By James Leiber, Regenexx, Sports Medicine, Stem Cell Therapy
Oftentimes, patients ask us what they can do to improve their joint cartilage and prevent arthritis. Cartilage acts as a cushion between the bones to protect our joints by absorbing shock.
The visual evidence of arthritis seen on imaging studies can be due to the decrease in quantity and quality of the cartilage, the decrease in joint space width, the formation of bone spurs, and degenerative changes in the bone underlying the cartilage. Besides wear and tear, there is also a biologic/internal component that affects cartilage.
The Truth About Cartilage Loss
Cartilage, in of itself, does not have nerve endings. Therefore, cartilage loss is NOT a direct source of pain. It is, however, the visual evidence that arthritis exists. That is, there are destructive substances in the joint that are breaking down the tissue. The cartilage is the victim of the arthritic disease.
You might be surprised to learn that people can have virtually no cartilage in a part of a joint (“bone on bone”) and have no pain at all. This is actually very common. On the other hand, a person can have robust amounts of cartilage and have a tremendous amount of pain – again, this is very common as well. The point is that cartilage loss is a sign of arthritis and protecting your cartilage is a way of limiting the effects of the arthritic process.
What Causes Joint Pain?
There are a number of structures that do cause pain. The synovial lining of the joint is rich in nerve endings that sense pain and is responsible for producing healthy fluid and lubricating substances. With arthritis, the synovial lining can become bumpy and painful. It will also produce abnormal inflammatory fluid that breaks down tissue in the joint. Determining what’s in that fluid and how to control the synovial lining is one of the keys to halting arthritis.
Another source of pain in a joint is the bone underneath the cartilage. This bone is quite hardy and able to tolerate heavy loads often without any problems even when there isn’t any cartilage to protect it. There are times when the bone in areas of decreased cartilage begins to breakdown and become swollen representing little micro-breaks in the bone. These bone marrow lesions can sometimes be painful and can only be seen on an MRI.
Can We Re-grow Cartilage?
Getting cartilage to re-grow is an admirable goal and it may one day be possible to consistently do this, but it seems that it’s actually more important to keep the synovial lining under control and to strengthen the bone under the cartilage so that it can withstand more pressure. It is also important to make sure that there is stability around the joint – that is, the ligaments, tendons, muscles, and nerves are healthy and functioning normally.
Stem cells can help cartilage to regrow but it is inconsistent and minimal at this time (despite what you may have heard). They can, however, improve the quality of the remaining cartilage, the strength of the bone, reprogram the synovial lining so that it produces healthy protective chemicals instead of destructive ones, and strengthen the ligaments and tendons so that there is better stability around the joint. Using stem cells in this way requires working with a highly trained physician who performs the proper analysis and executes a procedure to precisely inject the tissues that are in need of improvement.
Receiving a stem cell injection blindly into a joint by someone who dabbles in this approach is not the way to go.
The key to understanding how to keep more cartilage as you age is to understand what causes cartilage loss. Here are the most common causes of cartilage loss along with a few solutions to help prevent it.
1. Obesity (Mechanical)
Physics has taught us that being heavier places more wear-and-tear forces on our cartilage and therefore, arthritis.
Although it can be tough to accomplish, losing weight is the ultimate solution to improve symptoms and slow the progression of arthritis.
2. Obesity (Biochemical)
Not only does obesity break down cartilage by wear and tear, but is also can cause changes in the patient’s insulin-response system that can break down cartilage. This is referred to as “metabolic syndrome.”