Blogging From ACR


I’ve been busy this past week serving as the official American College of Rheumatology Blogger for Medscape.  The meeting was held in my home town, Philadelphia.

Here’s the link:

http://www.medscape.com/public/blogs

Would welcome comments


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For Natural Herbal Freaks… Some Good News!


Now that the stem cell/ PRP launch is out of the way, I can breathe a bit.

Let’s go off in a different direction.  I’ve talked about conventional medicines and not-so-conventional procedures.  Now let me provide an update on some herbal remedies for arthritis…

This interesting study was written about by Anastasia Stephens in the Daily Mail on September 26, 2009. According to research presented at the British Pharmaceutical Conference, ” when taken orally, concentrated extracts from two types of basil – Ocimum americanum and Ocimum tenuiflorum – reduced joint swelling by up to 73 per cent within just 24 hours.

‘We assessed the antiinflammatory capacity of both plants and found they were similar to those seen with diclofenac, an antiinflammatory drug widely used in the treatment of arthritis,’ says Vaibhav Shinde, of Poona College of Pharmacy in India, who conducted the research.

But unlike diclofenac and other drugs of its type, basil has not so far been found to cause side effects such as gastro-intestinal irritation and abdominal burning and pain. These can be significant problems for arthritis sufferers who take daily pain-relieving medication.

The investigators theorized that “eugenol, the oil that gives basil its distinctive aroma,” may be “the active molecule responsible for the anti-inflammatory effect.”

Another herbal remedy, turmeric, was described by Carole Jackson for Bottom Line’s Daily Health News. She interviewed registered herbalist David Winston, RH (AHG), a founding member of the American Herbalists Guild.

According to Winston, turmeric has a wide variety of healing abilities including powerful anti-inflammatory components which safely reduce the pain and swelling of arthritis, carpal tunnel syndrome, bursitis and tendonitis.

A typical dose of turmeric is two to four milliliters (ml) of the tincture three times a day, or two capsules of the powdered herb two to three times daily. Turmeric should be used with caution in individuals prone to bleeding and, because it stimulates bile secretion, it should not be used by people with a bile duct blockage.

Joe and Teresa Graedon of The People’s Pharmacy reported that celery seed was a traditional treatment for rheumatism. Ethnobotanist James Duke, PhD, author of The Green Pharmacy, attests that celery seed extracts have helped him ward off gout attacks.

Many other readers of the People’s Pharmacy website say that sour cherries can also help against gout. One reader reported: “I used tart cherries to cure a gout attack and it worked. The real news is that the pain from osteoarthritis of the hip joint diminished also.”

Remember…the effects of these herbs will be modest at best.  But they are worth knowing about.


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An anniversary and the stem cell/PRP program past the halfway point


Wow! Yesterday was our 25th anniversary.  Judy is in Boston helping her parents out.  One of them had a medical event.  Things are under control. At least up there.

Here… it’s a different story.

I can’t believe we  started the stem cell/PRP launch just a couple of days ago.  We’re past the halfway point and my staff and I are thinking about “pulling the project off the shelves soon.  Permanently or  temporarily.  Can’t say.

My advice… get it while you still can

http://www.domainnamesanity.com/webumake/wwwsites/www.aocm.org/StemcellandPRP.html

You’ll be glad you did.


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Stem cell/PRP launch is going nuts!!!


A bit over 24 hours ago, we launched our new informational project and the response has been sensational.

If you or someone you care about has painful osteoarthritis or tendonitis you need to check this out.

It’s about as natural as you can get (your own biologic material) and you can often avoid surgery and its risks.

It’s possible that joint replacement may be come a thing of the past.

Go to:

http://www.domainnamesanity.com/webumake/wwwsites/www.aocm.org/StemcellandPRP.html


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More questions and answers about stem cells and PRP…


There have been many more questions asked since we released the latest information on stem cells and PRP.  I have attempted to consolidate some of the questions and hope my answers make sense…

Question: Do Blue Cross and Blue Shield cover doctor visits and stem cell therapy?

Answer: Most likely not.  If you have any insurance questions you can call the office and ask to speak with an insurance person at (301) 694-5800.

Question:  How many patients had this procedure done last year?

Answer: 23.  Of these, 17 were knees, 2 were shoulders, 4 were hips.

Question: How many decided to have a total knee replacement afterward?

Answer: 1

Question: What is the average regrowth after 6 months, 12 months, 18 months, 36 months?

Answer:  Since we’ve only been doing this procedure for little more than a year, I can say that we have no data for 18 months and 36 months.  The parameters we chose to measure include patient visual analogue scale, physician visual analogue scale, WOMAC 9a measure of quality of life), 50-foot walking time.  All these measurements are subjective.  We also included  ultrasound measurement of patellofemoral compartment thickness at 7 points (objective).

