In the many years that we have treated patients with knee problems, there has always been the instance when a patient will ask us if they can continue with their anti-inflammatory medications. The answer is typically no. When the patient asks why? We have to remind them that regenerative medicine techniques like the ones we use, count on the beneficial aspects of inflammation. Inflammation is the way Nature heals. If we stop the inflammation, we stop the healing.
This simple statement, that inflammation is Nature’s way of healing has been the subject of great debate in the medical community for decades. Doctors argue that you have to shut down inflammation to prevent more damage. For decades, cortisone became the weapon of choice. Cortisone as doctors would later find out, would destroy joints and contributed to the great surge in joint replacement surgeries.
But don’t you need to shut down inflammation to heal? A group of medical researchers in Australia looked at inflamed knees. The researchers wanted to see what came first, knee inflammation or knee degenerative changes. In other words, did the inflammation cause the degenerative knee disease or did the degenerative knee disease cause the inflammation?
Knowing which came first would make a big difference for patients with knee pain and degenerative arthritis, and, towards helping doctors and patients understand a path of treatment. This treatment path would would move away from the use of anti-inflammatories as a primary step in “conservative care” of knee pain. The research team published their findings in The Journal of Rheumatology.(1)
Surgery is dangerous. Anti-inflammatories are more dangerous.
Before we look at the study on the inflamed knees, let’s first listen to what a recent study says about anti-inflammatory medications: This is from the Journal of orthopaedic surgery, (2) and university hospitals in the United Kingdom, The doctors in this study compared the long-term safety of taking anti-inflammatory medications with the long-term safety of knee and hip replacements. They are measuring side effects including mortality.
- Mortality was the highest for naproxen (Aleve, Moltrin) and lowest for total hip replacement.
- Highest gastrointestinal complications were reported for diclofenac (Voltaren) and lowest for total knee replacement
- Ibuprofen had the highest renal complications.
- Celecoxib (Celebrex) had the highest cardiovascular risk
The “results of this study show that medical management of hip and knee osteoarthritis, particularly with non-steroidal anti-inflammatory drugs, may carry higher mortality compared to surgery.”
I have written an extensive article Dependency on painkillers may lead to unsuccessful knee replacement that will help shed more light on this subject.
Understanding the healing and destructive roles of knee inflammation
In the research I mentioned at the top of this article, doctors looked at the inflamed synovial membrane in the knees of 413 patients with painful osteoarthritis. The patients were almost equally divided into similar groups of women and men, and the average age was 63 years old.
The synovial membrane is a tissue that surrounds the knee and protects the joint capsule. In addition, to acting as a protective lining, the membrane secretes synovial fluid. Synovial fluid is a lubricant that helps the cartilage of the knee glide through normal range of motion.
When the synovial membrane becomes inflamed, it secrets inflamed synovial fluid.
Inflamed synovial fluid makes more inflammation.
While rheumatoid arthritis or immune disorder can cause synovitis, this study focuses on the development of synovitis as being caused by degenerative wear and tear arthritis..
Back to the the Australian research team. In the subject patients the doctors measured:
- The inflamed fluid of the knee synovitis, cartilage defects, cartilage volume, and bone marrow lesions via magnetic resonance imaging.
- Joint space narrowing and osteophytes (bone spurs) were assessed using radiograph.
- Knee symptoms were assessed by using the popular Western Ontario and McMaster University (WOMAC) osteoarthritis index scoring system.
I am highlighting this measurement and scoring system because the researchers have come to a conclusion that inflammation is the result of degenerative changes, the degenerative changes are not the result of inflammation.
Here is the research conclusion:
Knee cartilage and subchondral bone abnormalities predicted change in effusion-synovitis (more inflammation), but effusion-synovitis (more inflammation) did not predict knee structural changes. These findings suggest that synovial inflammation is likely the result of joint structural abnormalities in established osteoarthritis.
What does this mean?
It means that anti-inflammatory treatments are only suppressing inflammation, the degenerative damage to the knees continues.
Moving away from anti-inflammatory treatments and moving towards pro-inflammatory treatments.
This is why treatments such as cortisone injections, Regenokine injections, NSAIDs (non-steroidal anti-inflammatories) do more damage than good. The inflammation is trying to heal damage, shutting off the inflammation makes MORE damage. This is why medicine is moving away from anti-inflammatory treatments and moving towards pro-inflammatory treatments.
In our clinic not only do we use Stem Cell Therapy and Platelet Rich Plasma Therapy. We have published research on the effectiveness of the treatments
You can read our published research in this article Stem cell therapy for knee osteoarthritis. In this article I will present research to support the use of stem cell treatments for knee osteoarthritis. I will discuss newly published research by the Darrow Stem Cell Institute on the use of bone marrow derived stem cells and discuss the use of amniotic and placenta tissue treatments, umbilical cord blood treatments and adipose or fat derived stem cells. We will explore the newest research and clinical applications.
Are you a candidate for non-surgical treatment of your back pain? Ask Dr. Darrow
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1 Wang X, Jin X, Blizzard L, Antony B, Han W, Zhu Z, Cicuttini F, Wluka AE, Winzenberg T, Jones G, Ding C. Associations Between Knee Effusion-synovitis and Joint Structural Changes in Patients with Knee Osteoarthritis. The Journal of Rheumatology. 2017 Sep 1:jrheum-161596.
2 Aweid O, Haider Z, Saed A, Kalairajah Y. Treatment modalities for hip and knee osteoarthritis: A systematic review of safety. Journal of Orthopaedic Surgery. 2018 Nov 8;26(3):2309499018808669.
There is controversy in the medical community about umbilical cord blood stem cells. Some insist that the injectable solution contains abundant live umbilical cord blood stem cells. Some suggest that the stem cells are not alive. I have seen the flow cytometry showing live stem cells. The research shows that these stem cells release cytokines and growth factors that awaken native stem cells. I have tried this treatment on myself for both shoulders and knees. After great success, I started using this treatment on patients. I still use PRP and bone marrow depending on the patient’s pathology and requirements. To date the results are excellent for all of these treatments. We are in the process of doing a study on cord blood stem cells (we have done others on bone marrow and PRP) to see which treatments are the most successful. We are awaiting more long term results.