Chicago Arthritis and Regenerative Medicine- Weekly Live Event 2020/06/24
-Comparing our Weekly Live event and our Weekly Education meeting.
-Weekly Live with the Arthritis Foundation.
-Covid19 Phase 4. Sports league examples, Tennis vs NBA.
-Regenerative medicine treatments in Inflammatory Arthritis.
1. Severely active Psoriatic Arthritis.
2. One joint inflammatory arthritis.
3. Rheumatoid arthritis case where regenerative medicine treatment would not help.
Check us out live on Instagram and Facebook every wednesday at 12:15pm cst.
Discussing relevant issues regarding state of the care for arthritis, tendinitis, injuries, and back pain.
Hello everyone. This is Siddharth Tambar from Chicago Arthritis and Regenerative Medicine. Welcome to our weekly live event. It’s June 24th 2020. I hope everyone is doing well. Hope everyone is healthy, and hope everyone is not only just getting through and surviving everything in life currently. but is trying to grow and improve and thrive as well if possible.
A couple things I want to announce before I get started. The first is that I have started a weekly educational broadcast as well, that’s different than the weekly live broadcast. So the weekly live broadcast is me basically talking about different relevant topics that are occurring at work. Not to mention things that are related to not only COVID, but rheumatology, regenerative medicine, things that we see at Chicago Arthritis and Regenerative Medicine, and my thoughts as well. The weekly educational events will be different. On Mondays, I meet with a few of my team members and I answer their questions. Whether it’s questions that they directly have, or whether it’s questions that they’re hearing from patients. And we’re kind of riffing back and forth about those kind of things. It’s been really interesting and helpful for me, because I’ve learned a lot. Not to mention I’ve also had some interesting discussions as well. And so I’m looking forward to doing more of those as well.
We started to do some of the weekly live events along with the Arthritis Foundation now. I think that’s absolutely fantastic. The Arthritis Foundation has been around for a long time, they do such good work in terms of patient outreach. Research related funding as well for arthritis patients, as well as arthritis physicians and practitioners as well. So such a worthy and honorable organization, and I’m really proud to be connected with them in any way.
There are a couple things that I want to talk about today. First is COVID, getting back into some version of normal life. And here in Chicago, in Illinois, we’ve gone from phase three, and we’re about to enter phase four, I believe beginning of next week. So essentially what that means is we’ve been allowed to do things like eating at restaurants, and small numbers of people outside. They’re going to progressively start letting people start doing some of those kind of activities, and limited numbers of people indoors. It also means that certain types of gyms are going to start opening up at limited capacity as well. Exciting, because it means that we’re slowly making progress. It seems like just yesterday or rather a few months ago, when we couldn’t do anything. And so really pretty positive that we’re starting to move forward. With that said, let’s still be sensible. Let’s still use the right precautions, masks, social distancing, we still need to do that.
There are a couple interesting things. I’m not going to get into any sort of political rallies or stuff like that, but in the sports world, that are very, very educational. The first is I’m a big tennis fan, and Novak Djokovic had a tennis series that he had started in Eastern Europe recently. And unfortunately, they were taking none of the appropriate precautions, in terms of mask and social distancing. Amongst not only players but their entourage and fans, and they had 4,000 fans at an event. And four top level players came back COVID positive. So they had to cancel that whole mini tour. And it really speaks to that, even if things are improving, don’t be reckless, still be sensible, still do the right thing to protect yourself, your family, your community and others as well. Because realistically, the people who are most at risk for problems, are the elderly people that have multiple other issues as well. Which is a challenge.
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The counter to what’s happening in the tennis world is what’s happening in some of the sports leagues here in the US. So the NBA has a really interesting approach that they’re trying to do to complete their playoffs. They’ve actually invited their playoff teams to Orlando. To, essentially they’re renting out Disney World for a couple months. And they’re going to do everything right there, in a very controlled fashion. And it’s interesting because, Number one, their guidelines are over 100 pages long. But there are a couple things that I found interesting. Number one is how they’re restricting people that can come and go. Number two is how often they’re really checking players to make sure that they’re safe. And then lastly, another interesting aspect is, if people turn out to be COVID positive, not only are they trying to protect those players and the people around them, but before they let the players get back into a competitive atmosphere, they’ll actually do cardiopulmonary testing, heart and lungs. That’s really smart. And I haven’t seen anybody else talking about that. But from like a health standpoint for people who are trying to stay physically active, that’s a really smart idea. Because we know with COVID, that not only for lung involvement, because it’s a respiratory illness, but also from a vascular standpoint with the heart, that it’s potentially causing problems. And so I think that’s a really smart thing that the NBA is doing to help protect their players, and provide value to fans as well. So getting back to some version of normal life, but you still need to make the right smart decisions, to protect yourself and your family and community.
