Stem Cell Therapy for Arthritis

What Is Arthritis?

Arthritis is an inflammation of the joints and it affects over 350 million people worldwide. Arthritis can occur in one joint or in multiple joints, but the most common joints affected by the condition include the knee, hip, shoulder, neck, spine, and small joints like those in the hands or feet. While there are over 100 types of this painful condition, the two most common types are osteoarthritis, caused by wear and tear or injury of the cartilage that cushions the joints, and rheumatoid arthritis, caused by an autoimmune disorder. For more information on how Innovations Stem Cell Center treats rheumatoid arthritis, click here. Osteoarthritis usually develops gradually with age and is a common ailment for patients over the age of 40, but some patients may develop the condition as young as adolescence. Symptoms of arthritis include pain in the joints, swelling, and stiffness.

How Do You Use Stem Cells for Arthritis?

Innovations Stem Cell Center treats many of the joints affected by arthritis by deploying SVF through injection. In many cases, stem cells are also deployed through an IV. The benefits of IV deployment include the ability to reach less involved joints and tissues and to reduce inflammation.

Am I a Candidate for Stem Cells for Arthritis?

Patients with osteoarthritis who are ideal candidates for stem cell therapy include patients who have not responded to current medical treatments, who are no longer responding to current medical treatment, cannot tolerate recommended treatment for their condition, or those who want to avoid the recommended treatment for their condition, such as surgery, and patients for which nothing has been effective. SVF stem cell therapy is minimally invasive, which gives patients an alternative to painful surgery and lengthy recovery.

When Will I See Results?

Patients who undergo SVF stem cell therapy for arthritis report a reduction in their painful symptoms and an increase in range of motion and mobility. Stem cell therapy helps to quickly reduce joint inflammation, and many patients see improvements in just 1 to 2 days. Anti-inflammatory results of the procedure last 2 to 3 months, and many patients see gradual improvement in their overall condition over time.

How Can Stem Cell Therapy Can Treat Osteoarthritis?

Osteoarthritis is the most common form of arthritis. It is also known as wear and tear arthritis and degenerative joint disease. Osteoarthritis is associated with age, being more common in each decade of life beginning around age 40. It is also associated with previous joint injuries so it can be seen in those under 40.

The FAQ section below is designed to help you gain a greater understanding of the use of adult stem cells for osteoarthritis and offer a framework for evaluating if stem cell treatment is a potential step for you or your loved one.

Q: What are the current medical treatment options for osteoarthritis?

A: Osteoarthritis is a chronic condition and therefore typically requires long term medications.  The commonly used treatment options are:

  1. Mechanical – braces, wrapping etc.
  2. Physical – exercise, physical therapy and occupational therapy
  3. Medications which include:
    1. Non-steroidal anti-inflammatory drugs (NSAID)
    2. Steroid anti-inflammatories
    3. Non-narcotic pain medications – primarily Tylenol/acetaminophen
    4. Narcotics such as hydrocodone and others
  4. Injections into affected joints.  This includes steroids and numerous other newer medications
  5. Durable medical equipment such as wheelchairs, canes, walkers, etc.
  6. Joint repair surgery
  7. Joint replacement surgery

These therapies are often considered as a hierarchy with each level building on the one below as illustrated in this diagram.

An osteoarthritis patient may be prescribed one, several or all of these at one time or another during the course of their illness.  Some patients suffer without using any treatments.  The effectiveness of treatment varies greatly both between patients and over the course of the illness.  Many patients with osteoarthritis do very well for many years with exercise with or without NSAID.  Others do very well with periodic injections or repair or replacement surgery.

For more information on the treatment of osteoarthritis visit
http://www.mayoclinic.com/health/osteoarthritis/DS00019/DSECTION=treatments-and-drugs

If you are a person doing well using these options, this might not be the right time to consider adult stem cell treatment.

Q: Who should consider adult stem cell therapy?

A: If you are doing well with your current medical therapy, you may not be an ideal candidate for adult stem cell therapy.  Persons should consider adult stem cell therapy for osteoarthritis include:

  1. Persons who have not responded to current medical treatment
  2. Persons who are no longer responding to current medical treatment
  3. Persons who cannot tolerate the recommended treatment
  4. Persons wishing to avoid the recommended treatment such as surgery
  5. Persons for whom nothing has been effective.

Adult stem cell therapy DOES NOT assure a response in these patients. However, it does offer an alternative that they may wish to consider.  We will discuss results below.

Q: What is an adult stem cell?

A: All stem cells, adult stem cells or from other sources share two important characteristics:

  1. The ability to multiply.  This means in theory they can make an infinite number of copies.
  2. The ability to become any types of cells.  For example, stem cells from fat can become skin, muscle, or bone stem cells.  The transformed cell can then make an infinite number of copies.

