One out of three people older than 65 will have osteoarthritis, the most common form of arthritis in the world.
“Basically it’s degeneration of the cartilage in the joints,” said Dr. Alejandro Badia, an orthopedic hand surgeon and founder of the OrthoNow urgent care centers in South Florida.
Osteoarthritis most commonly affects joints in the knees, hands, hips and spine but it can damage any joint.
The bad news is there’s no cure. The good news is there are new ways, still unproven, to possibly boost the use of an arthritic joint and decrease the pain.
Orthobiologics, which use cells or parts of cells to effect a change instead of chemical-based medicine, is “the fastest-growing field in sports medicine and orthopedics,” said Dr. Michael Swartzon, associate medical director for Miami Orthopedics and Sports Medicine Institute at Baptist Health South Florida.
The problem is that no large-scale studies have been conducted and the procedures are still considered experimental. The procedures work better on patients who are not obese and whose disease isn’t in the advanced stages.
Being overweight adds stress on weight-bearing joints and generates fat tissue that produces proteins that cause harmful inflammation in the joints, Badia said.
Dr. Clifton Page, assistant clinical professor of orthopaedics and family medicine at UHealth-University of Miami Health System and a doctor for the Miami Marlins, injects platelet-rich plasma (PRP) into a patient’s arthritic joint. The theory is that the platelets contain healing proteins to help repair the cartilage, Page said.
“We’ve been doing this type of therapy for the last five to six years,” Page said. The patient’s blood is drawn and spun in a centrifuge that separates out the platelets. Then “we use the ultrasound to look inside the joint and place” the PRP precisely into the problem spot,” Page said.
As platelet-rich plasma injections are still considered experimental, the FDA hasn’t approved them and insurance generally doesn’t cover the cost.
“Here it’s $800 per injection. One time is usually good,” Page said.
A week later a patient begins physical therapy and has a follow-up doctor’s visit a month later. Sometimes a second injection is needed.
“The results for the most part are pretty good,’’ Page said. “They don’t go on to have surgery and are able to do the activities they used to do.”
Dr. Wellington Hsu, writing in the Journal of The American Academy of Orthopaedic Surgeons, said the most promising use of PRP seems to be for tennis elbow, osteoarthritis of the knee and ACL reconstruction surgery
“Results of rotator cuff and Achilles tendon repairs have not found significant difference in outcomes with or without the use of PRP,” Hsu wrote.
A study comparing 120 patients with early stages of knee osteoarthritis treated with PRP to 120 injected with hyaluronic acid found better and longer-lasting results with the PRP. The improvement was greater in the more active patients with less severe cartilage damage.
“I’m not saying it will regrow their cartilage back to normal,” Swartzon cautioned. “PT works for a lot of people, medicine works well, cortisone injections work for a lot of people. Losing weight is essential. But cortisone is short term and has side effects, “ Swartzon said.
For those patients who have tried everything else and don’t want a knee or hip replacement, biologics might be a solution.
The newest orthobiologic application for osteoarthritis is stem cells. Swartzon’s practice uses stem cells from amniotic fluid, not embryos. The process “requires protocols that are at or exceed organ donation,” Swartzon said.
One of Swartzon’s early patients was David Weissman of Boynton Beach. Five years ago, the pain in his left knee was around eight on a scale of 1 to 10, he said.
Swartzon diagnosed the condition as osteoarthritis and gave Weissman a series of three shots of Synvisc, a patented name for hyaluronic acid. That brought the pain to a six for several years, but eventually the pain increased.
“I really didn’t want an operation,” Weissman said of getting a knee replacement. Then Swartzon told him he was starting to do stem cell treatments.
“It was remarkable. The pain went down from an eight to a four. Then I had a second shot a few months later,” Weissman said, and the pain decreased more.
“I exercise, I play golf. I’m amazed that it works,” Weissman said. “It has been six months. He doesn’t know and I don’t know how long it will last. I’ll settle for a level of one to two” in pain, Weissman added.
Page said UM has approved him doing stem cell procedures in his practice. Depending on the injury being treated, he can combine stem cells with PRP therapy.
“The theory is it helps reduce inflammation in the area. The plasma-rich cells act as generals directing the stem cells to work on healing,” Page said of the combined therapies.
PRP or stem cell treatments are for people who don’t want surgery and whose arthritis is moderate, not severe.
“If you have bone-on-bone arthritis, injections are not going to help,” Badia cautioned.
Nonetheless, the doctors were encouraged by the strides being made to treat arthritis.
“We have so few options to treat chronic, degenerative arthritis,” Swartzon said, adding, “It’s important to be a little skeptical but with a lot of cautious optimism that maybe we can finally get some better treatments for arthritis than what’s available now.”