HIV Foundation Health Osteoarthritis in the knee: How stem cells can repair damaged cartilage

Osteoarthritis in the knee: How stem cells can repair damaged cartilage

It crunches and cracks, and some movements during exercise are really painful. When the knee shows signs of wear and tear, those affected want a miracle cure that rebuilds the cartilage. Hope rests on stem cells.

  • The body’s own stem cells have a positive effect on osteoarthritis-related inflammation in the knee.
  • A study now wants to clarify whether they actually build up permanent cartilage.
  • A transplant can repair minor cartilage damage in young patients.

After a certain age, signs of wear and tear become noticeable in the knee . After the age of 30, the risk increases linearly. The painful, inflammatory breakdown of cartilage in the operating room and with an artificial knee ends 150,000 times a year. Then smooth metal has to replace the cartilage layer, which allows round, painless movements in a healthy knee.

The idea frightens many people suffering from osteoarthritis. They hope for new methods to rebuild lost cartilage: stem cells should help.

Belly fat provides the best stem cell material

The doctor uses the patient’s belly fat as a starting material. The idea behind it: stem cells can be obtained particularly easily and in relatively large numbers from vascular fat tissue. Injected at the location of the defect, they learn from the microenvironment into which cell type they should develop.

According to this principle, the doctor and stem cell researcher Eckhard Alt uses the undifferentiated cells : Stem cells from the patient’s fat tissue are processed in the operating room within an hour and injected into the patient where he needs them – for example into the osteoarthritis knee.

The founder of the “Interdisciplinary Stem Cells Research Center” in Houston and a private clinic in Munich sees stem cells as the future therapy for chronic inflammatory diseases of the musculoskeletal system – among other things.

The cell extract in the knee does not guarantee success

Some orthopedic practices that offer the procedure honestly state that it is a not generally recognized attempt at healing with no guarantee of success. Rather, it is a final experimental attempt to remedy knee problems without a joint replacement.

“In this so-called ‘point-of-care’ application, a cell extract is injected that not only consists of stem cells,” explains Oliver Pullig from the Fraunhofer Translational Center for Regenerative Medicine in Würzburg. How many stem cells that are supposed to develop into cartilage material actually get into the knee is just as little regulated as the preparation of the suctioned off belly fat.

Development of osteoarthritis

Osteoarthritis most commonly occurs on the fingers, thumbs, knees, hips and big toes.

Arthrosis is always preceded by cartilage damage. Cartilage is considered to be a “shock absorber” for the joints. Initially, the damage to the cartilage is often superficial and limited to a small area. In the advanced stage, the symptoms worsen. Tension pain occurs and the joints change.

The joints react to the cartilage damage with pain, swelling or inflammation.

Stem cells instead of knee prostheses

A Europe-wide study is currently looking for scientific evidence of the anti-osteoarthritis potential of the body’s own stem cells.

A small one with six patients in Würzburg and twelve in Montpellier, France, led to success in 2013: Almost all participants canceled their previously unavoidable operation for a knee prosthesis. “Your complaints had improved throughout,” explains Oliver Pullig. “A reconstruction of cartilage was unlikely with such a large damage.”

The follow-up study that has just begun with 153 participants at ten European locations therefore fulfills a requirement that the German study director Ulrich Nöth from the Evangelical Forest Hospital Berlin-Spandau formulated back then: Stem cell therapy is best suited for patients with middle and middle-aged osteoarthritis. You are no longer eligible for a cartilage transplant, but you are too young to have an artificial joint.

New cartilage from stem cells? A study should show it

Like the pilot study, the ADIPOA2 study uses so-called mesenchymal stem cells from the abdominal fat of each subject. These precursor cells of the connective tissue have the ability to develop into cartilage, bone or fat cells.

Biologist Oliver Pullig explains: “We take 100 milliliters of belly fat from each participant. The stem cells obtained from this are multiplied millions of times in special laboratories. That takes a good two weeks. 51 patients then receive two million of these pure stem cells injected into the joint, 51 patients receive an injection with 10 million cells and 51 patients receive a placebo. “

Results should be available by the end of 2018, and thus scientific proof of whether stem cells fulfill the hope of permanently building cartilage. The scientist is optimistic: “If successful, the therapy with stem cells as a drug could be ready for the market at the next study level. It doesn’t take five years. “

Cartilage transplant only helps to a limited extent

Another method to restore lost cartilage is transplantation, which has been tried and tested for 20 years. So far, however, it has only been successful in the case of centimeter damage in an otherwise intact knee. The operation is laborious and the healing process long.

