Stem cells and knee arthritis: ready for prime time?
Piper, 54, plays piano, walks for exercise. Doesn’t own a TV!
You can’t tell by looking at her how knee osteoarthritis (the wear-and-tear kind) dictates even minor movements. In her 20s, Piper played wallyball (it’s volleyball on steroids), diving and bouncing off the walls. Today, rising from a chair, her knees hurt. After a long plane ride, they feel like they’d “explode.”
She takes sulindac (an NSAID, like ibuprofen) daily. This spring, she got a hyaluronic-acid knee injection. Like a miracle, she could walk up and down stairs pain-free. But in two to three weeks, the pain returned.
Then she saw a flyer on stem-cell treatment for arthritis.
Stem-cell clinics – more common overseas decades ago – have inundated the U.S. wellness market. The cells, harvested from bone marrow, body fat and birth tissues, promise to treat anything from Alzheimer’s to zits.
Hmm, not so fast.
In adults, stem cells exist in almost all organs. They're “pleuripotent,” or “multi-capable” of growing into different organs. But coaxing them to mature into a specific organ – in a healthy, orderly fashion – is extremely complicated. Injecting them into blood or the troubled organs doesn’t guarantee they’d follow the desired genetic blueprints. Like raising a baby in a household of musicians, naming it Freddie Mercury doesn’t guarantee it’ll grow up singing, dancing, or be any good at it.
Currently, stem cells are FDA-approved to treat certain blood disorders. All other indications – heart, joints, brain, skin – are in the early research stage.
Doctors are seeing complications, some disastrous.
In 2009, the first reported stem-cell nightmare involved an Israeli boy with a rare form of neurological disease. His parents took him to Russia for repeated stem-cell injections. In years, he developed multiple brain tumors, originating from different donor cells.
The FDA has begun to crack down on stem-cell clinics. Last month, it successfully sued one in Florida, which had been injecting eyes and caused three patients to go blind.
In a 2019 for-patient section, the American Medical Association recommends the following knee-arthritis treatments: weight loss (if applicable), low-impact exercise (swimming, tai chi, walking, biking), NSAIDs. In severe cases, knee replacement. Steroid injection helps short term (weeks). Frequent use can cause cartilage loss which further compromise the joints.
It cautions about treatments with "no consistent evidence of benefit," such as “insoles or special medical shoes; glucosamine, chondroitin, and other supplements; injections of hyaluronic acid or platelet-rich plasma; stem-cell treatments; and arthroscopic surgeries including debridement or partial meniscectomy.”
What do I think of its do-not-recommend list? Some help, for a while; some hurt (joints or wallets); some do diddly-squat.
Do I believe in stem cells? Yes, I do. Like I believe my kids can be president someday – just not today.
Piper’s final treatment goal: avoid knee surgery. Last summer, she lost 10 pounds and noticed a big difference in her knee pain. The winter weight gain set her back. But she’s confident she can do it again.
She opted not to repeat the hyaluronic-acid injection (relief is short-lived). And not to pursue stem-cell treatment. “If stems cells are so effective,” she said, “wouldn’t I hear from my rheumatologist first?”