We’ve collected data on 10 patients so far at eight months.  All 10 patients have had objective improvement in cartilage thickness at the patellofemoral joint.  The increase reaches statistical significance at the p<.001 level.  One person had a poor result subjectively but had objective increase in cartilage thickness.  He may have a total knee replacement (he hasn’t decided yet).  One person has had a fair result subjectively.  The other eight have had a good to excellent result. I realize these are small numbers.  However, the objective findings are encouraging.

I also must mention that we have been very selective in our choice of candidates for this procedure.   Only one patient with stage 4 disease (“bone on bone”) underwent this procedure and he actually had an excellent result both subjective and objective.  All others were turned away.  Patients exceeding a certain body mass index (too heavy) or who had any type of angulation deformity were also rejected.  Roughly only 1 out of every 7 patients who called in about this procedure were accepted.

The ideal study of effectiveness of stem cell therapy would involve arthroscopic digital images of cartilage damage pre and post treatment.  Unfortunately, such a study would be expensive and I don’t see this type of funding being available to us in the near future.

Question: What other materials are being used?

Answer: Advanced Biosurfaces has a metal/plastic component that can be inserted.  It requires an open incision.  Other types of pastes consisting of ground up cartilage and growth factors are also being evaluated. Osteochodral grafting, microfracture, and other cartilage transplant techniques are being evaluated.  These require a significant invasive approach and the recuperation is about a year or more.

Question:  Any infection or rejection?

Answer:  No infection or rejection.  We would not expect rejection with our technique which uses autologous stem cells… the patient’s own stem cells.  Problems may occur with allogeneic stem cells (donor stem cells).  Our technique is done in an operatory… strict sterile technique.

Question:  Is anyone doing accelerated cell growth outside the body and implantation similar to what is done for racehorses?

Answer: A center in Denver is doing this.  I’m not sure what their data is.  They claim that growing cells outside the body is better. I’m not sure I agree with them.  And I do know the FDA frowns upon removal of human cells and stimulation with factors outside the body.  Because of this FDA regulation, I doubt whether any study will be done in the near future comparing their method with ours.

Question:  Can you recommend a doctor in Pennsylvania who has this expertise.

Answer: No one I’m aware of.


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Questions and answers about stem cells…


We’ve had many questions about stem cells in response to some of the videos that have gone out.  Here are the responses…

Question:

Have you seen any bodybuilders who have problems with the long head of the biceps as a result of a labral tear operation?

Answer: The simple answer is no.  The long head of the biceps has its origin at the superior labrum of the glenoid portion of the scapula.  This area is difficult to visualize using ultrasound. Since you can’t see it, it’s not a good idea to try and treat it. However, once the biceps tendon is visualized at the top of the humeral head and further down, it’s easily trackable with ultrasound and we can treat the tendon in that location with good results.

Question: Does insurance pay for stem cell procedures?

Answer: The answer is, it depends.  Insurance companies vary in whether they’ll pay for any or part of this procedure.  They consider stem cell treatment to be investigational. If you are absolutely dependent on an insurance company paying for your procedure, then I recommend you not get the procedure done.  For more information, you can contact our office at (301) 694-5800.

Question: Will stem cells restore normal blood flow to the hip if I have avascular necrosis?

Answer: No, it won’t.  It may restore cartilage and possibly new bone if there is not too much deformity.  When that happens, blood flow may eventually come back if there is collateral flow.  No one really knows. However, if there is complete collapse of the femoral head, I would advise surgery.

Question: How do you know the stem cells stay in place?

Answer:  When we do a procedure in a joint, the answer is pretty easy.  Each joint is a capsule lined with synovial tissue.  Once the stem cells are placed inside the joint, it’s hard for them to leave.  So shoulders, knees, elbows, wrists, etc. are self-contained. However, there are complicating features.  For instance, 25% of patients have a hip joint that communicates with the iliopsoas bursa, located in front of the joint.  If the patient is not kept lying on their back for a couple of days after the procedure, the stem cells can fall out into the bursa … where they’ll do little good.  In order to ensure stem cells stay in place, we add another ingredient.  That is, we use a matrix of fat (the patient’s own fat) along with other materials that cause the stem cells and PRP to congeal and form a sticky gel that stays put.

Question:  Do stem cells cause cancer?

Answer:  There is concern that embryonic stem cells may cause cancer.  In fact, it has been reported to occur in at least two cases I’m aware of.  Also, donor stem cells (allogeneic) are a concern since we don’t know the donor’s family history.  We use only autologous stem cells- a patient’s own stem cells.  There is no cancer risk.


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Chinese herbal remedy works for rheumatoid arthritis


Researchers at the National Institutes of Health say thunder god vine, a Chinese herbal remedy, which has been used in China for centuries to treat a variety of inflammatory diseases, may benefit people with rheumatoid arthritis.

