Can stem cells heal degenerative joint disease after years of cortisone, anti-inflammatory and painkiller damage?

How stem cells heal degenerative joint disease after years of cortisone and painkillers

Ross Hauser, MD

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

There are many reasons why you have degenerative joint osteoarthritis, physically stressful job, high level of activities, even including past histories of arthroscopic surgery.

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?

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.

The amazing chondrocyte and its ability to repair and regrow cartilage

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.

Stem cells do have the ability to change this degenerative toxic environment into a regenerative healing environment

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 painkillersMore 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.

Six years into that future, here are three papers from 2016 and one from 2017.

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

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

1. Pei M. Environmental preconditioning rejuvenates adult stem cells’ proliferation and chondrogenic potential. Biomaterials. 2017 Feb;117:10-23. doi: 10.1016/j.biomaterials.2016.11.049. Epub 2016 Nov 25. [Google Scholar.]

2. Hauser RA. The Acceleration of Articular Cartilage Degeneration in Osteoarthritis by Nonsteroidal Anti-inflammatory Drugs: Journal of Prolotherapy. 2010;(2)1:305-322. [Google Scholar]

3. Salem O, Wang HT, Alaseem AM, Ciobanu O, Hadjab I, Gawri R, Antoniou J, Mwale F. Naproxen affects osteogenesis of human mesenchymal stem cells via regulation of Indian hedgehog signaling molecules. Arthritis Res Ther. 2014 Jul 17;16(4):R152. doi: 10.1186/ar4614. [Google Scholar]

4. Caron MM, Emans PJ, Sanen K, Surtel DA, Cremers A, Ophelders D, van Rhijn LW, Welting TJ. The role of prostaglandins and COX-enzymes in chondrogenic differentiation of ATDC5 progenitor cells. PloS one. 2016 Apr 6;11(4):e0153162.[Google Scholar]

5. Foulke BA, Kendal AR, Murray DW, Pandit H. Fracture healing in the elderly: A review. Maturitas. 2016 Oct 31;92:49-55.[Google Scholar]

6. Kono Y, Kawano S, Takaki A, Shimomura Y, Onji M, Ishikawa H, Takahashi S, Horii J, Kobayashi S, Kawai D, Yamamoto K. Oxidative stress controlling agents are effective for small intestinal injuries induced by non‐steroidal anti‐inflammatory drugs. Journal of gastroenterology and hepatology. 2017 Jan 1;32(1):136-45. [Google Scholar]

7. Hernigou P, Trousselier M, Roubineau F, Bouthors C, Chevallier N, Rouard H, Flouzat-Lachaniette CH. Stem cell therapy for the treatment of hip osteonecrosis: a 30-year review of progress. Clinics in orthopedic surgery. 2016 Mar 1;8(1):1-8. [Google Scholar]

8. Wyles CC, Houdek MT, Wyles SP, Wagner ER, Behfar A, Sierra RJ. Differential cytotoxicity of corticosteroids on human mesenchymal stem cells. Clinical Orthopaedics and Related Research®. 2015 Mar 1;473(3):1155-64. [Google Scholar]

9. Collins KH, Reimer RA, Seerattan RA, Leonard TR, Herzog W. Using diet-induced obesity to understand a metabolic subtype of osteoarthritis in rats. Osteoarthritis and cartilage. 2015 Jun 30;23(6):957-65. [Google Scholar]

10. Monteiro R, Azevedo I. Chronic inflammation in obesity and the metabolic syndrome. Mediators of inflammation. 2010 Jul 14;2010. []

11. Taylor ME. Nutritional Support for Soft Tissue Healing. Journal of Prolotherapy. 2011;3(3):709-713.

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