Can stem cells heal degenerative joint disease after years of cortisone, anti-inflammatory and painkiller damage?
Before you read on, if you have questions about how stem cells heal degenerative joint disease after years of cortisone and painkillers, get help and information form our Caring Medical staff
The main factor however is that the osteoarthritic joint is degenerating faster than the body can fix it. The body’s healing response is inflammation. Inflammation will turn on and continue staying on until the joint is healed.
But what if the joint does not heal because the injury is too severe for the body to heal on its own?
- Then the inflammatory mechanism will be stuck in the “open” position, chronic inflammation will continue trying to heal something it can’t.
The pharmaceutical industry has made billions and billions producing anti-inflammatories to try to get the inflammation to shut off. Nature’s way is for chondrocytes (healing and rebuilding cells in our body) to repair damage and produce its own anti-inflammatory protection system for the new cartilage the chondrocytes is building.
- Once repair is complete, the signal goes from cell to cell that healing has been achieved and the immune system stops the inflammation.
The amazing chondrocyte and its ability to repair and regrow cartilage
A chondrocyte is a cell that makes cartilage.
If you can imagine an example of a brick wall being cartilage. In degenerative joint disease part of that brick wall starts to break down.
- A chondrocyte is a replacement brick that secretes its own mortar and embeds itself into the damaged wall.
- When you have many chondrocytes doing the same thing, they create a healing environment of positive, healing inflammation. This is what cartilage regeneration is, repair cells acting in a positive inflammation environment.
- But, when the chondrocytes can not complete repair, it cannot shut off the inflammation, the inflammatory loop creates a toxic environment of oxidant stress.
- The stress factors create a diseased environment.
- It is the Dr. Jekyll/Mr. Hyde characteristics of inflammation in full display.
Stem cells do have the ability to change this degenerative toxic environment into a regenerative healing environment
- When stem cells are injected into a diseased joint they start talking to the repair cells, the blood cells, the inflammatory cells, and the native stem cells in a “reboot” command to restart the natural healing of the joint. This comes under the phenomena of “cell signalling.”
However, the stem cells can be bogged down and the messages blurred by the oxidative stress caused by the chronic inflammation, so repair can take longer and be more challenging. This problem is what new research is trying to tackle.
In a 2017 study, Dr. Ming Pei of West Virginia University publishing in the medical journal Biomaterials suggests that while adult stem cells are a promising cell source for cartilage regeneration, increasing evidence indicates that environmental preconditioning is a powerful approach in promoting stem cells’ ability to resist a harsh environment such as hypoxia (the lack of oxygen) and inflammation following surgery.(1)
In this study the idea is to get the stem cells ready to more efficiently heal by changing their conditioning and the joint environment by removing oxidative stress in the joint. This falls under our philosophy of treating the whole joint and advising on lifestyle and nutritional changes that would enhance the immune systems ability to heal.
Oxidative Stress and “degenerative treatments”
In our 25 years experience in seeing patients with chronic joint and back pain, one of the biggest challenges we face is treating a patient who has had long-term conservative care that included what we call “degenerative treatments.” Degenerative treatments cause oxidative stress in joints. This is covered in my article How stem cells heal degenerative joint disease after years of cortisone and painkillers. More examples of degenerative treatments and one-side effect are found in our articles: NSAIDs (non-steroidal anti-inflammatory drugs) and cortisone injections.
NSAIDs and Stem Cells
In 2010, this is what I wrote in my paper in the Journal of Prolotherapy entitled: The Acceleration of Articular Cartilage Degeneration in Osteoarthritis by Nonsteroidal Anti-inflammatory Drugs:
It is clear from the scientific literature that NSAIDs have a significant negative effect on cartilage repair and formation which causes an acceleration of the deterioration of articular cartilage in osteoarthritic joints.
- The preponderance of evidence shows that NSAIDs have no beneficial effect on articular cartilage and accelerate the very disease for which they are most used and prescribed.
- While the rapid deterioration of joints after long-term NSAID treatment can be from a loss of proactive pain sensations, it is much more likely that it is a direct effect of NSAIDs on cartilage.
- The long-term consequence of the deterioration of the joint is a need for joint replacement. This author notes that massive NSAID use in osteoarthritic patients since their introduction over the past forty years is one of the main causes of the rapid rise in the need for hip replacements and knee replacements both now and in the near future.(2)
Six years into that future, here are three papers from 2016 and one from 2017.
