Reversing Osteoarthritis: doable or not???

Several researchers and scholars have asked the question in human medicine: “If my cells are constantly reproducing, why do I still have pain in my back, knee etc.?” Excellent question! Bone cells turn over every 3 months, skin cells every 10 – 30 days, and your skeleton in general updates itself by 10% a year! (1) Stem cell research is the forerunner in the fight for regeneration. When we are talking about stem cells I am talking about naturally producing stem cells not injectable stem cells. High cellular turnover seems to protect against aging, however if high cell turnover is in conjunction with cellular mutations, it might also hasten the development of cancer. (2)

The reasons a joint might develop osteoarthritis (OA) is multifactorial. There might be mechanical damage (i.e. a torn ligament that leads to abnormal joint mechanics), or biochemical damage (i.e. inflammation in a joint leading to cartilage degeneration), or genetic (i.e. which could be a factor of conformation such as elbow or hip dysplasia).

In the early stages of OA, the body is trying to counteract the changes that are occurring. It tries to repair the damage to the cells, quell inflammation and deal with tissue damage. Chondrocytes ability to regenerate cartilage is severly limited and unless this destructive process is halted, the damage will be permanent.

Therefore, early diagnosis is of key importance, since therapies aimed at blocking or reversing cartilage damage will be more effective when there is the possibility of preserving normal homeostasis (i.e. The normal rate of cell destruction, restoration, and remodeling. This is the ‘turnover’ I was talking about earlier). At later stages, some different interventions may be required, such as tissue engineering in order to repair damaged cartilage. (3)

Prevention is always better than cure, so lets talk about stopping OA before it starts:

Lets take my dog for example: I have a 160 lb bullmastiff that had an FCE at 2. She has a lasting left hindlimb weakness and neurological deficits. 2 years later she is playing in the yard and she ruptures her R CCL. Was this preventable, maybe, maybe not. If I’m honest, I should have done a lot more rehab with her after her FCE but a shoemakers sons aren’t always shod. Mea Culpa! SO I should have been doing preventative work straight after the FCE considering I know better and her gait, constitution and capacity had changed dramatically, opening her up to further injury.

How not to be like me: You can become proactive in preventing osteoarthritis (as best you can)! You might also want to seek the guidance of a veterinary physiotherapist or rehab vet to help you address each goal.

Laurie Edge Hughes uses these principles to prevent or delay OA( 5 ):

Goal # 1: Manage the inflammation early. In a sudden onset trauma, inflammation is what signals the body to repair, but you don’t want the process to continue on for too long, otherwise it can do more harm than good. So, in the case of a joint injury (versus a muscle or tendon have an honest conversation with your vet and if possible, put your dog on the anti-inflammatory now. This is an acute treatment, not chronic. but a short-term use of non-steroidal anti-inflammatories is very helpful. The introduction of other modalities such as laser therapy, dry needling, or pulsed electromagnetic field will help reduce this inflammation. Rest and remain under supervision: Leash walks only, no playing, no sporting activities. If this is a genetic condition (i.e. hip or elbow dysplasia), this phase might be shorter than if this is a new trauma (i.e. a torn CCL, or post-surgical condition).

Goal # 2: Stimulate tissue healing. Laser therapy, extracorporeal shockwave, and therapeutic ultrasound all have an effect on tissue regeneration. There are some interesting research papers that look at repairing damage to joints in cases where they ‘induced osteoarthritis in mice’ (the researchers made cuts to the cartilage in the mice joints in order to start an inflammatory and subsequent arthritic process). In many of those studies, they were able to significantly reduce the arthritic changes seen weeks and months later compared to the mice that didn’t receive therapies! (5)

Goal # 3: Strengthen the surrounding muscles (after the acute inflammatory phase is over). Strengthening helps cushion a joint by minimizing concussive forces. Strengthening protects joints from the abnormal or additional forces that can occur secondary to muscle weakness around a painful joint. Specific muscle building exercises for the joint in question is imperative.

Goal # 4: Maintain full joint range of motion. A joint gets its nutrition from lubricating all of its surfaces in synovial fluid (i.e. the fluid within the joint). So, wherever the joint doesn’t get lubricated, that’s where the degenerative processes will start. To stop this, your dog needs to be able to bend and straighten that joint fully. You might do this manually, or you can find an exercise that will accomplish this. For example, cavaletti walking at different heights, forcing the front and hindlimbs to flex and extend is great for elbow and knee joint issues.

Goal # 5: Start the supplements immediately- from now till forever. There are a number of supplements that aim to improve cartilage health. Vitamins, minerals, glycosaminoglycans, avocado-soybean unsaponifiable fractions, methylsulfonylmethane, s-adenosylmethionine, undenatured and hydrolyzed collagen preparations, phytoflavonoid compounds found in fruits, vegetables, spices, teas, and nuts, and other nutrients on the horizon. (4)

We are really only talking about early onset of arthritis or inflammation. Not everything we discussed today will be pertinent to your older more advanced dog. Be proactive. Talk to your rehab practitioner for input or your vet if they are well informed about these things.

In conclusion: can OA be reversed? Maybe if you are super proactive and catch it timeously.

References:

http://book.bionumbers.org/how-quickly-do-different-cells-in-the-body-replace-themselves/ accessed April 15, 2019.
Wodarz D. Effect of stem cell turnover rates on protection against cancer and aging. J Theor Biol. 2007 Apr 7;245(3):449-58.
Goldring MB. Update on the biology of the chondrocyte and new approaches to treating cartilage diseases. Best Pract Res Clin Rheumatol. 2006 Oct;20(5):1003-25.
Lopez HL. Nutritional interventions to prevent and treat osteoarthritis. Part II: focus on micronutrients and supportive nutraceuticals. PM R. 2012 May;4(5 Suppl):S155-68.
Laurie Edge-Hughes, BScPT, MAnimSt (Animal Physio.), CAFCI, CCRT: Reversing Osteoarthritis, www.FourLeg.com 09 May 2020