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Rhuematism

By Dr. Jim Ferguson

I get as frustrated as anyone else when I hear that our government has given some researcher precious resources to study the mating preferences of fruit flies or build robot squirrels; I didn’t make these up.  And there are hundreds of even more wasteful programs.  For the last three years Senator Tom Coburn from Oklahoma has published a long list of profligate spending by our government.  Check it out and you’ll begin understand it’s not the girls, but The Washington Boys’ Gone Wild.

However, sometimes basic research leads to discoveries or improvements that have spin-off value for all of us.  Some examples are from NASA research which brought us memory foam, cochlear implants, insulin pumps, and Tang.  The Implications of Basic Research section in the New England Journal of Medicine (NEJM) is where I go to better understand medical research.

Mornings are cold in February and my old truck seems to creak and groan as much as I do until we warm up, get stretched out and get the juices and oil pumping.  Old timers used the term “rheumatism” to describe their aches and stiffness.  With modern science we can be a bit more precise in categorizing and diagnosing a patient’s rheumatologic (muscle, joint, and fibrous tissue) complaints.

Let’s go back to Anatomy or Health 101.  Muscles attach to bones by tendons.  Bones are held together by ligaments such as the ACL or anterior collateral ligament, one of the ligaments that stabilizes the knee.  The brain conceives of a movement (praxis) then sends an organized signal down through the spinal cord and nervous system telling the muscle to contract thereby pulling on the tendon and moving the skeletal part.  Conceptualize the skeleton as the frame of a car held together by bolts analogous to ligaments.  Muscles are the motor of the body activated by the computerized electronics (the brain).  The tendons transmit the power to move the parts as does the transmission.

When patients complain of pain I take this at face value.  My job is to translate symptoms and signs into a diagnosis and hopefully a therapy.  It’s especially important to note whether the pain seems muscular or skeletal, whether it is in the joint or in the fibrous attachments (tendons and ligaments).  Not infrequently I see patients whose muscles and sinews have been over worked by a trainer.  This often results in night time muscle cramps and morning stiffness.  I’ve seen many patients with chest wall pain resulting from the overzealous use of weight machines.

Muscles and joints can become inflamed by immune system problems and present with muscle soreness and weakness or joints that are red, hot, and swollen.  An important clue is how long morning stiffness lasts.  If it’s like my truck and my body, the stiffness goes away with a few stretches and a few minutes under a hot shower.  If the stiffness lasts more than an hour or the joints look inflamed, it’s probably something more than just aggravation.

A recent basic research article in the NEJM dealt with replenishing cartilage in worn out joints utilizing the body’s own stem cells.  The basic problem in non- inflammatory osteoarthritis of the joints is a degeneration of cartilage brought about by injuries (such as in football or basketball, etc), excessive mechanical stress (as in obesity) or through inherited tendency.  Have you ever wondered why your finger joints are as knarled as your mother’s?  Folks, we inherit the good and the not so good, but hopefully not the ugly from our parents.

Most of us have seen a soup bone.  The end often includes the rounded joint that is covered with a glistening bluish-white surface comprised of cartilage.  This same fibrous tissue is in your ear lobe, and is spongy and smooth when healthy.  Unfortunately, cartilage has a relatively poor blood supply and doesn’t recover well from injury and becomes worn over a lifetime of use.

Imagine a new drive way that is smooth and without pock marks.  Now, imagine a driveway after twenty years of wear and tear.  It’s no longer as smooth.  Wear and tear over the surface of the knee cartilage is similar.  There’s even a medicinal product made from the cartilage of a rooster’s comb that can be injected into the degenerative knee in an attempt to do a little resurfacing.  Unfortunately, this treatment can’t fill pot holes and surgical joint replacement may be necessary if temporary cortisone injections are unable to calm the inflammation and pain.

Stem cells are what doctors called pluripotential cells.  These cells can turn into any type of cell given the right stimulus and conditions.  Researchers are working on a method to induce adult stem cells to differentiate into new cartilage cells by stimulating them with a protein produced by our own bodies.  This compound called kartogenin is injected into the joint to grow new cartilage cells.  Formally, scientists have tried to regenerate cartilage by drilling holes in the damaged joint surface and filling the holes with harvested plugs of cartilage from other body sites, analogous to the hair transplant technique.  If this research advances we may someday treat worn out knees with chemicals to regrow damaged cartilage rather than surgically replacing knee joints with metal.

This may sound a bit like Star Trek where Captain Kirk’s poor eye sight is corrected by the periodic injection of one of Dr. McCoy’s concoctions.  Never underestimate the ingenuity of man whose survival and success is in part due to his inquisitive nature and reason.

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