About 27 million Americans have osteoarthritis (OA), a chronic condition that causes joint cartilage to break down and wear away resulting in decreased mobility, pain and stiffness. [1] Cartilage is a slippery tissue that prevents friction between the ends of bones that comprise joints. In OA, cartilage begins to break down and become rough, increasing friction and resulting in pain and inflammation. Eventually, the cartilage may wear away completely, leaving bones to rub against each other. OA can occur in any joint, but most commonly affects the knees, hips, hands and spine. The disease becomes worse over time, and to date, there is no cure.[2]

WHAT ARE THE SYMPTOMS?

Osteoarthritis tends to develop slowly, beginning as stiffness or mild pain in the joint, especially after overuse or prolonged inactivity. At the very start of the disease, stiffness and discomfort usually resolve once the joint is used. But over time, these symptoms worsen and the joint may become swollen and inflamed. Pain can also increase in the evening after the day’s activities have taken their toll on joints that are already compromised.

In addition to joint stiffness and pain, other symptoms associated with OA include joint tenderness, loss of flexibility in the joint and a grating or grinding sensation in the joint during movement. Eventually, repeated wear and tear can cause bone spur formation, which can result in additional discomfort.

Some people experience only the earlier, milder signs of OA, while others go on to develop severe symptoms that can become debilitating, making it difficult to complete everyday tasks like walking, climbing stairs or even sleeping comfortably. [3]:

TRADITIONAL MANAGEMENT

Since there is no cure for osteoarthritis, management is aimed at relieving symptoms through medication, physical therapy, lifestyle changes and, when necessary, surgery.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are most commonly used to help relieve both pain and inflammation. Over-the-counter products are the first line of defense, although stronger NSAIDs are available by prescription. Long-term use of NSAIDs can cause upset stomach, liver and kidney damage, cardiovascular problems or bleeding problems. Topical NSAIDs may also be used and may cause fewer side effects.

When NSAIDs don’t provide enough relief, joint injections may help, using either corticosteroids to relieve inflammation or lubricating solutions designed to facilitate pain-free movement may help.

Both physical and occupational therapies can help maintain strength, flexibility and mobility while teaching you ways to perform everyday tasks that don’t exacerbate pain or inflammation. An occupational therapist may also be able to recommend assistive or adaptive devices to make tasks more comfortable, or show you how to use self-massage or heat and cold therapies to relieve symptoms.

Lifestyle changes, including losing weight, adopting a healthy diet and getting regular exercise, can help relieve physical symptoms as well as stress, anxiety and depression. Many patients find it helpful to join a chronic pain support group.[4]

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STEM CELL THERAPY FOR OSTEOARTHRITIS

While traditional approaches can provide some relief in many patients, many others will go on to develop debilitating joint pain and mobility issues that no longer respond to medications and therapy. For these men and women, stem cell therapy may be helpful. Studies evaluating the use of stem cells for osteoarthritis management rely on the use of mesenchymal stem cells, adult stem cells derived from bone marrow or fat (adipose tissue). Like embryonic stem cells, mesenchymal cells are able to differentiate – or transform – into many different types of cells, including cartilage and bone, both in the lab (in vitro) and in living hosts (in vivo).

Because osteoarthritis causes cartilage to break down, the goal of stem cell management is to replace damaged cartilage early in the disease cycle, obviating the need for joint replacement. The use of stem cells is proposed to eliminate potential damage to the articular surface of a donor site and makes cartilage repair possible even in patients where adequate donor cartilage is not available.[5]

The use of stem cells for the management of osteoarthritis involves injecting the cells directly into the affected joints where they can act to stimulate healing and, ideally, grow or differentiate into damaged cartilage. Stem cells’ anti-inflammatory properties also may work directly to prevent the inflammatory cascade that plays a major role in osteoarthritic joints; by reducing inflammation in the joint lining (synovium), stem cells can derail the process of joint destruction that occurs in the disease.[6]

Randomized controlled trials suggest that mild to moderate osteoarthritis may benefit from stem cell therapy and suggests that the more stem cells the better the result.