- NSAIDs makes pain worse and interferes with stem cells healing capabilities. NSAIDs do this by inhibiting stem cells’ ability to regrow bone. Further, residual NSAID presence in the joints may weaken bone, causing structural instability. This is supported by research from McGill University reporting on Naproxen’s effect on bone healing.(3)
- This research is from from doctors at Maastricht University Medical Centre and Boston University discussing the NSAID COX-2 inhibitor.
- COX-2 inhibitors influence COX-1 inhibitors causing delay and suppression of chondrocyte hypertrophy (the growth of cartilage cells) and natural repair of articular cartilage growth.(4)
- Doctors at Oxford University examining elderly patients with non-healing bone fractures found treatment of post-fracture pain with NSAIDs put the patient at the greatest risk for non-union of the fracture and questioned whether stem cells introduced into treatment could help these patients.(5)
- In the Journal of gastroenterology and hepatology, researchers examined the digestive and gastrointestinal distress caused by NSAIDs and found that they may have their origin in the patient’s low anti-oxidant inner milieu. In other words the immune system is too compromised to fight off the NSAIDs side-effects including ulcers.(6)
Clearly, NSAIDs inhibit and suppress the growth of bone and collagen, the stuff of ligaments, tendons and cartilage. If a patients has a long-history of NSAIDs this should be addressed prior to stem cell therapy and a treatment plan discussed.
Corticosteroids and Stem Cells
“Following corticosteroid therapy in osteonecrotic patients, abnormalities have been demonstrated in the bone marrow of the iliac crest, with a decrease in the stem cell pool.”(7). This single piece of research published by French doctors in the journal Clinics in orthopedic surgery should be enough to convince anyone that cortisone makes healing with stem cells difficult. Patients who see doctors who insists on cortisone first, should research this treatment decision.
If you consider the Mayo Clinic a reliable source of information then note that recent research from the Mayo Clinic suggests cortisone may hinder the native stem cells in cartilage. Cortisone threatens their innate regenerative capacity in exchange for temporary analgesia.(8). We do not need to in this article to continue the assault on the detrimental effects of cortisone on healing. One of our most visited articles provides much more research, read it here: Alternatives to Cortisone.
Obesity and Stem Cells
I am introducing a discussion on obesity at this point because of clear implication in making healing with any treatment much more difficult.
In a recent paper in the journal Osteoarthritis Cartilage from doctors at the University of Calgary. The doctors noted and speculated that obesity may prevent tissue remodeling – in other words your ability to heal. Since stem cells are closely associated with the remodeling and repair of bone and cartilage, these doctors hypothesized that obesity would alter the frequency, proliferation, multipotency and immunophenotype [healing protein expression] of stem cells from a variety of tissues.”(9)
Does this mean stem cell injection therapy will not work for obese patients?
The answer is not fully understood, obesity certainly makes healing more difficult.
This is a subject we cover extensively on our site, for more information please visit these articles
- What is obesity induced osteoarthritis? What is “inflammaging”?
- Metabolic syndrome and osteoarthritis joint pain
- Excessive weight and joint pain – the inflammation connection
Stem Cell treatments, like other components of our Comprehensive Prolotherapy program works best when the patient changes their immune situation from compromised to responsive.
In the Journal of Prolotherapy nutritionist Margaret Taylor wrote:
People who heal well obviously differ in some important way from those who we see with chronic non-healing injuries. The distinguishing feature is primarily the effectiveness of the healing cascade. Unless the factors contributing to this are considered, the outcome of Prolotherapy (and stem cell Prolotherapy) will also be affected.
Research shows the most important nutrients for the generation of new collagen for healing are protein, vitamin C, zinc, copper and manganese—all cofactors for various enzymes in collagen generation and stability. Nutrition in modern societies is shown to be inadequate in many of these areas and can easily be corrected. Malabsorption is also a cause of poor healing and musculoskeletal difficulties, and undetected celiac disease is common in our patients. Chronic widespread pain is similar but a separate entity, and thyroid and vitamin D deficiency need to be considered.(11)
This article briefly discusses the various factors that will prevent stem cell treatments from attaining their desired results, but it should be enough of an introduction to help guide you in making the treatment as successful as it can be.
If you have questions about how stem cells heal degenerative joint disease after years of cortisone and painkillers, get help and information form our Caring Medical staff
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