Fresh Ideas

An irony in the treatment of arthritis is that while outcomes in the treatment of rheumatoid arthritis have dramatically improved over the last 15 years, the non surgical outcomes for degenerative arthritis haven’t improved in the same way. At first blush this may seem surprising since rheumatoid arthritis is clearly the more aggressive and rapidly worsening condition. The difference is in how the medical profession treats these conditions.

For RA the paradigm for treatment is early and strong treatment to stop active disease and prevent progression. It’s a proactive and aggressive approach that has changed people’s lives. For degenerative arthritis the response is underwhelming. It’s not common to hear physicians tell their patients with osteoarthritis that they should focus on pain medications, there’s not much that can be done, and eventually surgery will be required years down the line. Is this the best we have to offer?

A small published study from Cornell hospital in NY showed that 1 prp injection in patients with osteoarthritis of the knee resulted in not only improved pain and function at 1 year, but repeat MRI study showed no change in arthritis. One commentator in response to these results suggests that the no change in MRI findings may indicate a disease modifying effect in a joint with degenerative arthritis. Previous studies have found that people with knee athritis tend to lose around 5 percent of cartilage per year, thus no change on MRI may be a good result.

The science is still out on whether cell based treatments can truly change structural damage in arthritic joints long term, but it does suggest that our current approach to degenerative arthritis is incorrect. Rather than waiting for progressive degeneration, perhaps treating at a earlier stage to prevent progression would be a better approach. In a animal study of osteoarthritis, using autologous stem cells prevents progression of their arthritis. A newer paradigm for osteoarthritis should be considered. Non surgical autologous low risk treatments can be a first line treatment in osteoarthritis. Our future expectations in preventing progression of osteoarthritis should be similar to our expectations in rheumatoid arthritis.


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