In the first keyhole surgery, the doctor removes a small piece of healthy cartilage, hardly larger than a grain of rice. These cartilage cells are propagated in the laboratory in three to four weeks. In a second operation, the surgeon places these cells or the cartilage patch on the defective area in the knee.

After that, the knee must not be subjected to any load for six weeks, then only lightly for another six weeks. Only after a year is the joint stable enough for sport to be possible.

Cartilage from the laboratory is expensive

The transplant is only suitable for younger knee patients whose cartilage and joints are free from osteoarthritis. If this therapy is successful, it can prevent further cartilage damage and a later threatened knee prosthesis.

Then, in the long term, the costs of several thousand euros for cells grown in a laboratory will pay off.

Hyaluronic acid can at least relieve pain

If these methods are out of the question, another remedy can help: synthetic hyaluronic acid is often misunderstood as a substance for building up cartilage. However, it cannot produce worn cartilage, but serves as a lubricant and for joint care.

Orthopedic surgeons inject the moisture-retaining gel three to five times at weekly intervals. Hyaluronic acid relieves pain and promotes mobility – permanently for some patients, at least for a year or two for others. Then the treatment can be repeated.

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Yоur health insurance fund mау аlѕо bе able tо provide уоu wіth members-only discounts оn varying products оr services thrоugh уоur policy. Wіth ѕо mаnу health insurance providers competing fоr уоur business, comparing health plans саn definitely pay оff whеn уоu discover thе various perks еасh offers аѕ аn incentive tо win уоur business.

Additional services – thаt іѕ, services nоt covered bу Medicare, аnd реrhарѕ nоt covered оr оnlу partially covered bу оthеr private plans – mау bе раrt оf аn incentive package offered tо earn уоur business. Fоr instance, іf уоu wоuld really like tо hаvе vision cover іn уоur health insurance plan, it’s a great idea tо fіnd a provider whо offers thіѕ аѕ a bonus іn a plan thаt fits уоur budget аnd needs. Sоmе health plan funds wіll offer оthеr perks thаt aren’t directly medical related, ѕuсh аѕ a gym membership thаt wіll probably benefit уоur health аnd subsequently lower уоur health care expenses.

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Sоmе health plan providers mау еvеn offer a perk thаt hаѕ nоthіng tо dо wіth medical services but саn bе inviting, ѕuсh аѕ discounts оn sporting goods оr apparel.

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7 Day Plan: What to Eat to Cleanse Your Colon7 Day Plan: What to Eat to Cleanse Your Colon

The intestine can recover in just one week, complaints such as flatulence and sluggishness of stools disappear, the intestinal flora regenerates – and the immune system increases significantly. Everything about the wellness regimen for the intestines, with simple recipes for every day and extra tips for a healthy digestion.

The intestine affects our health much more than was known a few years ago. The intestinal mucous membrane with its special flora made up of billions of microorganisms has a decisive influence on how well our defenses are set up, whether there is a risk of chronic inflammation, acne, autoimmune diseases or obesity.

But even if these connections have now been proven, the way we deal with the most important factor influencing intestinal health has hardly changed: diet.

We know how important the intestines are, but we still don’t pay attention to them

Most of us still eat too much meat and sausage, sugar and fat, fast food and ready meals, plus the “intestinal enemies” smoking and alcohol .

  • The direct consequences: The intestinal flora is out of balance, flatulence , constipation and obesity result.
  • The indirect ones: there is a risk of immunodeficiency, skin problems, inflammation and, last but not least, an increased risk of cancer, at least for colon cancer.

Particularly harmful: Leftovers lie in the intestines for days

Especially when food remains in the intestine for a long time, it is harmful to health. In the process, animal protein (from meat and sausage residues) in particular forms toxins that can cause damage not only in the intestines, but also in the whole body.

The medical term is intestinal auto-intoxication. Typical toxins that arise in the intestine: including neurin, putrescin, indican and cadaverine, the dead body poison.

Cleanse the bowel, but do not drain it aggressively

A mild intestinal regeneration cure with the right diet, so that the intestinal flora can recover naturally, is therefore recommended, as a kind of wellness for the intestine , so to speak . A week can go a long way. In principle, there are only two things to keep in mind:

1. At the beginning there is colon cleansing. It often takes several days for the residues to pass after a meal. This can be supported with healing earth and flea seeds. These natural measures have a gentle laxative effect and are usually better tolerated than strong laxatives such as Glauber’s salt.

