The jury’s out on stem cell treatments for arthritic pain

It sounds so tempting.

Skip the surgery for arthritis-hobbled knees and hips.

Take a pass on post-operative pain following joint replacement surgery and what can be months of rehabilitation.

Instead, go to a clinic, have a procedure involving a shot into the joint, go home and start enjoying life again.

The promise of stem cell healing isn’t just being made about hips and knees. It’s sometimes being hyped as the answer to problems such as Parkinson’s disease, heart disease and macular degeneration.

Consumers are left trying to sort fact from fiction amid the ongoing blizzard of health claims.

Last year, the federal Food and Drug Administration said that inflated health promises made by some unscrupulous stem cell clinics are galloping ahead of reality.

“A select few, often motivated by greed without regard to responsible patient care, are able to promote unproven, clearly illegal and often expensive treatments that offer little hope,” FDA Commissioner Scott Gottlieb said.

Even worse, he said, they may pose significant risks to the health and safety of vulnerable patients.

One such case, detailed last year in The New England Journal of Medicine, involved a Florida woman with macular degeneration who was blinded after receiving stem cell injections into her eyes.

Stem cell treatments aren’t cheap. Consumers typically pay the full cost of the procedure, which for treatment of an arthritic knee or hip can cost roughly $6,500.

Dr. Chuck Murry, himself a stem cell researcher at the University of Washington’s Institute for Stem Cell and Regenerative Medicine, is among those who worry about some of the promises that are being made by the clinics.

“Many of these places are pushing it very aggressively and promising more than they can deliver,” he said.

Murry said he gets calls almost every week from people who want a stem cell procedure, asking his opinion of it.

While doctors at Stanford, Emory and Harvard universities are using stem cells to treat some patients with knee problems, Murry calls it “completely experimental.”

He said he’s concerned that there hasn’t been enough careful testing of how well the procedure works — and for how long.

Stem cells, which can divide extensively and develop into multiple cell types, are taken from a patient’s fat cells or bone marrow.

They are relatively rare in the human body, about 1 in 10,000 cells, he said. The cells are processed and then injected into a patient.

The idea that all you have to do is put them into an inflamed joint and they would act like bricks and mortar to repair it is not what happens, he said.

“You inject them, they float around for a bit, then die,” Murry said. “You’ve still got bone on bone, and the pain comes back.”

Some patients, however, do report less pain in their knees following a stem cell injection. Their endorsements often are included in advertisements and on clinic webpages offering the procedures.

While saying there’s little evidence that stem cells can actually replace lost cartilage, a report last spring in the Emory University’s Medicine magazine said such treatments may slow down cartilage degeneration, and reduce pain and inflammation.

Doctors there are monitoring up to 200 patients a year who have gotten the procedure for arthritic joints. Up to 80 percent of patients report improvement, the magazine reported.

Stanford University is conducting formal tests, called a clinical trial, on the effectiveness of the procedure. Results are expected late this year, according to its Medicine newsletter.

A Stanford physician participating in the study said he’s optimistic that stem cell procedures will be routinely used for patients with arthritic knees by 2020.

Locally, Dr. Mark Wagner, a Seattle family practice physician specializing in sports medicine, said about 900 of his patients have gotten the procedure at his clinic over the past one-and-a-half years.

About 85 percent of patients report improvements, he said, similar to results being reported at Stanford and the Mayo Clinic from patients with mild to moderately severe arthritis.

He opened a new clinic last fall, Seattle Sports & Regenerative Medicine, to help meet the demand.

“The University of Washington is not offering stem cell treatments,” he said. “It’s kind of a little behind the times.”

In addition to using stem cells to treat problems with arthritic joints, Wagner said he’s used it to treat patients with Achilles and patellar tendon tears.

Wagner said patients come back to the his clinic a year after their procedures “and they’re still having phenomenal results.”

He acknowledged that part of the positive reports from patients could possibly be due to the placebo effect — patients simply convincing themselves that a medical treatment is effective.

He said he tells all his patients that, at best, about 85 percent of those who get stem cell treatments report good results. “The worst case scenario is we may be sitting here in a year and you fell into that 15 percent that didn’t get better,” he said.

“Nobody gets worse when their own stem cells are used correctly,” Wagner said.

Dr. Bill Huang, an Everett Bone and Joint physician who specializes in joint replacement has conducted more than 4,000 of the procedures over the past 11 years.

He said he understands why patients facing joint replacement surgery would seek out the alternatives of stem cell treatments.

“You’re asking a patient to consider an operation that will remove their biological part and replace it with an artificial part,” he said. “It’s a very Draconian and irreversible decision.”

The biggest issue with stem cell treatment is the understanding of stem cells is so limited, Huang said. “What are the signals it uses to grow into cartilage as opposed to a tooth?”

Stem cell treatment may help reduce inflammation. “We just don’t know,” Huang said.

For patients who aren’t ready to have joint replacement surgery, he tells them that he doesn’t know of any good medical studies showing that stem cell treatments are beneficial.

But if they can afford it, he tells them it’s not unreasonable to try it.

There’s a difference between having anecdotal stories from patients on good results and rigorous scientific studies that would document whether stem cells actually help with inflammation or help repair and grow back cartilage, he said.

“We’re in the infancy of this,” he said of stem cell treatments. “Right now, I don’t know if there’s enough evidence for this to be a routine treatment.”

Sharon Salyer: 425-339-3486 or salyer@heraldnet.com.