Archive for the ‘Rheumatoid Arthritis’ Category

Treating Rheumatoid Arthritis with Stem Cells

Sunday, August 14th, 2011

hand arthritis stem cells

LZ is a 43 year old woman with rheumatoid arthritiswho was evaluated by us last year with a history of debilitating right foot pain and rheumatoid arthritis. She sought us out because she wanted a foot and ankle surgery alternative. Imaging and exam demonstrated that she had severe arthritis in the talonavicular joint of the foot. This joint connects the ankle bones to the foot bones on the inside of the area between the foot and ankle. Patients with arthritis in this joint commonly report trouble wearing shoes, as any direct pressure causes pain. While we don’t usually treat patients with rheumatoid arthritis, we agreed to cautiously proceed by injecting her own stem cells into this foot joint under imaging guidance. In December of last year she underwent a Regenexx-SD procedure and by March reported 65% improvement in her foot with an ability to do more walking. By the spring, noting improvement in her foot, she was eager to see if we could tackle her hands with more stem cell injections. She had a 4 year history of left wrist pain which hurt at a constant 6-7/10 pain and that was made worse by activities such as opening jars. On her MRI, she had a partial tear of the radial scapholunate ligament with arthritis in the second MCP joint of the hand (joint at the base of the second finger). She underwent another Regenexx-SD stem cell procedure in March of 2011 focusing on these areas. She then underwent a 2nd  same day stem cell procedure in May of this year where more finger joints and her bilateral wrists were injected. She recently wrote this note to Dr. Hanson:

“I wanted to give you an update on my hands. I’ve had very good results in both my hands. I would say I’m about 60% better. I started noticing big changes around my 6-7th week. I definitely have more grip and strength with my hands than before. I am able to open some jars with no assistance. I can shower and get dressed with less pain. My hands don’t hurt as much.”

We’re cautiously optimistic about LZ’s progress and hope that she continues to improve. Since rheumatoid arthritis is such a devastating illness where even simple things like opening a jar can become an impossible chore, any increased function we can give her will help her stay independent.

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Posted in Ankle, Foot, Latest News, Regenexx-SD, Rheumatoid Arthritis | Comments Off

Hip AVN and Stem Cells: Difficult Choices for a JRA Patient

Wednesday, March 23rd, 2011

hip avn avoid surgery

JM is a 33 year old with a long history of juvenile rheumatoid arthritis (JRA) who was seen in January of 2009 for AVN of the hip. At that time he had been in remission from the JRA for about 10 years and had been diagnosed at the age of 18 months. He already had his right hip replaced due to joint damage from the JRA and didn’t want another hip replacement. He initially came to us for a stem cell treatment of left sided hip arthritis, but on initial exam his MRI showed stage 1-2 AVN in the bone, so we redirected treatment at the bone rather than the cartilage, as treating cartilage didn’t make much sense if the bone would eventually collapse underneath the cartilage. Stopping the advancement of the AVN or osteonecrosis was therefore our main focus. As a result, he underwent a percutaneous core decompression of the hip with a Regenexx-C bone procedure on 1/29/09 (needle placed under x-ray guidance into the AVN bone lesion). He is now 2+ years out from the procedure and just sent us an e-mail this week (some of the info was personal or about complex health choices, so this is redacted):

“…the pain in my left hip is 50-60% better with that one treatment…”

JM now has a bigger quandry. Because of his long history of active JRA, many of his joints are failing. We didn’t treat the cartilage so it’s difficult to know if we could have helped that problem with Regenexx-C. Because of his severe JRA, he’s left with alignment issues in the hip and is trying to decide the best way to proceed. JM’s result brings up a key point that we always discuss with AVN patients. Our primary goal is to treat the bone collapse with a secondary goal of treating cartilage. If we catch the disease early, our clinical experience tells us we may help both. However, for JM, his cartilage loss began in many joints (including this hip) due to the JRA. The upshot? For our approach to AVN to be a total success, we need to see these cases when they are at stage 1-2 and before serious cartilage loss occurs in the joint. Our experience has been that patients with early AVN, but severe cartilage damage for other reasons, may only have be partial improvement in their pain. We’re trying to help JM decide on his best options going forward.

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Posted in AVN/Osteonecrosis, Hip, Regenexx-C, Rheumatoid Arthritis | Comments Off

Interesting Observation with Rheumatoid Arthritis Patient

Wednesday, November 17th, 2010

We have traditionally avoided the treatment of patients with Rheumatoid Arthritis (RA). The reason was that with our cultured procedure, it was very difficult to grow cells in these patients, often because of the large number of medications used to control their disease. RA is different from osteoarthritis. While traditional arthritis (osteoarthritis-OA), is a wear and tear problem (joints wearing out), RA is an inflammatory problem where the body attacks itself. These patients are often on significant drugs with severe toxicity to the body (many are immune suppressants). Animal studies have shown that mesenchymal stem cells may be helpful in treating RA. Recently we tried our Regenexx-SD for the knee of such a patient and tried APC (Autologous Platelet Concentrate) for one hand joint. We have confirmed that our APC contains Blastomere Like Stem Cells (CD66e positive using flow cytometry). Here’s the patient’s report at about 2 weeks out:

“My knee is definitely better, can almost climb stairs like a normal person, but don’t push it.  The real miracle is the stem cell…on my left hand.  WOW!!  The swelling and pain in my knuckles disappeared the next day,  my hand is now straight, and doesn’t look deformed, and for the first time in 2 years I can open some cans and bottles.  The wrist bone also looks a lot less swollen. When it is cold my shoulders still hurt a little, and I am a bit stiff after sleeping all night.”

What may have happened in the hand? The growth factors from the platelets may be modulating the swelling or it could be the BLSC’s. Either way, while the early report is encouraging, more time and patients will be needed to confirm these results. Does this means stem cells can heal RA? NO. This is just an interesting observation from a very low risk therapy, but one I thought worth sharing. If you’re an RA patient, I would take nothing from this observation other than this approach may be something to keep an eye on at this point. Until we know how long this effect lasts, the stem cells may be no better than a simple steroid shot.

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Posted in Hand/Thumb, Knee, Latest News, Rheumatoid Arthritis | Comments Off