OSTEOARTHRITIS 

OSTEOARTHRITIS

Osteoarthritis (OA), sometimes called degenerative joint disease or degenerative arthritis, is the most common chronic condition of the joints, affecting approximately 50 million Americans and this number is expected to increase to 67 million by 2030. The cost attributable to arthritis in the United States in 2003 was $128 billion, a figure that will undoubtedly increase in conjunction with health care cost inflation and the projected number of patients distressed with degenerative joint disease.

There are limited treatment options available for OA which further complicate the reality for the patients. Unfortunately, non-operative therapies or any pharmaceuticals have demonstrated questionable efficacy in reversing or halting disease progression, restricting treatment to long-term management of exacerbating factors and pain control.

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559256/

OA occurs most often in knees, hips, lower back and neck, small joints of the fingers and the bases of the thumb and big toe, generally speaking, it can affect any joint.

Cartilage, which is a firm, rubbery material covering the end of each bone in healthy joints, provides a gliding and smooth surface for joint motion and works like a cushion between the different bones. When the cartilage breaks down, it is resulting in pain, swelling, and problems moving the joint. We, in medical terms, consider such a condition as Osteoarthritis (OA)

Unfortunately, OA is progressive and it may therefore worsen over time. When bones break down and develop growths, it is called spurs. With continues movements, small parts of cartilage and bone may break off and float around in the joint. In the body, then an inflammatory process occurs, and cytokines (proteins) and enzymes develop, causing further damage to the cartilage. In the final stages of OA, the cartilage wears away, and bone rubs against bone leading to severe joint damage and more pain.

Osteoarthritis is most common in older adults, above 65, although OA may occur in people of all ages, Common risk factors include increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles, and genes.
Osteoarthritis is a chronic (long-term) progressive disease, and unfortunately, within standard medicine, there is still no cure.

Symptoms

Symptoms of Osteoarthritis may vary, and depend on which joints are affected. Patients often experience in the morning or after resting some pain and stiffness, but also joints may get swollen after athletic activities. OA is considered to be building up over time as a result of overusing and stressing joints.  

The following symptoms are experienced at patients:

  • A limited range of motion or stiffness that are going away after movement
  • Stiff or sore joints – especially the knees, hips, but also the lower back – as a result of overuse or inactivity.
  • Cracking or Clicking sound when joint bends
  • Pain is getting worse after activity or toward the end of the day especially at hips, knees, fingers or feet:

Activities, like walking, climbing stairs and lifting objects, may become difficult when the lower body joints are affected, and in case hand joints or fingers are affected, OA may make it difficult to hold or grasp an object.

Many patients believe that the effects of osteoarthritis are chronic and cannot be avoided, resulting in that they focus on limited pain management activities with its long-termed side effects, although healthy lifestyle, regular exercise and weight management can support their condition considerably.

In the following short video, we will briefly review the difference between Osteoarthritis (OR) and Arthritis (RA)

Treatment
Traditional Treatment

Although there is so far, no cure for the chronic OA disease, there are some excellent possibilities to manage the symptoms.

Main medications are:

  • NSAIDS, Nonsteroidal anti-inflammatory drugs.
    These drugs are used to ease inflammation and related pain. NSAIDs include aspirin, ibuprofen, naproxen, and celecoxib. They are usually available over-the-counter or by prescription.
  • Analgesics
    These are pain relievers and include acetaminophen, opioids (narcotics) and an atypical opioid called tramadol. They are also available over-the-counter or by prescription.
  • Hyaluronic acid.
    Hyaluronic acid is naturally available in the joint fluid and is acting as a shock absorber and lubricant. Apparently, the acid appears to break down in people with osteoarthritis. Those injections are performed in a doctor’s office.
  • Corticosteroids
    They are considered as being strong anti-inflammatory medicines and can be injected directly into a joint or taken by mouth at a doctor’s office.

These are standard medical treatments for OA, but in extreme cases, it is suggested to perform surgery with artificial hips and knees replacements.

Often patients with OA are using assistive devices like Scooters, walkers, canes, splints, or shoe orthopaedics as an example are assistive devices, which can help with function and mobility. Those tools can be found in medical supply stores and at pharmacies. Some of those specific items, like custom knee braces may be dispensed via a doctor and are typically fitted by a physical or occupational therapist.

A most beneficial way to manage OA, is "moving," although patients often underestimate this therapy even though many physicians “prescribes / suggest” it to be an essential part of treating OA.

Studies show that maintaining weight via easy exercises, even light activities, like walking around the neighbourhood may reduce pain and help support (or attain) a healthy weight. Those activities furthermore will help to reduce the pain by strengthening the muscles at OA-affected joints. About two and a half hours of moderate exercise per week, even for those with Arthritis, is recommended by many physicians including the U.S. Department of Health and Human Services.

To deal with symptoms and improve the overall well-being, many people with OA are investigating the use of natural or alternative therapies. These alternatives include nutritional supplements, acupuncture or acupressure, relaxation techniques and hydrotherapy, massage, and PEMF systems so-called Pulsed Electromagnetic Frequency devices.

