Weekly Education Meeting 20200824

by | Aug 28, 2020

Weekly education meeting at Chicago Arthritis and Regenerative Medicine 20200824

Topics discussed:
-The Basics, Inflammation vs Instability.
-Real stem cell treatment vs fake ones.
-Are mouse arthritis studies applicable to humans?

Live Weekly educational meeting for the team at Chicago Arthritis and Regenerative Medicine where we discuss the basics of what we do for arthritis, tendinitis, injuries, and back pain. 
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Hello, this is Siddharth Tambar from Chicago Arthritis And Regenerative Medicine. Welcome to our weekly educational broadcast. It’s August 24th, 2020. Welcome everyone. I hope everyone is feeling well and doing okay. In this weekly broadcast, I am talking to my team at work and we’re discussing topics that are relevant to us here at Chicago Arthritis And Regenerative Medicine. Frequently discussing questions that patients have, or that team members have regarding what we do here in the clinic. And again, here at Chicago Arthritis And Regenerative Medicine, we focus on treatment of arthritis, tendonitis injuries, and back pain, utilizing the most up to date methods of evaluation and treatment to maximize your function and minimize your pain in order to get you to maximize and live your highest quality life possible.

So, we have one new team member today, Susan, who is coming on as a medical assistant, and I thought great opportunity to discuss some of the basics of what we’re doing here at Chicago Arthritis. So, while we’re focused on musculoskeletal conditions, I generally break that up into inflammatory, meaning inflammation causing problems verses degenerative, meaning wear and tear tendonitis, arthritis, and injuries. And so when I really think about these things, I think of them as, does somebody have a primary inflammation problem throughout their body, or do they have a primary instability problem at the joint level? And these are very different because the way that you evaluate, treat, manage is very different from condition to condition. And the reason why it’s important to differentiate those is because number one, you want to understand what’s causing somebody’s problem as you develop a plan to try to maximize and improve their condition. And what drives inflammation is frequently very different than what drives instability. Now there’s definitely some overlap in conditions and sources of problems. And so you do need to be relatively subtle when you make some of these decisions, but they’re definitely very different and they definitely deserve very different approaches to treatment.

So, when we’re talking about inflammation, we’re talking about total body inflammation. That includes conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis. Those are conditions where the body’s immune system is miscommunicating, recognizing its own cells as problematic, which then leads to inflammation in the body.

On the other hand instability means that somebody has at some point, a soft tissue injury, let’s say a tendon injury, ligament injury, which then in turn, then leads to slight instability in that joint longterm, which then eventually leads to degeneration of the joint and the tendon.
So, the way that these conditions present they’re very different and the way that we evaluate them is slightly different. And for sure, the way that we treat them is very different. Now, what’s interesting is that there’s definitely cases where somebody may have a primary inflammation problem like rheumatoid arthritis, but that over time they also develop some instability and degenerative conditions as well. And you have to treat that a bit differently than you would treat the inflammation part.

So, some classic examples, let’s say this past week of what I saw. Number one is a gentleman that presented as a new patient who has a history of psoriasis and had a lot of different joints that were painful and problematic. So, naturally when you see someone who presents like that, you wonder, is there some kind of inflammation that’s causing inflammation in the skin, as well as in the joints. That is naturally very suspicious for possible inflammatory arthritis, meaning someone who has psoriatic arthritis. And the reason why is when you see someone that has many joints that are active, you have to ask, is there one common problem that’s driving everything. And so in his case, based on a combination of some examination findings, as well as ultrasound in particular, showing inflammation in his joints, and then labs that help in to confirm the inflammation as well, we’re able to kind of put him down the right road for treatment, which was treating the overall inflammation with medications. And, hopefully on that algorithm, he should do well with treatment.

Second example would be a individual who I saw recently that had pains in multiple joints in the hands and the feet. Again, you would think that could be very suspicious for rheumatoid arthritis. In her case, based on ultrasound and x-rays, I ended up giving her diagnosis of wear and tear arthritis rather than rheumatoid arthritis and her treatment algorithm because she’s already failed some conservative options like occupational therapy and supplements, I’m recommending a regenerative medicine treatment, utilizing her own bone marrow derived STEM cells as well as platelets. So again, based on some objective evidence of what’s driving her pain, able to guide her down the right path.

And the last one would be a individual that has, came to me with shoulder pain, a 77 year old man who had shoulder pain. And so naturally when you first see shoulder pain, you of course, think of some very common things, like, could somebody have a rotator cuff problem? Could they have a wear and tear arthritis problem? In his case, with a reasonable history, we were able to determine that he’s got pain in both shoulders. That’s a little bit unusual. And on ultrasound imaging, he’s got evidence of inflammation in the biceps tendon on both sides. So because he has symptoms on both sides that are very similar with inflammation, we naturally end up kind of looking to see, does he have something else going on, such as inflammation? And in his case, I ended up diagnosing him with a condition called polymyalgia rheumatica, which is an inflammation condition causing inflammation in joints, muscles, and tendons. So again, he falls into the inflammation algorithm and we’re going to treat that appropriately at this time. So, inflammation instability makes a big difference. And, we have the tools at the bedside, including exam and ultrasound to fairly rapidly help to make that diagnosis and put people down the right path for treatment.

Questions off the bat. Susan and Jackie.

  • [Jackie] I do have one, what’s the difference between the treatments they do here in the office and in Umbilical cord procedures.

