Diagnostics and Stem Cell-based Treatment for Osteoarthritis - OA:
Treat the Disease, not the Symptoms

On this page we inform you about Osteoarthritis covering an overview on important aspects of causes, treatment options, precision diagnostics that reveals the cause of pain and location of the pain-causing defect, as well as our stem cell-based therapies that we offer in Offenbach (near Frankfurt/Main) Germany.

Jump directly to the following topics:

• Conventional therapies
• ANOVA therapies for OA
  
• Expectations and limits
• Avoid joint replacement
  
• Our osteoarthritis treatment
  
• Diagnostics of pain-causing defects
• The ANOVA difference: targeted treatment
  
• You want a second opinion
  
• Workflow of the treatment process
• Other important therapeutic possibilities
• FAQ- frequently-asked questions
• Sources and Literature

Yes, there are different innovative (experimental) treatment concepts which specifically target cartilage defects with stem cell therapies and help to avoid joint replacement also in the long term. A surgical joint replacement requires long-lasting rehabilitation and often offers only moderate treatment success. Patients often re-acquire their strength and mobility after months but fail to improve their level of activity. Additionally joint implants have to be replaced regularly which results in several surgical interferences over the years for younger patients.

A specific, well-tailored stem cell therapy in contrast could postpone the surgical procedure and might even help to avoid joint replacement. For this, autologous (patient's own) stem cells are used to halt inflammation and initiate the body's own regeneration and repair system. New evidence-based external scientific and clinical studies have shown that stem cell-based therapies are able to modulate immune responses in OA and to stimulate regenerative processes in osteoarthritis by e.g. stimulation of chondrocyte replacement (the cells that produce cartilage).

Two Targeted Effects: Pain Relief and Progression Improvement

A stem cell treatment can elicit two effects in affected joints that build on one another. Due to the modulation of the underlying immune reaction the stem cell injection decreases or even stops the inflammation. As inflammation, especially in early stages, often is the main cause of pain, targeted stem cell injection often results in immediate pain relief up to complete pain-free movements of the treated joint.

The effects on disease progression builds on the inhibition of inflammation. Upon the halting of the inflammation the joint returns to a resting-phase and cartilage loss is reduced or stops. With adequate on-going therapy in combination with e.g. physiotherapy, regeneration of cartilage and formation of new cartilage can take place. As all effects are patient- and disease stage-dependent and may be influenced by additional, external factors, we always apply individual treatment plans. In general, pain is relieved, inflammation is reduced, further degradation and wear of the joints is slowed up to cartilage re-building.

BMC - Bone Marrow Concentrate - Autologous

Autologous (self) BMC are our main therapy option for locally-restricted Osteoarthritis especially when only the hip (Coxarthrosis), the elbow or the knee (Gonarthrosis) is affected.

In such cases we treat specifically this joint or these joints with targeted, localized BMC injections. BMC contains autologous meaning patients own, adult  stem cells (hematopoietic and mesenchymal stem cells in natural composition) which we isolate and concentrate from your pelvis crest in a short process under slight sedation.
These stem cells are supposed to inhibit the inflammation thereby relieving you from pain and to stimulate regeneration of the joint cartilage. For an on-going therapy, we combine BMC with PRP (platelet-rich plasma) or Hyaluronic Acid (see below). More information about this type of stem cell therapy is summarized on our page an BMC.

PRP - Platelet-Rich Plasma - Autologous

PRP is a comparably inexpensive experimental therapy as platelets (thrombocytes  naturally containing growth factors and stimulants) are isolated from autologous (own) blood without isolation of stem cells. For Osteoarthritis, we use PRP often in combination with BMC and is administered in-between BMC treatments to continuously support the anti-inflammatory effect. Besides this, PRP is well-known as a stimulant for wound healing in e.g. periodontitis therapy or as a measure against hair loss. More on PRP (as a combination therapy) is summarized on our PRP overview page.