Cellular Treatments

Science and technology in the field of cellular technology have advanced in the last years as never before, and stem cell therapy is considered by many practitioners as the disruptive revolution in medical treatments also well suited for Osteoarthritis.

Stem Cells has been demonstrated, first, to induce profound healing activity in animals with various forms of arthritis. For example, the company Vet-Stem routinely utilizes stem cells since years in horses with various joint deformities to accelerate healing. Besides healing of damaged tissues, stem cells have the unique ability to modulate the immune system to shut off pathological responses while preserving the ability to fight off disease.

In the recent ten years, there is a definite global movement to advance with stem cell treatment technology directly to the bedside in the responsibility of a physician as a medical procedure. In the clinics and partners, we are working with, already more than 10.000 stem cell treatments for many different conditions had been successfully provided without any serious side effects.

CellularStem Treatment Protocol

Over time we have seen the development of various treatment protocols. In our protocols, we use autologous Mesenchymal Stem Cells (MSCs) and growth factors from bone marrow and adipose tissue, Platelet-rich plasma (PRP) and where legally possible we use expanded allogeneic Mesenchymal Stem Cells from Umbilical Cord.

Mesenchymal stem cells help in regeneration of bone and cartilage along with activated PRP based biopolymer which holds MSCs at the site of lesion and medium and nourishment to stem cells so that they can work better together.

With a well-defined stem cell treatment protocol, a patient can expect a slowing down of the degeneration process and pain relief.

Allogeneic Stem Cells from Umbilical Cord

Although we are, due to regulatory reasons, in most western countries performing only autologous stem cell treatment, we are often asked: "What are the advantages of treating patients with allogeneic human umbilical cord tissue (HUCT)-derived mesenchymal stem cells?" Well, besides being expanded, i.e., they are available in much larger quantities to treat a condition the following had been scientifically established:

  • HUCT mesenchymal stem cells are immune system privileged; cell rejection is not an issue, and Human Leukocyte Antigen (HLA) matching is not necessary.
  • The stem cells with the best anti-inflammatory activity, immune modulating capacity, and ability to stimulate regeneration can be screened and selected.
  • Allogeneic stem cells can be administered multiple times over the course of days in uniform dosages that contain high cell counts.
  • Umbilical cord tissue provides an abundant supply of mesenchymal stem cells.
  • No need to collect stem cells through invasive procedures such as liposuction or bone marrow collection

There is growing evidence, showing that mesenchymal stem cells from umbilical cords are more robust than mesenchymal stem cells from other sources such as fat or bone marrow.

As mentioned before in our protocols we can use all those technologies, and after reviewing the medical history and condition of an individual, we are suggesting a treatment method we believe might be most suited for improving the status of a patient and in dependence of the country where the treatment will be performed.

In animal studies and a few human case reports, cell-based therapies have shown encouraging results. Most cellular research recently concentrated on the use of mesenchymal stem cells and peripheral blood platelets.

Many published studies on this topic, showed via the systematic research, and it's clinical trial data, encouraging, exciting, preliminary findings ranging from improvements of focal chondral defects to articular osteoarthritis degeneration.

If you like to participate in our patient funded investigational treatment program for Arthritis, Osteoarthritis (OA), Avascular necrosis of femoral head (AVN), please kindly contact us with your medical history to review whether you are a potential patient for a stem cell treatment.

In accordance with the severity of the condition we are offering two options:

1st Option

Treatment with own stem cells, from adipose tissue, bone marrow or MSCs from Umbilical cord in an ambulatory clinic setting. Treatment is done in our partner clinic, where a patient will stay 3 to 4 days. The accompanying partner will stay in the same clinic at no additional costs.

BASIC PROCEDURE:

The program consists of Autologous PRP procedure along with Mesenchymal Stem Cell for your condition.

  • Collection of your whole blood 150-250 ML which will be sent to the lab for processing (isolating Platelet-rich plasma) which is further activated by using suitable methods
  • The PRP is activated before infusion/infiltration at the proper location (joint space or joint capsule or adjacent tissues like tendons, ligaments, muscles) as determined by the treating physician depending on your case.
  • There may be an increase in pain at the site of infusion/infiltration for few hours or days for which appropriate treatment will be suggested.
  • Duration of the program consist of 3 to 4 days including PRP and stem cell treatment at the clinic; there may be minor variations which would be advised to you as and when needed.
  • Additional Nutritional support to improve the cellular structure (Telomeres) shall be provided by the need and request of the patient via our network marketing partner at reasonable costs.
2nd Option 

Treatment includes a Mind-Body treatment experience in India, where the Patient stays five nights in our partner Monastery in the Himalayas, to be exposed to particular detoxification of the Mind and Body, via Meditation and Tibetan Ayurveda medicinal therapy and after that will be treated in Delhi with allogeneic expanded umbilical cord stem cells and PRP. The accompanying partner will stay in the same clinic at no additional costs.