A study, recently published in the Annals of Internal Medicine, compared the efficacy and safety of a Chinese herb called thunder god vine [Tripterygium wilfordii Hook F (TwHF), also known as “lei gong teng”], and a conventional disease-modifying anti-rheumatic drug (DMARD) used for rheumatoid arthritis. Researchers randomly assigned 121 people with rheumatoid arthritis to take either 60 milligrams of the Chinese herb three times a day or 1 gram of sulfasalazine twice a day for 24 weeks.

Nearly half of the participants dropped out before the study was complete. But after 24 weeks of treatment, researchers found that a more people in the Chinese herbal remedy group experienced at least 20% improvement on a standard measure of rheumatoid arthritis symptoms compared with the sulfasalazine group.

Researcher Raphaela Goldbach-Mansky, MD and colleagues say the study was too short to show if thunder god vine also helped slow the progression of joint destruction from rheumatoid arthritis. But if further studies confirm these results in larger numbers of people, “thunder god vine may provide an affordable natural treatment option for rheumatoid arthritis.”

Comment: A much older study authored by Peter Lipsky also demonstrated the anti-inflammatory benefits of thunder god vine [Lipsky, P. E. and Tao, X. L. A potential new treatment for rheumatoid arthritis: thunder god vine. Semin.Arthritis Rheum. 1997;26(5):713-723]… so this isn’t really news.

In fact, it’s more of a curiosity than anything else.  The goal in rheumatoid arthritis (RA) is to help with both symptoms as well as disease progression. Sulfasalazine, the drug used as a comparator in the NIH study, doesn’t have good anti-inflammatory properties.  As a disease-modifier it’s pretty lame also.

Nonetheless, the take-home message is this:  Some herbal remedies do work for symptoms and they’re worth a try.  In the past, physicians, particularly academic types, would debunk these types of therapies as “snake-oil.”  As we learn more about the natural healing effects of herbs… and the natural healing powers we all possess (Examples would be PRP and stem cells), I think our ability to treat arthritis will improve significantly… and with fewer side-effects.   [A word of caution… don’t forget or nglect effective conventional therapies! ] NW.


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Killing two birds with one stone…


Every so often a unique medicine comes along.  Denosumab is a drug that’s going to be used for both osteoporosis as well as rheumatoid arthritis.  Sort of like the old Doublemint gum commercial with the Doublement twins.  Double your fun.

It’s given by subcutaneous injection every six months so the dosing interval is attractive.  What the price tag attached to this invention is the big question.

This is an abstract that appeared in a recent journal…

Denosumab for joints and bones

Current Rheumatology Reports, 07/30/09

Lewiecki EM et al. – Denosumab suppresses bone turnover by inhibiting the action of RANKL on osteoclasts. [Editor’s note: osteoclasts are the cells that break down bone] Denosumab reduces bone turnover and increases bone mineral density in postmenopausal women with low bone mineral density, reduces fracture risk in women with postmenopausal osteoporosis, and inhibits structural damage in patients with rheumatoid arthritis when added to ongoing methotrexate treatment. It is generally well tolerated, with a good safety profile. Adverse and serious adverse events, including infections and malignancy, are similar in patients treated with denosumab or placebo.

When this drug will be approved by the FDA is still uncertain.


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One of those weeks…


It’s been an eventful week.  Last Friday within a span of 5 minutes I got called about one of my sons who was in a serious auto accident and was being sent by ambulance to the emergency room and then another call from my sister who told me my dad had fallen and broken his hip.

Life is certainly quirky.

So anyway, this week I had a great interview with Dr. Rocky Tuan, the world’s foremost scientific expert on stem cell biology.  Dr. Tuan has headed up the Cartilage biology section at the National Institutes of Health since 2001 and is going to the University of Pittsburgh Medical Center to be chief of their new Regenerative Medicine section.

I also talked with Dr. Joseph Purita, an orthopedist who does alot of regenenerative stuff with PRP and stem cells in Florida.  Very nice man.  And we had a nice chat exchanging ideas.

Like any specialty in medicine there are those who are willing to share and eager to learn… and there are those who are bloodsuckers.  I prefer to avoid the latter.

The field of regenerative medicine for arthritis, tendinosis, etc. is exploding.  I just had a recent article published in the Journal of Musculoskeletal Medicine on stem cells and PRP.  Here’s the link

http://www.screencast.com/users/nathanwei/folders/Default/media/2c8018a1-9666-4a75-b26e-30bc5d88b641

Stem cell technology for the treatment of osteoarthritis and related conditions is constantly evolving as we learn newer techniques.

This coming week I’ll be interviewing Don Margolis, a stem cell crusader.

Which brings me to my secret.  I’m working a a new project on stem cells and PRP.  I’ll be letting out little hints pretty soon.  Some great content.  So make sure you follow the blog.

P.S. My Achilles that I had PRP on is doing very well.  Have started light jogging and rope skipping.


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