The mild cleansing is complemented by light fasting. Both measures work together like a “reset” of the bowel, driving it back to zero, so to speak. This can be rebuilt with the right, this time intestinal healthy diet.

2. This diet should contain probiotics (including lactic acid bacteria) because they can help the intestinal flora to repopulate with beneficial intestinal bacteria. In addition, fiber-rich fresh food is part of it. Because dietary fibers act like prebiotics, so they serve as food for the “good” intestinal bacteria.

In contrast, you should avoid red meat, sausage, high-fat dairy products, sugar, alcohol and coffee (and preferably not only) during the intestinal diet. Of course, it is important that you drink a lot during the bowel treatment. Only then will the fiber swell up well and be able to absorb, bind and transport a lot of pollutants out of the body.

Make rice water yourself

You can support these measures with rice water, the insider tip for a healthy bowel. The slightly milky brew contains dissolved fiber, mucilage, minerals and, above all, B vitamins. This combination cares for the intestinal mucosa and supports its healthy structure.

Make rice water yourself and drink a glass every day:

  • ½ cup of organic rice
  • 1 liter of water

Bring the water to the boil, pour in the rice, simmer for a good 20 minutes until it is almost boiled over. Strain, catching the water. The rice water can be stored in the refrigerator for up to three days.

Recipes for seven days of intestinal treatment

The bowel cure is suitable for all adults, except pregnant and breastfeeding women. Anyone who has chronic illnesses and / or has to take medication regularly should consult their doctor before beginning. And off you go:

1st day of the intestinal diet

In the morning : Drink a glass of lukewarm water with a level teaspoon full of healing earth on an empty stomach. This recommendation applies to the entire course. Healing earth attracts the toxins, so to speak, binds them and transports them out of the body.

Porridge – briefly toast a good handful of oat flakes in the pan without fat, add a little water and, if you want, a pinch of salt. After a few minutes, the gruel thickens a little. With this homemade porridge there is herbal tea to taste, after the meal a teaspoon of psyllium husks, like the healing earth, stirred into a large glass of water. Flea seeds also divert pollutants, swell up strongly in the intestine, in this way stimulate the natural intestinal peristalsis and thus shorten the time leftover food remains in the intestine. The mucilage in the flea seeds also nourishes the intestinal mucosa and helps it to regenerate.

Lunch : vegetable soup with potatoes and carrots, seasoned with a pinch of sea salt and caraway seeds.

In the evening : Sweet potatoes with dip – cut sweet potatoes into small pieces, sauté, plus there is probiotic yoghurt, which is seasoned with a little dill and a pinch of salt.

In between : drink a lot, herbal tea and mineral water, apples and pears (please chew each bite several times and slowly until a porridge has formed)

2nd day of the intestinal diet

In the morning : Serve oatmeal muesli with probiotic yoghurt, rub an apple under it, flea seeds and healing earth as on day 1

Lunch : Vegetable soup with easily digestible vegetables of your choice – such as fennel, celery, potatoes

In the evening : potatoes with quark – boil the potatoes in their skins, peel them and season with fresh herbs

In between : drink a lot again, apples, a banana

3rd day of the intestinal diet

In the morning : flea seeds and healing earth as on day 1, oatmeal muesli with yogurt and banana

Lunch : Polenta with vegetables – boil polenta in vegetable stock for ten minutes, let it steep for 15 minutes, stir in a small amount of butter, with steamed vegetables with fresh herbs of your choice

In the evening : vegetable soup made from carrots and potatoes

In between : drink a lot, apples, pears

4th day of the intestinal diet

In the morning : oatmeal muesli with seasonal fruit such as blueberries and strawberries; Flea seeds and healing clay as on day 1

Lunch: asparagus with potatoes, drizzle asparagus with a little butter and season with fresh herbs, with jacket potatoes

In the evening : Lukewarm vegetable salad with fresh goat cheese, sauté vegetables of your choice, such as celery and carrots, serve with fresh radicchio, season with salt and lemon juice, spread two tablespoons of fresh goat cheese over it

Occasionally : spelled crackers, apples, 1/2 liter of buttermilk

5th day of the intestinal diet

In the morning : Muesli of your choice (oat flakes, three- or five-grain flakes), yogurt, fruit, flea seeds and healing earth as on day 1

Lunch : Gnocchi with chicken and fennel – make your own gnocchi from boiled, mashed potatoes, flour and an egg, shape the gnocchi from the potato dough and cook in water until they float on top. In the meantime, clean the fennel bulb and cut into strips, sauté in a little safflower oil, cut a chicken breast into strips and add, season with salt, stir in a little sour cream and serve with the gnocchi.

