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The ugly answer to the arthritis riddle

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Future treatment of arthritis will involve harnessing the eruption of bone and cartilage that creates bone spurs to grow in the way we want it to grow to replace tissue.

You know that big, ugly bone spur that grows on the side of your finger, toe or knee, like a stalagmite in a cave? That growth is called an osteophyte — and it is stimulated to form by the disease called osteoarthritis. As painful as they can become, these growths hold the secrets to the riddle of a cure for arthritis.

A bone spur, if you look under the often tender red area of skin that covers it, looks like a white, shiny and perfect articular cartilage — the same material that covers the ends of the bones inside of our joints. Underneath the shiny surface is a column of new bone. It has the same architecture and cellular material of healthy bone and cartilage, but it is formed on the edges of the joint, rather than in the middle.

Arthritis often follows this sequence: First, there is a wearing away of, or damage to, the cartilage surface. Next, the bone beneath becomes deformed as it loses its protective covering. The rough surfaces then spread particles around the joint, leading to inflammation of the surrounding tissues. Those tissues produce enzymes that accelerate the disease and cause more swelling.

One of the body’s reactions to this process is to spread the weight-
bearing forces across the joint. This is done by increasing the surface area through the formation of these bone spurs.

In the past, treatments for arthritis have included drugs to decrease the inflammation, rest to diminish the painful grinding, surgery to clear away damaged tissue and ultimately, artificial joint replacement — usually after years of suffering.

In today’s “anabolic era” of orthopaedics, the preferred treatments are different. We use exercises to strengthen the muscles around the joints (and to increase the range of motion lost due to inflammation and tissue stiffness), injections of lubricants to decrease the friction, growth factors and stems cells to stimulate repair processes and surgical replacement of the meniscus, articular cartilage and ligament to restore the joint’s anatomy.

But the future of treatment lies in harnessing the Vesuvian eruption of bone and cartilage that creates bone spurs.

Our bodies already know how to form healthy, nearly perfect tissue at the edges of joints; we must learn how to direct the body to form them where we want them: at the site of the worn or injured cartilage surfaces. We’re learning how to do this through a series of studies of the paste graft technique. This process involves first creating a local fracture in the arthritic lesion, then packing the area with marrow and progenitor, stem and articular cartilage cells. It’s almost as if we’re nurturing a bone spur like a Bonsai tree and coaxing it to grow the way we want it to. Long-term data of arthritic patients followed for 10 to 23 years after this paste grafting demonstrated the success of this technique.

Other studies of the osteophyte itself will lead to additional novel techniques. It is clear that the body knows what to do, but it is directionally challenged. In this era of at-your-service Uber, driverless cars and pin-point drone delivery service, the call has gone out. Can our body learn to deliver cartilage where it’s needed and supply its own cure for arthritis?

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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