Osteoarthritis
Osteoarthritis is a degenerative condition which involves slow progressive deterioration of the cartilage lining the joints (articular cartilage). This is concurrent with changes to the synovial lining of the joint and the bone underneath the articular cartilage. It also includes structural deterioration of the ligaments and menisci (the disc shaped cartilages commonly torn in football injuries). The joint capsule also thickens.
There is often inflammation and pro-inflammatory cytokine (chemicals which attract inflammatory cells) production with activation of an enzyme that results in degradation of the cartilage cells.
Osteoarthritis may be determined by an inherited genetic tendency, advancing years and bodyweight along with trauma. The trauma can be repetitive or due to an accident or sporting injury. The results of these traumas result in joint laxity and/or malalignment. Other factors can also contribute to degeneration of most joints in the body.
Treatment of osteoarthritis
Treatment of osteoarthritis can include non-steroidal anti-inflammatory pain medication, exercise, rest, weight reduction and cortisone injections. Other options include injection of a ‘visco-supplement’ such as hyaluronic acid which acts as a lubricant. These injections are often carried out in association with an intensive physical therapy, muscle strengthening and rehabilitation program along with the occasional use of support bracing or taping.
These treatments can be palliative and provide symptomatic relief. Other treatments such as platelet rich plasma (PRP) and dextrose prolotherapy are ‘regenerative’ and can address the instability and ligament damage which is the likely cause of subsequent destruction of other tissues within the joint.
Surgical treatments include grafting the articular cartilage, microfracture or chondrocyte implantation. However these techniques are often limited to small areas of degenerative cartilage. They also appear to have limited long-term effect on the treatment of osteoarthritis.
The ultimate surgical approach is joint replacement or resurfacing which is a more significant intervention and its requirement can be significantly delayed by use of the less interventional injection treatments described above.
Regenerative medicine/Prolotherapy/PRP treatments
‘Regenerative’ or ‘prolotherapy’ treatments include injections of hypertonic dextrose, platelet rich plasma (PRP), ‘autologous blood’, mesenchymal stem cells or ‘gold induced’ cytokines.
‘Adipose derived stem cells’ ( a source of mesenchymal stem cells) are aspirated from body fat and express a variety of growth factors and cytokines recruiting other stem cells to facilitate repair in the affected joints.
Platelet rich plasma (PRP) is obtained from centrifugation of whole blood followed by separation of the platelet rich part of the plasma. This is then injected into the affected joint. Platelet rich plasma is a rich source of growth factors released by the platelets and which include ‘platelet-derived growth factor’, ‘fibroblast growth factor’, ‘transforming growth factor’ and various ‘interleukins’ which contribute to optimisation of stem cell function.
Growth factors from platelets can also regulate and enhance the production of hyaluronic acid (HA) which is a major component of synovial fluid. This acts as a lubricant within the joint and can protect the articular cartilage lining the joint whilst having several other beneficial effects on the degenerative joint process.
‘Dextrose prolotherapy’ acts to enhance the stability of the joint since the hypertonic dextrose is injected into the restraining ligaments. It is also injected into the joint and acts by stimulating regenerative processes mostly by growth factor release.
Both PRP and dextrose prolotherapy are offered by many Blackberry Clinics. They are offered in view of the lower cost compared to stem cell treatments. This is due to the less complex processes involved. Blackberry Clinic currently offers ‘platelet rich plasma’ and ‘dextrose prolotherapy’ as their preferred ‘regenerative approach’ to degenerative joint disease.
Find out more on Blackberry Clinic Treatment pages; Prolotherapy and PRP
