The first treatments for osteoarthritis, better known as "rheumatism" in the old days were balms which consisted of menthol and other herbal concoctions. These were applied topically and helped soothe some of the aches and pains.
Variations probably included immersion in hot springs, mineral baths, or other forms of hydrotherapy.
In the Far East acupuncture was being used to alleviate rheumatic symptoms.
Some authorities state that around 500 BC, willow bark was discovered as having pain relieving properties. It wasn't until 1897 when Felix Hoffman, an employee of Bayer Company, isolated the active ingredient, acetylsalicylic acid... better known as aspirin.
In the late 1940's and early 1950's cortisone was discovered and used in arthritis patients.
Other non-steroidal-anti-inflammatory drugs were developed with the idea that they could be an improvement upon aspirin in both efficacy as well as safety.
In the late 20th century, viscosupplements began to be used extensively for osteoarthritis of the knee.
More recently, nutritional supplements such as glucosamine and chondroitin have been scrutinized.
So what to do all these remedies have in common. Basically, they are used for symptom control. Now there's nothing wrong with controlling symptoms since symptoms are what bring arthritis patients to the physician.
However, treating symptoms does not have any effect on the underlying disease process.
Osteoarthritis is a condition that is due to the gradual wearing away of articular cartilage, the "gristle' that caps the ends of long bones. It is the end result of a biomechanical process that involves local inflammation as well as the production of protein messengers that cause the hyperproduction of destructive enzymes.
The pain of osteoarthritis is due to factors other than cartilage damage since cartilage itself has no nerve fibers. Theories include the irritation of the joint capsule, mechanical stretching of ligaments and tendons, and so on.
Scientists have tried to develop disease modifying osteoarthritis drugs (DMOADS). However, clinical experience using drugs such as diacerin, tetracycline derivatives, hydroxychloroquine and the like have been disappointing.
The end result of our inability to find treatments that will slow down and reverse cartilage loss, has been the explosion in the number of joint replacement surgeries performed annually.
While joint replacement surgery for osteoarthritis of the hip and knee is generally effective, almost 30 percent of patients have a complication of some type... most are minor but some are major including blood clots to the lungs, infection, and unexpected death. After all, it is major surgery.
The use of cartilage cell transplants, microfracture surgery, and mosaicplasty (cartilage plug surgery) have met with mixed reviews... successful for some athletes but uniformly disappointing in patients with osteoarthritis,
So what can be done?
In recent years, there has been increasing interest in the use of tissue regenerative techniques incorporating platelet-rich plasma (PRP) as well as autologous (a patient's own) stem cells. While anecdotal reports have been encouraging, there have been no double-blind-randomized controlled clinical trials. Fortunately, attempts at measuring efficacy are being conducted at our center and we hope to have early data available shortly.
The major question that needs to be answered is not whether the use of autologous stem stems cells work- they appear to be effective short term... but the length of time one can expect them to be effective and what the length of time a procedure should expected to last. This is another parameter we are measuring.
Other questions...Which method is best for delivering the stem cells? What is the best framework material should be used? Only through careful scientific scrutiny can we be assured that stem cell procedures have lasting benefits.