Great. Great, great, great, great, great question. So, common question that Jackie gets from patients and a common question on the regenerative side is what is the difference between some of the things that we’re doing in clinic versus some of the regenerative treatments like umbilical cord STEM cells? Big difference. So here in the United States, we have some very progressively clear guidance in terms of what we’re allowed to do for patients when it comes to utilizing their own cells, whether it’s using their own blood or using their own STEM cells, there are some very strict rules to this. So, the treatments that we use in the office are utilizing your own live cells, including your own live bone derived STEM cells. In an adult that is where you get the highest concentration of your own mesenchymal STEM cells. What’s become popular over the last several years is utilizing somebody else’s own umbilical cord cells. So, whether it’s umbilical cord or amniotic cells, those come from essentially birth cord tissues. After a baby’s born, there’s a high concentration of cells in amniotic and umbilical cord fluid. And those cells theoretically have the potential to be injected into somebody else without causing a reaction. That sounds very interesting. It sounds exciting. In the United States, however, there’s very clear guidance that you cannot inject somebody else’s live cells into them unless it’s within a research oriented study.

So, in order for amniotic and umbilical cord cells to be utilized, they need to be processed in the following way. Number one, they’re collected, they’re then freeze dried, they’re then gamma irradiated, essentially all the cells in that product have been killed off, they’re there then pulverized into a powder and then shipped over to a physician’s office where they can then be stored for 18 to 24 months. And when they need to be used they’re then hydrated, meaning you put some fluid into the vial and then they’re re-injected. Multiple organizations have looked at this. There are no live cells in those products. That’s important to understand because if you think you’re getting a STEM cell treatment, you want to have live cells, your own cells, you don’t want to have dead cells. They’re likely some growth factors in those products, but there are no live cells. Also keep in mind that the vast majority of research that’s available in the world when it comes to orthopedic use for these kinds of treatments are from utilizing your own live, bone marrow derived STEM cells. So very different. Unfortunately, they’re marketed as something different, the umbilical cord treatments, but very, very different concept.

So question on IG asking, can I discuss the recent Stanford study discussed in the New York times. So, a recent article came out where this was mouse study, where essentially they took, they did what was called a microfracture, where they poke little holes into the arthritic joints of a mouse to get some blood flow into the joint. They then utilize a medication called Avastin to effect a growth factor called VEGF. And they found that utilizing this combination seemed to help rebuild cartilage in a mouse. It’s kind of interesting study. The challenges to note with this are number one that was in a mouse, not in a human. There’s a big difference between a mouse model study and human beings. A lot of things that work in mice don’t work quite as well in humans. And the reason why is because we don’t present like mice, we’re not lab mice. And most mice studies are very specific and controlled. They take mice that have very specific genetic backgrounds, mice that have very specific problems. And it’s in a very controlled atmosphere. In humans, that doesn’t work as well. So, what’s interesting is that microfracture surgery in humans has been done for probably 20 years, if not longer than that. And the evidence of its effectiveness is relatively mixed. It’s not necessarily so great.

On the other hand, there’s other ways to utilize your own cells besides poking holes into the actual bone and that’s by injecting those same cells into the cartilage layer, into the bone that’s been damaged, into the soft tissue components as well. There’s much better evidence of that than there is in microfracture surgery. So what’s interesting is that that recent paper actually got reported in the New York times. That is a far, far away from actually reaching clinical utility in human beings. And part of that is because mice are not humans. And keep in mind that in that study, it’s not just that they’re utilizing someone’s own cells, it’s that they’re actually utilizing a medication as well. And there may be something to that in the future in terms of harnessing a person’s own cells and combining it with possibly medication to get a very specific kind of effect. But this is a long ways off from what we’re doing right now. But what we have to offer right now, has good effectiveness in human beings, regular human beings who have regular human conditions like arthritis and tendonitis and back issues and injuries. And that’s what I would stick with right now.

But it is interesting that in the lay press, you’re starting to progressively see more positive recognition. And I think part of that is because there is more and more scientific data. Part of that is also because we live in a world now where people have a more heightened perception of risk. And they’re starting to realize that there may be lower risk ways to get good results when treating people that don’t require more invasive procedures and surgeries. I hope that answered that question.

  • [Jackie] Yes. It did.
  • Jackie other questions for me.
  • [Jackie] There was actually, my main one and I didn’t know how to answer the difference in regards to the umbilical cord cells.
  • Yeah. I mean, it’s tricky because a lot of patients are told that, “Well, you don’t have enough cells in your own body after a certain age, and that’s why you should utilize someone else’s cells.” That in theory kind of makes sense. But the reality is when you look at the evidence, when it comes to effectiveness of treatment, as long as your cell count meets a certain minimum threshold, regardless of age, you can still get a very good result with your own cells. The flip side is, when you’re utilizing somebody else’s cells, in order to be done safely, they’re being done with dead cells. When you’re utilizing live cells, there may be some effectiveness to this, but there’s a lot less evidence of its effectiveness and safety compared to utilizing your own cells. So, good general rule when you’re thinking about risk, utilize your own cells because you avoid any of the issues with possible rejection. Utilize treatments that have a lot more evidence. It’s important to find things that work, things that are low risk and things that you can do in a legally compliant way in the country that you live in.
  • [Jackie] Thank you.
  • Anything else? Susan.
  • Okay. Very good. Great. Well, thank you for joining us on our weekly educational broadcast. As a reminder, we’re doing a streaming broadcast every Monday and Wednesday. Mondays are more about answering patient and team questions and Wednesdays are a little bit more, I think, big picture thoughts that I have on medical issues and related issues. Until our next broadcast, thank you for your time. Have a good day and live well. Bye bye.

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About this video
In this video Siddharth Tambar MD from Chicago Arthritis and Regenerative Medicine discusses evaluation and treatment of arthritis, tendinitis, injuries, and back pain without surgery or medication.