Evening : Avocado sandwich – make avocado cream yourself from a mashed avocado, mix with a little yoghurt, season with lemon juice and salt, with graham bread (whole grain bread, but chewed … slowly)

Occasionally : banana, apples, drink a lot

6th day of the intestinal diet

In the morning : banana porridge made from oat flakes – briefly bring the oat flakes to the boil in salted water, let them cool down, add a little yogurt and a mashed banana. Flea seeds and healing clay as on day 1

Midday : Wholegrain penne with vegetables and ricotta, cook the penne while chopping the carrots and onions and sautéing them in a little vegetable stock, seasoning with salt and a touch of garlic powder, adding the parsley, serving with the penne, spreading a little ricotta over the top.

In the evening : Sweet potato casserole, cut the sweet potatoes into fine wedges, place in a casserole dish, whisk an egg with a little sour cream, season with salt and pour over the vegetables, bake in the oven over a mild heat for about 25 minutes.

Occasionally : spelled crackers, apples

7th day of the intestinal diet

In the morning : porridge with a dash of kefir and fruit to taste, a few walnuts, psyllium and healing clay as on day 1

Midday : Cod on carrots and kohlrabi – chop kohlrabi and carrots and sauté in a little safflower oil, season with salt, season the cod fillet with salt and lemon, fry in a non-stick pan with a little fat, place on the vegetables, close the lid and leave to stand for another five minutes . Garnish with fresh parsley and, if you want a side dish, serve with potatoes.

In the evening : Beetroot bulgur salad with cottage cheese – boil the beetroot, cut it open and flavor it with a little lemon and salt while still warm, let it steep. In the meantime, bring the bulgur to the boil and let it steep until it is soft, then strain. Serve with the beetroot, season to taste, for example with turmeric. Crumble the cottage cheese over it and serve.

In between : banana, apples, sesame crackers

So that the intestine remains healthy in the long term

After this week the intestines have usually recovered well and digestion is working optimally. This means that the passage of food through the digestive organs has accelerated without the presence of diarrhea – which is undesirable, as is constipation. If you eat a healthy bowel diet now in the future, you will create the best basis for optimal digestion. Eating healthy intestines means:

  • drink a lot
  • Use fleas for intestinal care
  • take yoghurt, kefir or buttermilk more often because of the helpful lactic acid bacteria
  • Reduce sugar and fat
  • eat a lot of fruit and vegetables instead
  • Eat meat only once a week, fish once
  • it is best to cook it yourself, largely eliminate ready meals and fast food from the menu

It also makes sense to refrain from cigarettes and limit alcohol consumption. With this simple yet powerful program, you will not only support your bowels, you will also be doing the best for your overall health, preventing illnesses and probably even losing weight in the long run.

What really helps against joint painWhat really helps against joint pain

Natural active ingredients such as devil’s claw or NSAID drugs and opioids: These drugs are supposed to relieve joint pain in osteoarthritis. But what helps whom? FOCUS Online explains which treatments work for joint pain caused by osteoarthritis and what side effects they have.

  • Osteoarthritis results from wear and tear on bones and joint capsules.
  • Five million Germans suffer from the consequences.
  • Briefly explained: which osteoarthritis treatment helps whom?

If the joints hurt, it is usually osteoarthritis : it is the most common of all joint diseases. About five million Germans suffer from it. Osteoarthritis occurs when bones, ligaments, tendons and joint capsules wear out.

This is important to differentiate the disease from rheumatoid arthritis. Inflammation is the cause here.

This is important for osteoarthritis treatment

“Arthrosis is a disease that runs in waves,” explains Johannes Flechtenmacher, President of the Professional Association of Orthopedists and Trauma Surgeons. Less painful phases alternate with those that torment those affected.

The aim of the treatment is to relieve the pain on the one hand and to maintain or restore the ability to move on the other.

Osteoarthritis needs combination treatments

Ideally, the doctor combines non-drug treatments such as physiotherapy, nutritional recommendations, and hot or cold applications with medication. These are mainly used in the acute pain phase.

“In the less painful episodes, patients should try to avoid medication,” explains Flechtenmacher. In principle, movement in particular is an important component of therapy. His motto: “Move a lot, load little.”