MSEC - Mesenchymal Stem Cell Secretome - Exosomes - Autologous

Preventive and as a support of BMC especially for Poly-arthritis we treat OA patients with MSEC (secretome, exosomen, EVs) of mesenchymal stem cells (MSC, AD-MSC, adipose-derived, fat-derived stem cells) which we harvest from the patients belly in a mini-liposuction (very brief and limited liposuction) under slight sedation. Worldwide, ANOVA is the first stem cell clinic to acquire legal permission form the responsible governmental authorities and therefore, offers high quality, safe and legally-controlled autologous (own) exosome-containing secretome.

The main advantage of MSEC is that in contrast to live stem cells which would loose their therapeutic potency, can be frozen without loss of exosomes. This enables us to produce 10-20 injection doses from one liposuction which can then be administered over a longer treatment period. This is especially advantageous for serious cases of wide-spread poly-arthritis. What a Secretome/Exosome is and how they compare is explained on our overview page. 

Please note that this treatment is not a cure but as any stem cell treatment an experimental, potentially disease-modifying therapy. It requires regular and repeated travelling to Offenbach, Germany.

Hyaluronic Acid - HA

Another, cost efficient supportive treatment is injection of hyaluronic acid into affected joints. 

Especially in early cases, this can reduce pain and result in a better "lubrication" of the joints. Bone parts do not crunch directly on another after HA injection.

Hyaluronic acid alone, on the other hand, is not expected to have regenerative effects on the damaged cartilage or bone.

Therefore, we usually combine HA with BMC treatment and HA is given intermittently between BMC treatments.

Our patient care managers are happy to inform you about what information we need upfront (MRI, CT, X-ray), how to transfer large data files and schedule a counseling appointment with our physicians for you. Our patient care managers are happy to inform you about what information we need upfront, how to transfer large data files and schedule a counseling appointment with our physicians for you. Please use our contact form to support a fast processing of your case and request.

You are also always welcome to send us an e-mail about your case. The counseling appointment may also take place per telephone or video chat if you live outside Germany. For more intense counseling or additional diagnostic evaluations you may also book an on-site appointment. We can perform needed MRI on the same day. All services rendered by our patient care team are free of charge and we inform you about all physician appointment charges up-front.

What is Osteoarthritis?

Osteoarthritis (OA) is the most common joint disease worldwide. In the mostly older affected persons, there is a progressive degradation of cartilage substance, which can cause joint pain and severely restrict mobility. In healthy joints, cartilage, a pressure-elastic supporting tissue, forms a buffer between the bones that meet. The knee joint is most frequently affected by osteoarthritis, followed by the hip joints and the wrists, but in principle osteoarthritis can damage any joint.

What Causes Osteoarthritis?

Osteoarthritis is mainly considered a cause of aging, where aging itself is a complicated process which is not entirely understood. Younger people sometimes get early osteoarthritis, primarily in the form of joint injuries or excessive strain.

Risk Factors are:

• Joint injury
• Joints that are deformed
• Genetic defects related to joint cartilage
• Stress on the joints from certain jobs or sports
• Being overweight
• Getting older

What is the Difference Between Osteoarthritis and Rheumatoid Arthritis?

Rheumatoid arthritis is an autoimmune disease that causes inflammation of joints. So rheumatoid arthritis starts with inflammation, which then damages joints. Autoimmune essentially means that one's immune system attacks healthy cells because it thinks they are unhealthy. Different parts of the body can be affected at the same time (poly-arthritis). Rheumatoid arthritis is often found in the hands, wrists and feet.

Osteoarthritis, on the other hand, begins with joint wear, in the progression of which cartilage abrasion leads secondarily to inflammation. Osteoarthritis can be caused by a variety of non-autoimmune factors, including heavy stress on the joint, age, overweight (obesity), genetics, and birth defects.

Thus, although both conditions cause pain and discomfort due to inflammation of the joints, the course and cause, and therefore the drug treatment, differ. However, in both cases, stem cell products are a treatment option.

Is Osteoarthritis an Autoimmune Disease?

Osteoarthritis is not an autoimmune disease. This means that the weakening of joints and cartilage is not primarily caused by the immune system. It is only as the disease progresses that the joint damage causes an inflammatory response and the immune system then contributes to the further progression.

There are several risk factors that lead to osteoarthritis, such as age and weight (primary osteoarthritis) or overuse and improper stress (secondary osteoarthritis).

