a factor due to the decline in qualitative response of stem cells. They don't appear to multiply or divide as quickly as younger cells.

Weight is a key factor for obvious reasons. The more load on the joint, the less likely osteoarthritis will respond to most treatments. Encouraging reports from a Swedish study has demonstrated that load reduction of the weight-bearing compartment of the knee can lead to cartilage healing. Following a stem cell procedure, it is critical to unload the joint.

Significant anatomic deformity can probably not be overcome. Also, complete cartilage loss is another reason to pass on stem cell treatment.

The last factor is probably the most important in that an effective procedure involves more than just injecting stem cells. Each patient has a different set of issues with a difference in terms of anatomic problem, procedural approach, and so on.

Ultrasound guidance is critical to assessing the correct approach. In addition, it may be that more direction using arthroscopy can also be helpful.