Five osteoarthritis treatments put to the test:

1. NSAIDs: cortisone-free pain relievers

This is how the drug works: The non-steroidal anti-inflammatory drugs (NSAIDs) are the classic all-rounders in pain relief. They have both anti-inflammatory and analgesic effects, but do not contain cortisone.

Medicines include ibuprofen, diclofenac, or naproxen. They block two important enzymes that play a role in the sensation of pain: Cyclooxygenase (COX) isoenzymes I and II.

The so-called Cox II inhibitors are therefore well suited to treat acute joint pain associated with osteoarthritis.

NSAIDs also have an antipyretic effect.

Side effects: Gastrointestinal complaints and an increased risk of cardiovascular diseases are among the risks of NSAIDs. “That is why it is particularly important to tailor the osteoarthritis treatment to the patient,” explains orthopedist Flechtenmacher.

For example, ibuprofen is not suitable for patients with kidney problems, and diclofenac hits the liver. Both drugs also have a negative effect on the cardiovascular system. Naproxin is therefore better suited for heart disease patients with osteoarthritis.

2. Opioids

This is how the drug works: Opioids are effective remedies that are used against severe joint pain. By attacking the opioid receptors, they prevent pain from developing and being transmitted.

Tramadol is one of the morphine-like drugs. “Morphines are not suitable for treating acute phases of pain in osteoarthritis,” says Flechtenmacher. This is especially true for plasters. Morphine should only be used for chronic treatment if no other therapy is helping the patient.

Side effects: Many sufferers suffer from the exhaustion caused by morphine. Especially in older people, opioids aggravate many age problems. These include, for example, constipation and dizziness. This also increases the risk of frail patients falling.

3. Hyaluronic acid

In addition to drugs that directly combat pain, there are active ingredients that intervene in the mechanism of the disease. A typical representative is hyluronic acid.

This is how the drug works: Doctors inject hyaluronic acid into the joint to treat osteoarthritis. That’s the only way it works. “In contrast, it is pointless in tablet form, as is sometimes offered,” explains Flechtenmacher. Only in the joint does the drug help the knees or fingers move more smoothly.

With regard to evidence-based studies, hyaluronic acid should be viewed critically, adds the doctor. For example, the relief of osteoarthritis on knock knees or bow legs, where it is biomechanically induced, works less well than on straight legs.

Nevertheless, medical professionals have high hopes for hyaluronic acid. They are currently researching the structure of cartilage: “There are actually very promising developments in which hyaluronic acid is combined with stem cells or other molecules,” says Flechtenmacher. Damaged cartilage structures could be rebuilt.

Side effects: As a rule, osteoarthritis patients tolerate hyaluronic acid very well. Since it is injected directly into the joint, there is the usual risk of infection from the method.

4. Natural medicine

This is how the treatment works: Natural active ingredients such as nettle leaves, willow bark or devil’s claw should also relieve pain. The latter contains, among other things, harpagoside. Similar to the non-steroidal anti-inflammatory drugs, they are supposed to inhibit the formation of the pain messenger prostaglandin.

“So far, however, nothing has been identified in evidence-based studies that proves the effectiveness of the natural active ingredients,” explains Flechtenmacher.

Side effects: They are dependent on the natural medicine product. The instruction leaflet of the devil’s claw, for example, warns of possible gastrointestinal complaints such as diarrhea, nausea, flatulence, vomiting as well as dizziness and headaches or rashes.

5. Acupuncture

This is how the treatment works: As with natural active ingredients, evidence of how acupuncture works for osteoarthritis has not yet been provided in scientific studies.

On the contrary. An Australian study looked at the effects of acupuncture. The results published in the “JAMA” magazine showed: Acupuncture with needles or laser has no relevant effect on pain and function in patients over 50 with knee osteoarthritis and moderate or severe chronic pain.

However, acupuncture helps some osteoarthritis sufferers. Johannes Flechtenmacher, for example, relies on the alternative form of treatment

  • light and irregular pain
  • when many illnesses in the affected person rule out other drugs.

In addition, there are many patients who benefit from the doctor’s attention and empathy alone.

Side effects: The symptoms can get worse at first, writes the German Pain Society on acupuncture . And adds: “Occasionally there are slight bruises or bruises, and brief circulatory reactions can also occur during acupuncture treatment.”

In any case, those affected should not treat their joint pain independently, but should always have it checked out by a specialist.