joint injections and arthritis

Thursday, December 29, 2011

Finding a magic bullet to cure disease has always been a mantra in medicine. When time is short and treatment options are few, patients will go almost anywhere in search of a miracle. In the rarified air of professional sports, elite athletes act in the same manner as injuries and pain limit their ability to perform. This is especially true as an athlete ages. And so, based on a recommendation from the NBA’s Kobe Bryant, New York Yankee Alex Rodriguez made his way to Germany to have his arthritic joints injected with a not yet proven mixture of chemicals in hopes of decreasing pain and inflammation.

To be fair, there is good science behind the Orthokine injections that were performed on Rodriguez’ shoulder and knee but most of it has been done on racehorses. Orthokine is the brand name for a type of autologous conditioned serum, where certain proteins are extracted from the patient’s own blood and then injected into a joint. The supposition is that damaged cartilage leaks interleukin factor 1 into the joint causing inflammation and pain. Orthokine inventors believe that there is an anti-interleukin factor that can block that inflammation and they have combined that chemical with other anti-inflammatory proteins to be injected into inflamed joints. Their chemistry is a trade secret.

Drs. Moser and Wehling, the owners of Orthokine, have published but one study in 2009 that details the benefits of their procedure. It involved treating 310 patients split between three groups: Orthokine, hyaluronic acid (an approved injectable for arthritis) and saline. After 2 years, patients in all three groups experienced pain relief and better joint function with Orthokine patients having a statistically better outcome.

There are numerous studies of autologous conditioned serum injections in the equine literature where the levels of chemicals like interleukin and other cytokines that cause inflammation can be decreased but there was no effect on the cartilage metabolism itself. As well, studies have shown that in horses, joints become less swollen and have less bleeding in the membranes that line the joints. But the damaged cartilage is not repairing itself, therefore, treatments are palliative, meaning that they are meant to control symptoms and not curative.

There are a variety of newer treatment modalities available as adjuncts to joint arthritis. Some are approved in the United States and have significant promise backed by reasonable research. Plasma rich plasma (PRP) injections fall into this category. There are other treatment options that are less than legal from human growth hormone injections to Actovegin, a protein derived from calf blood.

Mr. Rodriguez has already experimented with PRP and has had a relationship with Anthony Galea, the Canadian doctor who was convicted of illegally treating pro athletes with human growth hormone. It seems that he is looking for the Holy Grail that will extend his career for just a little while longer. This behavior is totally understandable. People who suffer from catastrophic illness often seek alternative therapies when mainstream medicine is unable to produce a cure. From laetrile cancer therapies in Mexico to venous stenting to help multiple sclerosis patients, hope and fear drives patients to seek help.

In this situation, sports mirror life. Pro athletes have a limited career life span and as the end draws near, some reach out and look for any means to extend that career for a week, a month, a year. Others retire gracefully. Who is to judge what way is right.

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