Young, old, athletic and "couch potatoes" suffer from arthritis. We talk to Dr. Konrad Słynarski, an orthopedist from the Sports Medicine Center, who was the first in Poland to transplant cells that help rebuild articular cartilage.
Joint ailments can have various causes - from degenerative changes with age, through injuries and overloads, deformities, to infectious or systemic diseases. That is whyjointsare treated by rheumatologists, traumatologists and orthopedists.
What determines the condition of the joints?
» Konrad Słynarski, MD, PhD: Movement is of fundamental importance. The pond that we move often is properly nourished, that is, he althy. Moving a joint changes the pressure of the synovial fluid and thus moves it around the entire joint.
What is the most common problem with joints?
» K.S .: Certainly, these are degenerative changes in the joints, from which over 60% of people suffer. people over 50 years of age. Injury is also an essential part of our job, because it's not just about fixing a problem right away. It is also about the use of such treatment so that in the future degenerative changes do not develop at the site of the injury. The growing problem of joint degeneration is due to several reasons. First of all, we live longer and longer, so there is a bit more time for degenerative changes to arise. A big challenge for doctors are former athletes, who at the age of 40-45 have joints as damaged as other people at the age of 80.
And is it said that sport is good for he alth?
» K.S .: Because it's true. However, a clear line must be drawn between professional sport, when the whole body is intensively exploited, and the exercise necessary for each of us to function properly. But among the athletes there are also people who have not suffered any serious injuries in their entire careers. There are also those who - as the saying goes - have suffered a complicated injury on a flat road.
ImportantCell transplant heals damaged cartilage
The transplant of chondrocytes, i.e. cartilage cells, should be considered an epochal discovery in medicine. Cells are grown in laboratory conditions from a fragment of articular cartilage taken from the patient. You can use a piece of articular cartilage the size of a pinheadmultiply as many cells that they will cover, by implanting them into the joint, a cartilage defect of a dozen or so square centimeters. Understanding the mechanisms of chondrocyte multiplication became a great inspiration for Dr. Słynarski. He was the first in Poland to perform such a transplant. This discovery revolutionized not only the treatment of joints, but also the whole of medicine. The cultivation of articular cartilage cells, which is successfully used by orthopedists, initiated similar efforts by cardiologists and neurosurgeons.
The joint hurts because it gets sick?
» K.S .: Yes. Nature has endowed us with mechanisms, such as pain sensations, that tell us that something is wrong in the body. Pain or joint disability should attract our attention. At the first signs of ailment, you should seek specialist help to prevent further impairment of the joint performance.
What is Osteoarthritis?
» K.S .: The starting point is the changes that occur in the articular cartilage, that is in the tissue that covers the surface of the joints. However,degenerationaffects the entire joint, i.e. bones, tendons, ligaments, muscles,meniscus . But it all starts with articular cartilage. Often the changes taking place in the cartilage itself also initiate the progression of the degenerative process.
So the articular cartilage plays a major role in this process …
» K.S .: Articular cartilage is the aristocracy of the joint - it is easily damaged and extremely difficult to repair. Damage to the articular cartilage is very discreet, at least initially. First, the tissue becomes over-hydrated, which means it stores more water. In a he althy joint, cartilage is in the form of a gel, which makes it supple. Its surface is perfectly smooth. The coefficient of friction between the two surfaces of articular cartilage is ten times lower than that of two ice cubes. If it accumulates more water, it is similar to crab meat, which means that it is more watery, softer and more loose. Thus, it becomes less resistant to any injuries. Its surface begins to crack, it rubs more easily, but we do not feel this process yet. Cartilage particles that detach from its surface appear in the interarticular space. They irritate the synovium. It begins to produce enzymes - their task is to dissolve annoying particles. But the enzymes produced by the synovium also affect he althy cartilage, which is destroyed more quickly. The joint begins to become inflamed and gradually spread to the bones that make up the joint. That's when we begin to feel pain. Changes that arise at this stage,unfortunately, it is impossible to reverse anymore.
So we are doomed to failure, because we do not feel the first changes in the joint, and when pain occurs, it is too late to rescue?
» K.S .: It's not like that. The first sign that something is wrong with your joints is pain at rest. What does it mean? If we sit in the cinema for a long time or drive a car and feel that the leg is numb, we have an irresistible urge to move it - this is the first sign that the cartilage is not in good condition. The immobility causes the joint cartilage to be compressed, the synovial fluid does not move, so the cartilage is not nourished. Moreover, when the cartilage is loose, it is easier to compress, and it does not absorb the energy with which bones are pressing against each other. And since the bones are innervated, we start to feel a dull pain similar to that of a tooth. At this stage, the degeneration of the joints can be stopped. You can eliminate the cause of the ailments, e.g. operate on previously damaged ligaments, modify the lifestyle, administer appropriate drugs to the joint or, for example, make the patient slimmer.
And if we miss this moment and a significant part of the surface of the articular cartilage is damaged?
» K.S .: Then the only rescue is surgery.
That sounds not very optimistic.
» K.S .: I do not agree with this statement. For people who suffer from degenerative joint changes, we have a wide range of help. I have already mentioned the possibility of stopping damage to the articular cartilage. But in fact, the type of therapy must be chosen according to the severity of the disease. Some people can be treated with rehabilitation, others need surgery followed by rehabilitation treatments.
The problem is not only degeneration, but also gout or rheumatoid arthritis. Who heals them?
» K.S .: This is the domain of internists and rheumatologists. There are many joint diseases that are caused by bacteria (e.g. borreia, chlamydia), develop after being bitten by ticks that transmit Lyme disease or are caused by a malfunctioning of the immune system. Hyperthyroidism and hypothyroidism can cause changes in the joints, accelerate the development of degenerative changes. Likewise, diabetes or gout. In the interest of the patient, the best would be the cooperation of specialists from many fields, and joint search for the most effective help. But most importantly, the underlying disease must be cured or controlled. And if an intervention or an orthopedist's help is needed, we do it. Unfortunately, in Polish conditions it is difficult to achieve such cooperation.
What do you think about the advertised "inventions" that are supposed to heal joints?
» K.S .: It is a natural aspiration of each of us to get back into shape as soon as possible in the event of illness, especially when it is accompanied by pain. Ads encourage the use of such miracle agents. Lots of people fall for it. Of course I understand the placebo effect. My professional experience shows that patients who self-medicate too often come to the clinic, and then there is not much that can be done for them.
What about glucosamine?
» K.S .: That's a completely different matter. Glucosamine - it has been scientifically proven - inhibits degenerative changes. However - what is worth paying attention to - it does not regenerate the articular cartilage. I give this drug to my patients, but I always add that it prevents degenerative changes and that is why it is worth taking it.
Let's also talk about the effect that cabbage leaves have on the joints.
» K.S .: Cabbage contains ingredients that reduce joint swelling. This relieves patients but does not cure the underlying medical condition. However, you have to be careful not to cause chafing of the skin. In my opinion, it is better to put ice on a sick pond.
Your own recipe for he althy joints?
» K.S .: I play sports. I go to the swimming pool, to the gym, I play football, I go snowboarding in winter. I've also lost weight recently. I eat my diet in such a way as to maintain a proper body weight and thus not overburden my joints.