Stem Cells for arthritis. Posted by Rheumatologist in Dubai.

Stems cells taken from just a few grams of body fat are a promising weapon against the crippling effects of osteoarthritis.  This interview is from the Chicago Tribune.

For the past two decades, knee, hip or other joint replacements have been the standard treatment for the deterioration of joint cartilage and the underlying bone. But artificial joints only last about 15 years and are difficult to repair once they fail.

Stem cell injections may offer a new type of therapy by either stopping the degenerative process or by regenerating the damaged cartilage, said pioneering researcher Dr. Farshid Guilak, a professor of orthopedic surgery and director of orthopedic research at Duke University.

Guilak, one of the first researchers to grow cartilage from fat, explains why stem cells are a bright light in osteoarthritis research and why widespread clinical use is still years away. Below is an edited transcript of the interview.

Q: How are stem cell injections purported to help?

A: Several studies in animals show that stem cell injections may help by reducing the inflammation in the joint. Stem cells appear to have a natural capacity to produce anti-inflammatory molecules, and once injected in the joint, can slow down the degenerative process in osteoarthritis.

(Since this interview, research published in Stem Cells Translational Medicine has found that stem cells may also be an effective way to deliver therapeutic proteins for pain relief related to rheumatoid arthritis.)

Q: Does the bulk of research look at how stem cells heal traumatic injuries, or does it look at degenerative conditions such as arthritis?

A: Nearly all previous studies on stem cell therapies in joints have focused on trying to repair small "focal" damage to the cartilage. Only a few recent studies have begun to examine the possibility for treating the whole joint, either to grow enough cartilage to resurface the entire joint or to use stem cells to prevent further degeneration.

Q: Meaning one day, entire joint surfaces such as hips and knees could be grown in a lab?

A: That has been one of our primary research goals, so that people with arthritis can simply resurface the cartilage in their joints without having a total joint replacement. To do this, we have developed a fabric "scaffold" that can be created in the exact shape of the joint, while allowing stem cells to form new cartilage. One of our most exciting findings was the discovery that fat tissue contained large numbers of stem cells that could form cartilage and bone. In this way, we could easily get enough cells from a small liposuction procedure to completely resurface a person's worn-out hip or knee.

Q: Is it legal to get stem cell treatment for osteoarthritis in the U.S.?

A: While there is great promise for stem cell therapies, there's little clinical evidence supporting it for arthritis; we don't yet know if this type of treatment is safe in humans, or for that matter, that it even works. Some physicians are offering these treatments without FDA approval, but I feel it is irresponsible and potentially dangerous to perform such a procedure without having a clear understanding of the possible risks and benefits. Several clinical trials are planned and ongoing, mostly outside the U.S.

New test for Rheumatoid arthritis not available in UAE

The only tests available for Rheumatoid arthritis in UAE are rheumatoid factor and anti-CCP>
The 14-3-3eta lab-developed test is based on the 14-3-3eta protein biomarker through an exclusive license agreement in the United States with Augurex Life Sciences. One test provides results of 14-3-3eta blood levels, while a comprehensive panel provides results of blood levels of the novel marker as well as the conventional RA markers CCP antibodies and RF.

Physicians may consider results of RF, CCP antibody and 14-3-3eta tests, along with a medical evaluation and X-rays, to diagnose RA.

Quest Diagnostics already provides the RF and CCP antibody tests, and a panel that incorporates these assays as well as 14-3-3eta has certain advantages, including potentially higher sensitivity for detecting RA, than any of the three markers can provide alone. A panel also allows a physician to test a patient only once and receive a single report.

This “one blood draw, one report” approach is significantly more convenient for the patient and clinician in those cases where a physician may believe consideration of results of all three tests would aid diagnosis.

On the other hand, a physician may not believe results of all three tests are required for a reliable diagnosis or perhaps a patient received certain tests already, perhaps under care of a different doctor, and additional testing would be redundant and unnecessary. In these cases, single tests may be more appropriate.

How do these novel tests allow for early diagnosis of RA?
Research shows that elevated blood levels of the 14-3-3eta biomarker outperform conventional RF or CCP antibody testing for RA. When physicians consider results of all three markers, the sensitivity improves even further.

In addition, co-morbid conditions, such as type 1 diabetes, osteoporosis and gout, do not abnormally raise blood levels of 14-3-3eta.

What to ask your doctor regarding your Lupus?

1. Do I have kidney or other organ involvement?

2. How active is my SLE presently?  Are my C3 C4 low and dsDNA high as these can be signs of active lupus?

3. Should I take calcium and Vitamin D supplements?

4.  I have heard lupus patients are at high risk for heart disease.  Do I need to have my cholesterol checked?

5.  I have heard a medication called Hydroxycholoroquine can reduce lupus flare.  Should I take this?

6.  Should I have a bone density test?

Back pain treatment

(HealthDay News) – Injection of autologous, bone marrow mesenchymal cell concentrate (BMAC) into degenerated lumbar discs may relieve low back pain of discogenic origin, according to research presented at the American Academy of Pain Medicine's 29th Annual Meeting, April 11–14, in Fort Lauderdale, FL.

D. Joseph Meyer Jr., MD, PhD, of the Columbia Interventional Pain Center in Columbia, MO, and colleagues conducted a retrospective study of 24 consecutive patients treated with injections of autologous BMAC into degenerated lumbar discs for pain relief.

According to the researchers, of the 24 patients treated with BMAC injections, 12 patients received only one treatment, and 12 patients received one or more lumbar injections or surgical treatments. None of the patients reported worsening of pain after BMAC injections. Of the 12 patients who received only one treatment of lumbar disc BMAC, 10 patients reported to have pain relief at two to four months. Long-term efficacy and safety results are pending.

"The results of our case review are encouraging," said Meyer in a statement. "Currently, when conservative treatment measures fail, therapeutic options are limited for individuals with back pain due to disc degeneration. Many resort to disc surgery or spinal fusion with mediocre results. Our goal is to help develop a safe, natural method to boost the body's own capacity to heal discogenic pain."

Coffee decreases gout attacks

According to researchers from Boston University and Harvard Medical School, four cups of coffee per day can halve the chances of gout in women.

The latest findings were published in the American Journal of Clinical Nutrition.
The report comes after a long-term study that included almost 90,000 female nurses in the US for over a 26-year period during which researchers monitored their health and dietary habits.
Almost 900 nurses developed gout during that time.

While analyzing the beverage intake, researchers found that women who had consumed larger amounts of coffee during that period were at less risk.
Researchers did not know the reason of the positive effect of coffee however the theory is that it can reduce the insulin level in the blood.

“Long-term consumption of coffee is associated with a lower risk of gout in women”, researchers said.
Gout develops when uric acid, a natural byproduct, is not disposed properly by the body. And it is known that there is a link between higher insulin and higher uric acid.

Although there is a genetic predisposition to it, diet and excess in alcoholic drinks can also trigger the condition.
Gout attacks can produce unbearable pain and can last up to a week.
There are also studies that suggest that gout could be an early warning of heart disease.

Lupus test

The ANA test or anti-nuclear antibody is used to test for SLE or lupus.  Normal or healthy people can also test positive for ANA but in low titers.  ANA test greater than 1/160 are significant and need follow up tests.  Tests such as dsDNA or Smith can confirm lupus.  An antiRO and anti La test is suggestive of Sjogren's.  This test should only be done if there is a suspicion of connective tissue disease.