According to the European Report by Health at a Glance 2012 OECD25, it is estimated that worldwide, 9.6% of men and 18% of woman at 60 years old have symptomatic OsteoArthritis. It is considered that age is the primary predictive factor for the development and progression of osteoarthritis. Osteoarthritis is more frequent in woman; it increases from age 50 and is most prevalent in hands and knees. Other risk factors include obesity, genetics, sedentary lifestyle, tobacco, excess alcohol consumption and previous trauma. From the clinical point of view the main symptom of osteoarthritis is pain, mechanical characteristics in relation to the use of the joint. Initially it is self-limiting, but as the disease progresses it becomes more persistent. But besides pain, osteoarthritis is characterized by stiffness after a period of inactivity, joint deformity, swelling and loss of function.
According to the ArtRoCad study conducted by the Spanish Society of Rheumatology and Spanish Society of Primary Care, gonarthrosis triples the prevalence of hip osteoarthritis, knee osteoarthritis 66.3% against 23.5% coxarthrosis. 10% have both joints affected. OA is a multifactorial disease, which in some cases results from the interaction of acquired factors, coupled with an inherited predisposition to multiple contributing genes. Knowledge of these genetic factors involved in the onset of the pathology allows us to identify and control individuals at greatest risk by diagnosing the disease earlier, carrying out the introduction of new therapeutic measures, which effectively curb the evolution of process. Formerly osteoarthritis was considered only an acquired disease, however, today it has been shown that this condition has a strong hereditary predisposition, as well as diseases such as diabetes, obesity and osteoporosis among others. For this reason, these types of pathologies have been clustered together under the umbrella of complex diseases, which are the result of the interaction of genetic and environmental factors. This hereditary component explains that while faced with similar external stimuli certain individuals develop the disease and others do not.
Our group started the clinical application of intraarticular injection of growth factors in humans suffering from knee OA after studying the literature on the topic. Parallel to this we initiated two studies on chondral defects, performed in femoral condyles in rabbits treated with intraarticular injections of growth factors and the results obtained from patients with knee OA treated with intraarticular injections of growth factors were collected and published.
The results showed a tendency to cartilage regeneration and the paper titled “PRGF-Endoret Intra-Articular Injection in OsteoArthritic (OA) Knee. A Non Randomized Prospective Longitudinal Analytical Study” all the studied parameters showed statistically significant improvement. Based on all this we decided to conduct several studies to further evaluate the efficacy of intraarticular infiltration of different treatments in knee OA: regenerative cells derived from bone marrow (BMC), regenerative cells derived from adipose tissue (ADRCs) and Plasma Rich in Growth Factors.
knee osteoarthritis is a disease that causes intraarticular pain and functional disability. It is one of the main reasons people go to the doctor.
With age this disease worsens and affects a larger number of people, in adults the figures are around 52% and in older populations up to 85% and in addition, women older than 50 are affected more than men. The World Health Organization WHO defined OsteoArthritis as the resulting mechanical and biochemical events that disrupt the balance between synthesis and degradation of cartilage and subchondral bone. Today it is known that this imbalance, apart from just age, can be caused by many other factors: sex, genetics, race, climate, body weight, work, physical activity and sport, mechanical injuries, bone mineral density, diet, alcohol and tobacco and associated pathologies.
Conventional medical treatments have negative impact on patient health as they affect other organ systems, and also on the economy due to the pharmaceutical expenditure involved.
Conventional surgical treatments work temporarily but over time they wear and because patients are older than when they received the first intervention, it is more difficult to perform the next surgery, and there is a greater health risk for the patient as well as yet another health expense.
Regenerative Medicine poses a radical change in healthcare, it offers the challenge of using the potential of the cells to solve health problems and delay degenerative processes. Using inducing proteins and cells that are activated by the aforementioned proteins means the possibility of solving lesions with the bodies own resources while adding years with improved quality of life. However, there are still no conclusive works that clearly answer questions such as: is the application of inducing proteins sufficient for the treatment of regenerative processes or is the application of cells that respond to stimuli of these proteins required? If cells are used what volumes are effective? What types of cells are suitable for knee OA?