On a clinical level, I had a couple patients where got me thinking about regenerative medicine treatment options for inflammatory arthritis. So in my own practice, we have how we treat our inflammatory arthritis patients, meaning folks that have autoimmune conditions like rheumatoid arthritis, psoriatic arthritis, conditions like that. Inflammation conditions where the immune system is attacking the joints and tendons. We generally treat that in a systemic fashion. Meaning talking about medications, sometimes diet, exercise, supplements as well. Then we’ve got our osteoarthritis and tendinitis patients where we’re using regenerative medicine treatments. Where we’re utilizing things like your own blood, bone marrow cells, stem cells, platelet rich plasma, to treat those kind of conditions. The reality is that there is some overlap here. And so what are the indications and ways that we’re using regenerative medicine treatments for inflammatory arthritis patients. It comes up in a few different ways. And I’ll give you sort of three different examples that I saw in the last week. To give you a sense of that.
The first would be a psoriatic arthritis patient that has widespread disease. Meaning really severely active skin involvement from psoriasis, and a lot of very inflamed joints as well. And in that kind of case where someone has like 10,20 joints involved, systemically very active condition. If they’re asking me can we use a treatment like their own bone marrow derived stem cells, that’s not the right candidate at that moment. They’re in a situation where the best way to treat them, is to first control the overall big picture condition. Whether that’s with medications, dietary intervention, other kind of interventions like that, but get the systemic overall condition under control, and then decide what to do. Meaning if there are overall systemic inflammation is under control, they might be 80% better, 90% better, and they may not need any additional treatment from a joint standpoint. Alternatively, if they’ve been treated, and they still have one or two joints that are involved, then it’s sensible to then treat some of those other areas. But taking a big picture approach in that kind of condition is the right way to take it on.
The second version of that would be someone that’s already been treated, and has maybe one joint that’s still problematic. Or alternatively, if somebody comes in, and says look, I’ve got inflammation in this one joint, and how do I treat this? So that’s interesting. So I saw a patient recently, who’s had this progressive inflammation in their knee. Pain and swelling in that knee. And they don’t have a lot of structural problems, they’ve got little bit of instability. But when you take the fluid out of the knee, it’s definitely inflamed. The traditional way to treat that would be to use anti inflammatory injections and medications to try to suppress that. That may work temporarily, but from like a bigger picture standpoint, that might be a little bit too aggressive. And that’s someone who we could actually utilize a regenerative medicine approach to actually possibly get a better treatment result. So in my own practice, what I’ve noticed is when you take someone that has an overall inflammatory condition, that if you’re treating that one joint that’s still active or problematic, whether that is one inflamed joint or one osteoarthritic joint, that joint can do not only very well from a treatment standpoint, but that’s a joint that will actually stay protected longer term.
So a great example that I have is a psoriatic arthritis patient, who had originally come to see me for pain and swelling in one knee. He definitely had active psoriasis. But he only had that one joint that was problematic. That joint was definitely inflamed. We ended up utilizing his own bone marrow derived stem cells, and he’s done really well with treatment for that one knee. But since that time, over the next couple years, he’s developed pain and inflammation in other joints. That knee remains protected and still doing well, because that’s the knee that we treated, but his systemic condition has affected other areas.
Another example would be a patient who’s had chronic RA, and that’s actually under control, but he has one joint that’s still problematic. Still a bit inflamed, very osteoarthritic. And again, he’s done really well, because we’re treating that one joint. Another great example of where you can utilize regenerative medicine techniques in an autoimmune patient with rheumatoid arthritis or psoriatic arthritis. So a nice way to sort of combine those two clinical interests of mine, but two different ways of approaching somebody that has inflammatory arthritis, or rheumatoid arthritis or autoimmune related arthritis, and they can still do well.
