Arthritis Treatment: Knee Osteoarthritis And The Epidemic Of Knee Replacements - Part 2

Osteoarthritis (OA) is the most common form of arthritis affecting more than twenty million Americans.

OA is a disease of articular cartilage, the gristle that caps the ends of long bones. Articular cartilage is responsible for withstanding the usual loads that accompany the activities of daily living. Cartilage acts as a shock absorber. It will partially deform but springs back to its normal shape under normal circumstances. It also provides a gliding surface which is enhanced by a small amount of synovial fluid, produced by the joint lining that acts as a lubricant.

Osteoarthritis is essentially a wear and tear disease of cartilage. It arises as a result of the lack of ability of cartilage to keep up with excessive breakdown.

Current forms of treatment for this condition are inadequate.

While advising a patient who is heavy to lose weight and exercise is admirable and necessary, it is an admonition that is usually ignored.

In addition, other measures such as analgesic medications (pain killers), non-steroidal anti-inflammatory drugs, physical therapy, bracers, and injections of glucocorticoids and viscosupplements provide only temporary and palliative relief.

Ultimately, patients will go on to get knee replacements.

In a recent report, Madonna Behan writing for Healthday reported, "The number of new-knee procedures doubled over the last decade, reached more than 620,000 in 2009, and the researchers said younger patients -- those 45 to 64 -- accounted for a disproportionate amount of that growth. In addition, researchers "estimate that nearly 53 percent of men and 52 percent of women diagnosed with symptomatic knee [osteoarthritis] will receive a total knee replacement in their lifetimes."

Knee replacement surgery is not an innocuous procedure with the potential for complications such as infection, excessive bleeding, blood clots, worsening pain after the procedure, nerve damage, and death.

So what else can be done? Attempts to find a pharmacologic solution, so-called disease modifying anti-osteoarthritis drugs (DMOADS) have been disappointing at best.

The most promising new development is the use of autologous mesenchymal stem cells. These are adult stem cells found within many areas of the body including the bone marrow, fat, deciduous teeth, and periosteum of bone.

Anecdotal reports and small uncontrolled studies in both animal models as well as humans appear promising as a method for slowing down the rate of cartilage loss in knee OA and possibly even allowing for cartilage regeneration.

(Wei N, Beard S, Delauter S, Bitner C, Gillis R, Rau L, Miller C, Clark T. Guided Mesenchymal Stem Cell Layering Technique for Treatment of Osteoarthritis of the Knee. J Applied Res. 2011; 11: 44-48)