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Personalized joint injections

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In the near future, medical professionals hope to use non-invasive analytic devices, like a mini MRI scanner, that will produce a readout of a joints’ chemical profile without the need for a needle. (Courtesy photo)
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Normal joints dry out with aging. The tissues lose hydration in a process similar to what happens to women during menopause. And just as estrogen replacement helps women’s tissues return to normal lubricity, specific anabolic and lubrication therapies may one day be able to help everyone’s aging joints.

We are on the threshold of a new diagnostic and therapeutic era, where we will be able to chemically profile your injured joint and provide the specific replacement and stimulant therapy needed to restore its health. Our team and others are engaged in research investigating this possibility.

We already know that injured and/or arthritic joints have an increased level of degradative enzymes that break down cartilage. Cortisone or corticosteroid injections shut down the cells that make those degradative enzymes, thereby reducing inflammation. Unfortunately, corticosteroids also shut down normal cellular activity — weakening the very tissues we want to heal and leading to tendon ruptures. (Thus, the general move away from using cortisone.)

Oddly, arthritic tissues sometimes have higher water content than normal tissues — but this is accompanied by increased brittleness. This is because the chemistry of the cartilage matrix changes with age, adhering to water molecules but inhibiting the normal fluid flow that creates tissue elasticity. The mechanical and chemical profiles of each joint — within each person and between people — are different and treatable.

When we inject lubrication fluid, growth factors and stem cells into our study patients, we also withdraw a small amount of fluid. We study its initial chemical profile, then test it again a week after the therapeutic injections. Over time, we will learn the range of joint fluid chemistries. The variation is likely to be specific to each person’s joint injuries and body chemistry. This should help us understand exactly which injections make the most sense for each personal chemical profile.

In today’s new Anabolic Era of orthopaedics, the tools we have to change the joint from a degradative or injured status to an anabolic or healing status include injecting lubrication fluids plus anabolic stem cells and growth factors. These stimulate increased hydration and possibly accelerate healing of the joints. At our clinic, we use the most potent source of growth factors: the amniotic fluid and tissue from young healthy mothers who donate the tissue at C-sections. Other researchers are using PRP, bone marrow and fat sources of stem cells and growth factors. All are a mixture of potent stimulants. Some are more potent than others, but none are yet specific to a given patient’s injuries.

The questions are: Which cells and factors to use; when and how often to use them; and will they successfully protect the joint from arthritic degradation?

There are specific things the patient can do to promote healing as well. Exercise increases blood flow to all the tissues of the body, bringing healing factors in natural fashion. Increasing non-impact exercise almost always improves joint health. Supplements such as glucosamine and chondroitin sulfate are the precursors the body needs to build the matrix of cartilage in the joints; they promote the production of the natural joint lubricant called hyaluronate.

At this writing, we do not yet have an accurate measurement of personal joint chemical profiles. But in the near future, hopefully, we will have the data from our studies and non-invasive analytic devices: like Star Trek’s medical scanner or a mini MRI that will produce a readout of a joints’ chemical profile without the need for a needle. Once we can follow an individual’s unique joint profile, we will be able to intervene with either pills or injections to optimize the joint environment. Similar to your car’s oil change, synthetic oils and natural stimulants will keep your body’s joints purring for years to come.

Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco.

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