The last one that I think is interesting is I saw a patient this past week, he sees somebody else who has rheumatoid arthritis. He’s on medications, he’s generally doing quite well, but he has one knee that still kind of persistently swollen. So he came to ask, asking well, if we utilize his own bone marrow derived stem cells, can that get better? So it’s interesting because when I examined him, his knee was definitely swollen but not hyper-inflamed. And when we actually do an ultrasound of his knee, what’s curious is that he doesn’t have a large amount of fluid, and he doesn’t have active inflammation. What he has is called synovial hypertrophy. Which means that the joint’s been inflamed in the past. So it has a distended look. It has a swollen look. So if you only look at this as someone that has a swollen knee, would this be a candidate for treatment, maybe. But when you realize why he has swelling, which is that it’s not actively inflamed, and he doesn’t really have pain. What he has is a chronic joint finding imaging that’s causing that swelling. But that’s not going to get better, just with the kind of injectable treatment that we can give. And so in this case my recommendation was, I wouldn’t rush to jump to an additional treatment in your case, because I think your overall inflammation is controlled. And because injecting your own stem cells into the knee, is not going to reverse that chronic damage that you already have, that I would just watch this at this stage. You don’t have active inflammation, you don’t have pain, you don’t have an active osteoarthritic joint. You have a chronically thickened synovial hypertrophy, thickened lining of the joint, and that’s not going to get better with any additional treatment. And so it’s a case where on initial surface, you would say maybe he could benefit from one of our treatments. But when you kind of dig deeper, which is to kind of look at what are his actual symptoms, what are his actual concerns. Not pain, more just that chronic swelling, and what does he have on ultrasound. You can actually give them better guidance, which is don’t proceed with the regenerative medicine treatment, stick with just what you’re doing on the rheumatology side, and you’ll be fine. And so that guidance was helpful for him, because we didn’t push them into more treatment. We kept them on the right path in that case.
When it comes to medical decision making, you can take things that can be a little bit nuanced and complicated, but a combination of an understanding of the pathology and condition of what’s going on, and understanding of what you’re seeing on examination. Some bedside imaging that you can do right off the bat such as ultrasound, you can then come to a pretty good decision to actually help protect somebody and guide them the right way. And I think a interesting thing that I’m finding, is some of the conversations I’m having with folks right now, is it’s beyond just, hey, what hurts and what’s swollen. It’s more along the lines of what’s your goal? How do we get you onto the right track? And how do we get a better result long term, based on what your goals are. Whether that is less pain, whether it’s better function, or sometimes it’s maybe goals that we can’t quite achieve, with what we actually have, and maybe additional treatment isn’t the right way.
So even though we’re in a different world, meaning we’re not back to normal, right. You can still utilize good human communication, good medical communication and still convey value to people, when they have needs and challenges. And I think utilizing good common sense, and good connection with patients based on what’s important to them, you can still come to some smart decisions. And I think as we all start to reintegrate into life, continue to use good common sense, continue to use your trusted physician sources, to come to some sensible decisions about your own risk tolerance, about your own treatments, and about how to proceed forward in all those ways.
A personal challenge that I know we’re going to have at my own house is, we’re trying to reintegrate our own lives, back into some of our usual kind of situation. Whether it’s some of my activities for my daughter, because she’s a regular six year old kid, and needs to get back into some semblance of normal life. Or whether that’s how do I get back to playing tennis or going to the gym. How do we do some of these things in a safe way? Because it’s not just making decisions, based on our own personal health. It’s taken into consideration things like. Well, Who are we working with at the office. Whether it’s patients, my other team members. Even things like I’ve got my in-laws coming next next month as well. Those are things we need to proactively think about to protect people.
I keep on coming back to this understanding that risk assessment does not mean you need to be panicked or concerned. It means you live your life with your eyes wide open, with an understanding of what a reasonable risk, and reasonable things to take chances on, because they’re worthwhile living for. And I think if you do that appropriately, you can get through the next several months, which are going to be challenging. In a way that is healthy, productive and still growth oriented.
Thank you for your time. And until next week, I hope everyone is safe and healthy. Again, if you want to learn about more educational stuff that we’re doing, check out our weekly educational video that we put out every Monday as well. It’s sort of contrasts a little bit with what we’re doing in a live video as well, and I think it gives a different flavor in terms of, some of the things that we’re doing at work, and ways that we can help. But until next week, have a good day. Be healthy and live well. Bye bye.