Treatment costs

Please note that treatment costs, besides the selection of options, also is depending on the medical history and condition. For further details we suggest to please complete our Patient Application Form, - see under contact - stipulating your condition and treatment request, mentioning preferred option, and send it to our Delhi or Europe office. We actively strive to reply to any request either immediate or latest within two working days with details.

Quality of Stem Cells

Licensed physicians administer the stem cells intravenously (IV) and into the affected joint(s) via intra-articular injection. Stem cells may also be applied in certain circumstances, intrathecally and intramuscularly. Extra intra-articular injections for multiple joints can be arranged as medical requirements dictate. Stem cells used are certified by the lab providing the cells to our partner clinics.

Medical Procedure Treatment

As stem cell treatments are personalized treatments, results from one patient cannot be transferred to another, although we have many anecdotal cases where the condition of patients had been improved considerately. Often patients experience:

  • A general relief
  • Enhanced flexibility
  • Pain and stiffness are gone
  • There is no or much less restriction in movement
  • Improved mobility
  • Cartilage improvements
Side effects and Follow up

When it comes to side effects, our patients have not experienced serious side effects from the stem cells treatment, and we are monitoring the well-being of our patients in the first 24 to 48 hours by a dedicated patient coordinator.

Our stem cell treatment does not end with the procedure in our partner clinics. We care about how you are doing after you return home. So, we will monitor your post-treatment progress on a regular basis. The proper follow-up, i.e., 1, 3, 6, 12, 24 months, also helps us evaluate the effectiveness of our treatments and improve our protocols based on observed outcomes even further.

Clinical Trials, Studies & General Information

According to ClinicalTrials.gov statistic, in November 2017 there had been 2793 trials for Osteoarthritis registered. 63 studies are stem cell related treatment reviews.

https://clinicaltrials.gov/ct2/results?cond=Osteoarthritis+and+stem+cells&term=&cntry1=&state1=&Search=Search

Slideshow: A Visual Guide to Understanding Osteoarthritis
https://www.webmd.com/osteoarthritis/ss/slideshow-osteoarthritis-overview

ORTHOPEDICS  - Stem Cell Research & Medical Publication

Safety of Intravenous Infusion of Human Adipose Tissue-Derived Mesenchymal Stem Cells in Animals and Humans
Jeong Chan Ra,1 Il Seob Shin,1 Sang Han Kim,2 Sung Keun Kang,1 Byeong Cheol Kang,3,4
Hang Young Lee,1 Youn Joung Kim,1 Jung Youn Jo,1 Eun Ji Yoon,1 Hyung Jun Choi,3,4 and Euna Kwon

https://www.ncbi.nlm.nih.gov/pubmed/21303266

ORTHOPEDICS  - Stem Cell Research & Medical Publication

Treatment of Knee Osteoarthritis With Autologous Mesenchymal Stem Cells: Two-Year Follow-up Results

Orozco, Lluis1; Munar, Anna1; Soler, Robert1; Alberca, Mercedes2; Soler, Francesc3; Huguet, Marina4; Sentís, Joan5; Sánchez, Ana2; García-Sancho, Javier2
https://www.ncbi.nlm.nih.gov/pubmed/23680930
ORTHOPEDICS  - Stem Cell Research & Medical Publication

Mesenchymal stem cells in osteoarthritis
Curr Opin Rheumatol. 2004 Sep;16(5):599-603

Authors: Luyten FP

https://www.ncbi.nlm.nih.gov/pubmed/15314501

ORTHOPEDICS  - Stem Cell Research & Medical Publication

Knee Surg Sports Traumatol Arthrosc. 2013 Dec 11. [Epub ahead of print]
Clinical results and second-look arthroscopic findings after treatment with adipose-derived stem cells for knee osteoarthritis.
Koh YG, Choi YJ, Kwon SK, Kim YS, Yeo JE.

https://www.ncbi.nlm.nih.gov/pubmed/24326779

ORTHOPEDICS  - Stem Cell Research & Medical Publication

Arthritis Rheum. 2003 Dec;48(12):3464-74.
Stem cell therapy in a caprine model of osteoarthritis. Murphy JM, Fink DJ, Hunziker EB, Barry FP.
https://www.ncbi.nlm.nih.gov/pubmed/24326779

ORTHOPEDICS  - Stem Cell Research & Medical Publication

Intra-articular injection of autologous mesenchymal stem cells in six patients with knee osteoarthritis.
Emadedin M, Aghdami N, Taghiyar L, Fazeli R, Moghadasali R, Jahangir S, Farjad R, Baghaban Eslaminejad M.

https://www.ncbi.nlm.nih.gov/pubmed/22724879

ORTHOPEDICS  - Stem Cell Research & Medical Publication

Transplantation. 2013 Jun 27;95(12):1535-41. doi: 10.1097/TP.0b013e318291a2da.
Treatment of knee osteoarthritis with autologous mesenchymal stem cells: a pilot study.
Orozco L, Munar A, Soler R, Alberca M, Soler F, Huguet M, Sentís J, Sánchez A, GarcíaSancho J.

https://www.ncbi.nlm.nih.gov/pubmed/23680930