What is Rheumatoid Arthritis?

Rheumatoid arthritis is a chronic (persistent) inflammatory sub-type of rheumatism and is also called chronic poly-arthritis because the symptoms usually occur in very many joints. Rheumatoid arthritis is an auto-immune disease in which the misdirected immune system attacks the body's own cells and structures, causing chronic inflammation of the synovium. Women are affected by RA about 3 times more often than men. Overall, RA affects about 1% of all Europeans.

What is Rheumatism?

Rheumatism is not understood as one disease, but rheumatism summarizes various diseases. Rheumatism is therefore a collective term for more than 100 different so-called rheumatic diseases.

All rheumatic diseases have in common that they are painful and affect the musculoskeletal system or parts of it. The musculoskeletal system includes all 206 bones of the human body, more than 400 muscles and all joints, tendons and ligaments. In the course of rheumatism, the painful changes of the musculoskeletal system lead to movement restrictions.

What is the Difference Between Osteoporosis and Osteoarthritis?

Osteoporosis (bone loss) affects the thickness and strength of bones. This happens when, for example, estrogens are lacking in old age and therefore the activity of the bone-forming cells is reduced. Osteoporosis can also be triggered by hyperthyroidism or drugs such as cortisone (secondary osteoporosis). As osteoporosis progresses, the bone structure becomes large-pored or porous, i.e. increasingly thin overall, making the bones fragile. Consequently, this often causes bones to break easily. This disease can affect any bone in the body, but typical body parts affected include the spine, hips and wrists. Osteoarthritis, on the other hand, occurs when the cartilage or protective cushion between joints begins to thin. Symptoms do not include loss of bone mass or density, unlike osteoporosis.

Is Osteoarthritis Genetic? Is Osteoarthritis Hereditary?

According to studies published by the NCBI, genetics, or heredity, plays an important role in osteoarthritis. If osteoarthritis runs in your family, the risk of suffering from osteoarthritis later in life is estimated at 35 to 65%. However, since these are statistical probabilities, it does not mean for sure that you will develop osteoarthritis, especially if you have an active and healthy lifestyle. Evidence-based studies published by NCBI also state that the probabilities of inheriting osteoarthritis are different for different parts of the body. For example, there is a 40% chance of osteoarthritis occurring in the knees if these traits are inherited. While inheriting the osteoarthritis traits for the hips and hands has a 65% chance of leading to later disease.

Because osteoarthritis appears to have partly hereditary factors, scientists are working to learn more about the disease by analyzing genomes and bio-bank data.

Early Detection of Joint Changes can Prevent Osteoarthritis

While the concept of prevention through early detection of benign precancerous lesions, e.g. colon polyps or "carcinoma in situ" of the breast, has long been established in the case of cancer, such prevention concepts do not yet exist in the case of osteoarthritis. In expert circles, however, the concept of "pre-arthrosis" has recently been the subject of scientific discussion. With the aid of modern imaging techniques, it is possible to visualize early onset structural changes in articular cartilage and sub-chondral bone structure that indicate the onset of osteoarthritis. Magnetic resonance imaging (MRI) and optical coherence tomography (OCT) play an important role here, although OCT requires instruments to be inserted into the joint. Caught early, countermeasures can be taken: Relieving joint stress, improving bio-mechanics, exercise, hormone replacement, and therapies with cytokines and stem cells can slow down osteoarthritis.

How Does Cortisone Work?

Injection of cortisone (corticosteroids) into inflamed joints is still widely used today. It typically results in rapid pain relief, but its effects usually do not last longer than 4 weeks. However, in the long run, cortisone injections accelerate joint wear by damaging cartilage cells, which are essential for maintaining articular cartilage.

What are NSAID, NSAP, NSAR?

All these abbreviations stand for anti-inflammatory drug groups that are used for inflammatory processes and diseases such as rheumatism, osteoarthritis and arthritis. NS always stands for non-steroidal, i.e. substances that are not derived from steroids such as cortisone. All non-steroidal anti-inflammatory drugs have sometimes serious side effects such as damage to the gastrointestinal mucosa or heart and kidney damage. Some preparations have therefore been withdrawn from the market.

