What is Osteoarthritis?
Osteoarthritis is a condition associated with the failure of the diarthroidal joint. It is a disease described by not only cartilage degeneration but also impairment to the synovial joint in which all the tissues are affected. These include:
Osteoarthritis is the most common joint disease in humans causing functional impairment, and in particular impaired walking capabilities due to OA at hips or knees. There are currently no mainstream therapies available that have the potential of regenerating the affected tissue.
How common is the incidence of osteoarthritis?
Osteoarthritis is one of the most common types of arthritis affecting cartilage in joints. It is estimated that over 1.6 million Australians have been diagnosed with osteoarthritis, with the condition being more common among women than men. In 2007-08,15 percent of all Australians (3.1 million people) had some form of arthritis. Of those persons with arthritis, the two most prevalent forms were osteoarthritis and rheumatoid arthritis. These accounted for 51% (1.6 million) and 14% (428,500) of all cases respectively.
What is the impact of osteoarthritis?
The latest Global Burden of Diseases study, which assesses the burden of a particular disease relative to other health conditions, highlights that non-communicable diseases, particularly musculoskeletal conditions, are an emerging global issue that must be addressed in the coming decade. The study shows that in Australasia, musculoskeletal conditions account for 15.3% of the total burden of death and disability, just behind cancer at 16.2% and ahead of heart disease (13.8%) and mental health and substance abuse (13%). These are all important health issues and are recognised as national health priorities by the Australian government, but to date, musculoskeletal conditions have not received an equitable level of priority.
What causes osteoarthritis?
Osteoarthritis is the arthritis of middle age. It is characterised by degenerative changes and, sometimes, hypertrophic changes (enlarged cells) in the bone and cartilage of one or more joints. There is also a progressive wearing down of adjacent joint surfaces with consequent distortion of joint position, usually without bony stiffening. The condition is also called degenerative arthritis, degenerative joint disease and hypertrophic arthritis. Osteoarthritis is more prevalent with increasing age, although the average age of onset is about 45 years. Genetic factors and female gender are also predisposing. The major risk factors for osteoarthritis are obesity, physical inactivity, joint trauma and injury, repetitive joint use, and misalignment. In addition, many patients with osteoarthritis have multiple co-morbid conditions including obesity, synovitis, muscular sprains, and heart disease.
How is osteoarthritis treated?
To date, clinical management of osteoarthritis has focused on lifestyle changes, using allied health therapies such as physiotherapy, osteopathy and acupuncture for short term pain and functional improvements, pharmacological pain management, glucosamine and fish oil supplementation, corticosteroid injections, and improving synovial fluid with artificial substrates such as hyaluronic acid, all of which have short term improvements in disease symptomatology without altering disease progression. More severe cases progress to surgical procedures such as arthroscopy or joint replacement.
Newer therapies include those that aim to arrest and improve some of the underlying biomechanical causes of osteoarthritis. These include a combination of trigger point releases in over-loaded muscles, prolotherapy of ligamentous attachments, and autologous platelet rich plasma therapy into ligament attachments and joints. Further to this, autologous stem cell treatment is fast becoming a more commonly utilized approach in the treatment of orthopaedic conditions.
How can autologous stem cells be used to treat osteoarthritis?
Adipose tissue was recently identified as a new and rich source of mesenchymal cells. Mesenchymal stem cells are non-hematopoietic, multipotent progenitor cells, which can be isolated from various human adult tissues. Lipoaspiration provides relatively simple access to this stem cell pool, and with the large number of cells present in adipose tissue, its potential as a stem cell reservoir for cell therapy is extremely promising.
Many recent studies have focused on the use of adult (adipose and/or bone marrow derived) stem cells for disorders such as osteoarthritis. The potential of MSCs to form cells of chondrogenic lineage has indicated the potential of these cells to treat cases of osteoarthritis. In recent years, MSCs have been shown to possess a broad range of regenerative capabilities, modulating disease progression and repairing cartilage lesions associated with osteoarthritis.