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Insider Arthritis Tips February 2009 Newsletter
March 15, 2009
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Current concepts in osteoarthritis treatment

Wei's World

"You must be the change you wish to see in the world." -- Mahatma Gandhi, Statesman

Current concepts in osteoarthritis treatment

Osteoarthritis (OA) is one of the most common conditions leading to disability and impaired quality of life in the Western world.

Ironically, while more effective disease-modifying therapies have been developed for rheumatoid arthritis, particularly within the last 10-15 years, rheumatologists still treat osteoarthritis with symptomatic and supportive therapies.

As a result, the inexorable progression of this disease results in the performance of more than half a million joint replacements annually in the United States. While joint replacement surgery has made gigantic strides, it is still a major surgical procedure.

Risk factors for the development of OA include: genetic factors, obesity, joint injury, surgery, and the presence of associated metabolic disease.

It is clear from the research that OA is a disease that involves not only the cartilage- the gristle that caps the end of long bones and cushions the joint, but also the synovium- the tissue lining the joint- as well as the bone that underlies cartilage.

While genetic factors play a significant role in the incidence of osteoarthritis, the damage that occurs is a result of a complex interaction of inflammatory messengers. Among these are cytokines, prostaglandins, nitric oxide, growth factors, and proteases.

These substances, which are produced by chondrocytes (cartilage cells) that are subjected to abnormal forces lead to a situation where there is premature aging and destruction of cartilage substance.

The production of these inflammatory proteins also contributes to inflammation of the synovium and excessive amounts of bone growth.

Present therapies, as issued by guidelines proposed by the Osteoarthritis Research Society International (OARSI), are clearly aimed at symptom relief. These treatments include: analgesics, non-steroidal-anti-inflammatory drugs (NSAIDS), topical agents (“rubs”), and joint injections with either glucocorticoids (“cortisone”), or hylauronic acid lubricants.

Current research has been aimed at finding the triggers that cause inflammation to start and also to identify specific markers that might identify those patients who are at greatest risk for rapid progression of disease. These markers would also be useful in measuring improvement once newer drugs that can slow down disease progression in OA can be discovered.

However, all of these investigations are futile unless and until specific disease-modifying osteoarthritis drugs (DMOADS) – drugs that slow down the rate of cartilage loss- can be developed.

Drugs aimed at inhibiting cytokine and protease function show some promise but it is still too early to tell whether they will have the desired effect. Examples of these drugs include: matrix metalloproteinase inhibitors, drugs that block interleukin 1, bisphosphonates, calcitonin, as well as nutritional supplements such as glucosamine and chondroitin.

And it may not be enough to find drugs that simply slow disease progression.

The “holy grail” is still the treatment(s) that will rebuild cartilage. The type of therapy that shows the greatest promise to date is the use of autologous stem cells. These are stem cells harvested from the iliac crest of the patient using local anesthetic. The stem cells are then injected into affected area of the knee using ultrasound guidance. Platelet rich plasma is also injected to stimulate stem cell division and multiplication. A special matrix is also injected. The matrix is used to allow the stem cells to adhere and grow.

Early results at our center look extremely promising. For more information about stem cell treatment for osteoarthritis of the knee, contact the Arthritis and Osteoporosis Center of Maryland at (301) 694-5800.

Mei-Mei and Me

Growing up I had very few pets: a couple of salamanders I caught in a little creek, a goldfish, and a hamster. My parents weren’t big pet people and I had severe asthma and was allergic to a lot of things.

When our kids started coming along they wanted a dog. Becky, our oldest, when she was five, asked about a dog. My wife, Judy, told her, “No… honey, we can’t get a dog … your dad’s allergic to them.”

One day Becky came home from school and asked Judy whether we could get a “‘puter.” And Judy, knowing I was technologically incompetent said, “No… I don’t think your dad would want to get a computer.” So Becky asked, “Is he allergic to ‘puters too?”

To move the story along, Emily is our daughter, whom we adopted from China. She is a sweet and wonderful child who happens to have some learning disabilities. According to my wife, many experts in the field of education have written that a dog can help children with learning issues. Emily also has severe asthma but received desensitization shots so she could be around animals.

Well… through sheer persistence and determination, Judy kept bringing up the dog issue. And I kept saying, “No!”

Until one day in December when she announced to me, “Today we’re going to pick out a dog.”

I nearly lost my dentures! I was speechless… and powerless. Like in the movie, My Big Fat Greek Wedding, “the man may be the head but the wife is the neck and the neck moves the head any way it wants to.”

We drove to a breeder in Fauquier County, Virginia. And Emily helped pick out a Labradoodle puppy. Since the puppy was a newborn, we had to wait a month or so to pick her up. But the day came. Judy and Jeffrey (our older son who was home on break) got the puppy.

Judy and Emily named her Mei-Mei. Mei-Mei in Chinese means “little sister.” Emily has always wanted a little sister and now she has one.

Those of you who have dogs know that the training process can be… to put it mildly… a little messy. And it has been. But I have to admit… I’m getting a bit attached. Don’t tell anybody though.



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