• NSAID - non-steroidal anti-inflammatory drug
• NSAP - non-steroidal anti-inflammatory drug
• NSAID - non-steroidal anti-inflammatory drug (translated non-steroidal anti-inflammatory drug)

What are Anti-Phlogistic Drugs?

Anti-phlogistic drugs are anti-inflammatory drugs. Anti-inflammatory drugs include the following groups of drugs:

• Glucocorticoids (e.g., cortisone).
• Non-steroidal anti-inflammatory drugs (NSAIDs, non-steroidal anti-rheumatic drugs)
• Immunosuppressants (DMARDs, disease-modifying anti-rheumatic drugs
• Certain novel biologic-derived drugs (biologicals, e.g., JAK inhibitors)

Effects, Risks and Side Effects of Drugs and Treatments

Patients are always individuals with their own history and specific disease course. Therefore, for drugs or treatments, one can generally never guarantee an effect or grant or exclude risks and side effects. Common expectations are summarized below. However, patient-specific deviations are to be expected.

When do I Need Joint Replacement

The established therapies for osteoarthritis aim to reduce pain, ideally to slow down the degenerative changes. In the end - when the pain becomes too severe with conventional treatment - the only option left so far in most cases is joint replacement with artificial joints, so-called endo-prostheses. Despite modern technology, these cannot completely replace the function of the natural joint, since even the necessary surgery damages the functional interaction of bones, muscles and tendons. In most cases, lengthy rehabilitation measures are required after the operation and sporting activities are restricted. Hip prostheses are now usually used successfully, while complications still occur frequently with knee prostheses, so that some physiotherapists advise against knee prostheses because they see greater chances of improving the patient's situation by means of physiotherapy without joint replacement. Also, the life of arthro-plasties is limited because metal and plastic are subject to constant abrasion and structural fatigue. This wear is not compensated for by remodeling and regrowth of tissue, as is the case with natural joints. Thus, many endo-prostheses have to be replaced after 10 - 20 years, which leads to even greater functional limitations.

What is Bone Marrow Concentrate - BMC?

Bone Marrow concentrate (BMC) is a source for Mesenchymal Stem Cells (MSCs) and Hematopoietic Stem cells (HSC). It contains many important growth and regenerative factors, in addition to the MSC and HSC in natural composition. The BMC procedure is relatively simple and minimally invasive, therefore it has been a favorite source for stem cell-based therapies in the previous decades. Many clinics rely on BMC as their main stem cell treatment, sometimes with exaggerated claims. However, BMC has demonstrated impressive results for effective treatment of numerous diseases, among them being osteoarthritis. Read more about our BMC Treatment here.

What is Platelet Rich Plasma - PRP?

Platelet Rich Plasma (PRP) is a blood-derived, cellular product with concentrated supply of regenerative growth factors and cytokines, obtained from the patient's own blood. It is very simple to acquire, and it has shown promising results in the treatment of several inflammatory and degenerative diseases. For the treatment of specific diseases, it can be combined with BMC or adMSCs, as it has synergistic additive effects to the treatment. PRP has "special" functions: it serves as a growth medium to maintain stem cells healthy; ensures adequate cellular environment where enough energy is provided to allow the cells to perform their regenerative work.

Is Therapeutic Success Guaranteed?

No therapy can guarantee a 100% success after treatment. However, in the case of experimental therapies such as stem cell therapy, the attending physician must perform a benefit-to-risk analysis for each patient and determine both the benefits and the risks for that particular patient. If the potential benefit outweighs the potential side effects, the doctor may recommend experimental therapy.

What are Other Treatments for Osteoarthritis?

Doctors often combine treatments that are optimized to fit a patient's needs, lifestyle, and health. Osteoarthritis treatment has four main goals

• Control of pain
• Improve joint function
• Keep a healthy body weight
• Achieve a healthy lifestyle

Osteoarthritis treatment plans can involve:

• Exercise
• Weight control and diet, such as:
  • Low saturated fat, high fiber-rich foods, fruits and vegetables. Some nutrition supplements appear to be helpful.
• Rest and joint care
• Non-drug pain relief techniques to control pain
• Medication
• Complementary and alternative therapies