Suggested References:

  1. Osteoarthritis. National Arthritis Foundation.
  2. Osteoarthritis. Mayo Clinic.
  3. Osteoarthritis Symptoms. Mayo Clinic..
  4. Osteoarthritis Treatments and Drugs Mayo Clinic..
  5. Nöth, U, Steinert, AF, Tuan, RS. Technology Insight: adult mesenchymal stem cells for osteoarthritis therapy. Nature Clinical Practice Rheumatology. 2008. doi:10.1038/ncprheum0816.
  6. Lent, PLV, Berg, WBVD. Mesenchymal stem cell therapy in osteoarthritis: advanced tissue repair or intervention with smouldering synovial activation?. Arthritis Research & Therapy. 2013;15(2):112. doi:10.1186/ar4190.

Therapeutic application of mesenchymal stem cells in osteoarthritis.

Ruiz M, Cosenza S, Maumus M, Jorgensen C, Noël D.

Expert Opin Biol Ther. 2016;16(1):33-42. doi: 10.1517/14712598.2016.1093108. Review.

Adipose Mesenchymal Stromal Cell-Based Therapy for Severe Osteoarthritis of the Knee: A Phase I Dose-Escalation Trial.

Pers YM, Rackwitz L, Ferreira R, Pullig O, Delfour C, Barry F, Sensebe L, Casteilla L, Fleury S, Bourin P, Noël D, Canovas F, Cyteval C, Lisignoli G, Schrauth J, Haddad D, Domergue S, Noeth U, Jorgensen C; ADIPOA Consortium..

Stem Cells Transl Med. 2016 Jul;5(7):847-56. doi: 10.5966/sctm.2015-0245.

Adipose derived mesenchymal stem cell therapy in the treatment of isolated knee chondral lesions: design of a randomised controlled pilot study comparing arthroscopic microfracture versus arthroscopic microfracture combined with postoperative mesenchymal stem cell injections.

Freitag J, Ford J, Bates D, Boyd R, Hahne A, Wang Y, Cicuttini F, Huguenin L, Norsworthy C, Shah K.

BMJ Open. 2015 Dec 18;5(12):e009332. doi: 10.1136/bmjopen-2015-009332.

Adipose-Derived Mesenchymal Stem Cells With Microfracture Versus Microfracture Alone: 2-Year Follow-up of a Prospective Randomized Trial.

Koh YG, Kwon OR, Kim YS, Choi YJ, Tak DH.

Arthroscopy. 2016 Jan;32(1):97-109. doi: 10.1016/j.arthro.2015.09.010.

Mesenchymal stem cell therapy for knee osteoarthritis: 5 years follow-up of three patients.

Davatchi F, Sadeghi Abdollahi B, Mohyeddin M, Nikbin B.

Int J Rheum Dis. 2016 Mar;19(3):219-25. doi: 10.1111/1756-185X.12670

Treatment of Knee Osteoarthritis With Allogeneic Bone Marrow Mesenchymal Stem Cells: A Randomized Controlled Trial.

Vega A, Martín-Ferrero MA, Del Canto F, Alberca M, García V, Munar A, Orozco L, Soler R, Fuertes JJ, Huguet M, Sánchez A, García-Sancho J.

Transplantation. 2015 Aug;99(8):1681-90. doi: 10.1097/TP.0000000000000678.

Intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritis of the knee: a proof-of-concept clinical trial.

Jo CH, Lee YG, Shin WH, Kim H, Chai JW, Jeong EC, Kim JE, Shim H, Shin JS, Shin IS, Ra JC, Oh S, Yoon KS.

Stem Cells. 2014 May;32(5):1254-66. doi: 10.1002/stem.1634.

Treatment of knee osteoarthritis with autologous mesenchymal stem cells: a pilot study.

Orozco L, Munar A, Soler R, Alberca M, Soler F, Huguet M, Sentís J, Sánchez A, García-Sancho J.

Transplantation. 2013 Jun 27;95(12):1535-41. doi: 10.1097/TP.0b013e318291a2da.

Disclaimer:
Actual results may vary. The statements are not intended to imply that the results would be the same or similar for each patient. Each patient is unique and no particular result or outcome can be predicted or guaranteed. The statements in this website have not been evaluated by the Food and Drug Administration. Some of these procedures may be considered experimental. These procedures are not intended to diagnose, treat, cure or prevent any disease. The use of stem cells is not approved by the Food and Drug Administration to combat aging or to prevent, treat, cure or mitigate any disease or medical condition mentioned, cited or described in this website. The science of treatment with stem cells is in its early stages and stem cell treatments are not considered to be the standard of care for any medical condition, ailment, illness or disease. There could be significant and unknown risks associated with stem cell treatments, as long-term studies have not been performed.