Stem cells that are obtained from mature adult tissues are referred to as adult stem cells.  The potential exists for adult stem cells to become any type of cell.  This ability to become any type of cell and then make as many cells as needed make adult stem cells an area of extreme interest.  Some adult stem cells also have widespread availability.  We simply have to harvest them from adult tissues.  The two tissues most commonly used tissues to obtain or harvest adult stem cells are bone marrow and fat.

Fat adult stem cells are also known as adipose derived adult stem cells.  Adult stem cells from fat are easier to obtain and exist in larger numbers than bone marrow adult stem cells.  These qualities have resulted in an increasing interest in fat (adipose) derived adult stem cells.

Q: What results can I expect from adult stem cells for osteoarthritis?

A: Currently there are no treatment groups large enough to answer this question conclusively.  The Food and Drug Administration (FDA) has NOT approved the use of adult stem cells/SVF for any disorder including osteoarthritis.  With those things said, we do have enough experience to talk about early trends in therapy.  Adequate numbers of knee, hip and shoulder osteoarthritis patients have been done to give us the following patient satisfaction numbers:

  1. Knee – 85% patient satisfaction
  2. Hips – 75% patient satisfaction
  3. Shoulders – 95% patient satisfaction

A satisfied patient can be considered a patient that is happy they had the procedure. The satisfied would make the decision to do it again after having undergone the procedure.

In another group of 34 patients who had been recommended to have knee replacement, a similar 85% patient satisfaction was seen.  Out of this group, only one had gone on to have knee replacement at 18 months.

Q: How are adult stem cells harvested from fat?

A: Harvesting adult stem cells from fat is very safe. The procedure has little discomfort and fairly easy recovery. First an area such as the stomach or leg is picked to remove the fat. We then take you to the procedure room and sterilize the area. A local anesthetic is then injected into the area. Fat is suctioned using special syringe and cannula. Typically we suction about 50 ml (about 1 1.2 oz.) of fat.

 

Swelling and bruising is common following the procedure at the harvest site. Swelling and bruising typically resolves within 2-3 weeks after the procedure. Most patients receive a prescription for pain medications for use as needed. We give a dose of antibiotics before the procedure but no antibiotics are needed afterwards.

Nest we take the harvested cells and use a centrifuge and incubator to do some simple processing. The processing isolates the adult stem cells from the other fat cells. The final product is called Stromal Vascular Fraction (SVF). SVF obtained from fat can contain up to about 25 million adult stem cells from 50 ml of fat. SVF also contains a large amount of growth factors. Growth factors are chemical “text messages” our cells use to communicate with each other. After we have obtained the SVF, the next step is to deploy the SVF for your peripheral neuropathy.

Q: How are adult stem cells deployed for osteoarthritis?

The term for actually using the adult stem cells/SVF is deployment. The typical deployment for osteoarthritis is into the affected joints.  Separate protocols exist for injections into:

  1. Knees
  2. Hips
  3. Shoulders
  4. Ankles
  5. Elbows
  6. Hands
  7. Neck and spine

For many of these joints, injection involves using x-ray, ultrasound, MRI or other imaging tools.  These help insure the adult stem cells/SVF is deployed directly into the joint.  For most joints like shoulders, hips and knees, office ultrasound can be used. CT and MRI are usually necessary for deep joints like the back or neck. .  Frequently, a portion of the adult stem cells/SVF is also given intravenously (IV).  This allows benefit to other less involved joints and soft tissues.  IV deployment is also believed to have an anti-inflammatory effect.

Q: What should I expect after my deployment?

A: This is the most common question asked by our adult stem cell/SVF patients.  Our current level of understanding of using adult stem cells/SVF can probably answer this question better for osteoarthritis than any other area.  In osteoarthritis and other disorders with a strong inflammatory component, the response tends to be quite quick.  Improvement in one or two days is common.  We believe this is due to the strong anti-inflammatory effect of the growth factors associated with adult stem cells/SVF.  This anti-inflammatory effect lasts form 2-3 months.  From there, we most commonly see continued gradual improvement as the adult stem cells help provide healing to the joint.

 

It is too early to say conclusively that adult stem cells treatment promotes the growth of new cartilage.  However, some early evidence is pointing in that direction.  Osteoarthritis may or may not require repeat deployment.  Typically it is best to wait 3-6 months before considering repeat deployment.  Most of the time repeat deployment is done because some improvement has been seen and more is sought.  Occasionally, repeat deployment is done because the patient has lost some benefit previously gained.  The question of how many and how often is an area of intense interest and close study at this time.