Treatment of Degenerative Arthritis with Human Growth Hormone either with or without Intraarticular Ozone and Regenerative Injection Therapy
Richard Gracer, M.D.
Degenerative arthritis is a common and often disabling condition that plagues many of us as we age. The most commonly affected joints are the knee and the hip, although the other joints can also be involved.
As we age, the ligaments can become lax. This can be caused by either even a minor injury or by the stress of daily use. At the same time the cartilage gradually loses water content making it more rigid and therefore more vulnerable to damage. The cartilage lining the joints is gradually worn down causing pain and limitation of motion.
The most common treatment for this condition is the use of painkillers, especially non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, and more recently Celebrex and the other COX-2 selective medications. These drugs alleviate pain, but do nothing to mitigate the underlying cause and may actually accelerate the joint degeneration by allowing increased use and therefore stress on already damaged structures. They may also slow down healing because the inflammatory process is part of the healing process.
Intraarticular injection of corticosteroids is a common and effective treatment for degenerative joint pain. These steroid hormones are a powerful anti-inflammatory and can produce pain relief that can last up to several months. It was thought that as they decrease scarring and can inhibit healing that they would also accelerate cartilage destruction in weight bearing joints(the hip and knee), especially with the increased joint use that would result from the pain reduction produced by the treatment.
A recent two year study of patients with knee arthritis showed that there was significant pain relief and no increased cartilage destruction in the steroid treated group, compared to a control group that did not receive steroid injections. Patients were not followed more than two years and hips were not studied. Therefore, while these injections are a viable option for pain relief, they should be considered only for short term treatment as they do not help the underlying pathology and may accelerate joint destruction.
Another treatment is the injection of hyaluronic acid preparations into the joints on a weekly basis from three to five times. The major brands available are Hyalgan, Synvisc, and Starpurz. These injections mimic the natural joint fluid, increasing lubrication thereby decreasing pain. These are effective in some patients, but the results are usually temporary as there is no change in the underlying joint condition.
When the pain is uncontrollable and the cartilage is gone the joints are replaced. These artificial joints have become more and more durable and sophisticated in the past few years, but they have a finite life and therefore are not recommended for middle aged patients. Many sufferers are left with few alternatives and a severely curtailed lifestyle.
Western conventional medicine does not treat the actual underlying problems, ligament laxity and the dehydration and wearing of the cartilage. The body created these connective tissues and these same processes can rebuild them.
Effective treatment of this condition should be aimed at slowing down the degenerative process and correcting the joint laxity, as well as stimulating cartilage growth. In order to do this several areas must be addressed:
- Nutrition is the foundation of the whole treatment regimen. It is paramount that the body be able to produce the ligament and cartilage that will repair the damaged and /or worn joint.
- The ligaments must be tightened. Joint laxity is often the original cause of the joint degeneration. A small ligament sprain can set up abnormal stresses that can lead to severe joint degeneration years later.
- The cartilage must be regenerated. The joint cannot function properly without a cartilage lining. The cartilage does not have to be as thick as it was originally, but even some increase in thickness can cushion the joint, allow increased range of motion, and reduce pain. (The cause of joint limitation is often due to boney spurs. This motion reduction will persist after treatment.)
- There must be a physical rehabilitation program to maintain joint motion and muscle strength.
The treatment program consists of the following components:
- Nutritional supplementation including glucosamine sulfate, chondroitin sulfate, MSM, high dose vitamin/mineral supplementation with high dose vitamin C, and pharmaceutical grade fish oil. Nutritional counseling may also be suggested in specific situations.
- Regenerative injection therapy(prolotherapy) for ligamentous laxity if needed. This is performed usually every two weeks from four to six treatments depending on the underlying lesion and joint involved. RIT is the injection of a mild irritating solution onto ligaments and tendons to stimulate the normal healing process.
- Ozone/oxygen mixture injected into the joint at the time of the RIT. Ozone is used extensively in Italy and Germany for many medical conditions. Ozone is a powerful oxidizer which when injected rapidly dissolves in the intraarticular fluid and then reacts with whatever molecule it encounters, creating free radicals. These are easily quenched by the body's antioxidant systems. This causes the release of locally acting hormones called cytokines which start and maintain the healing and repair processes. This ozone therapy can be repeated regularly during the treatment period.
- Intraarticular injection of human growth hormone (HGH). HGH is injected into the joint every one to two weeks. This stimulates bone cells to change into cartilage producing chondrocytes by a process called "morphoangiogenesis". This has been researched and developed by Allan Dunn, MD, an orthopedic surgeon in Florida. He has extensive experience and has reported excellent results. (See his website is www.IAGH.com for his specific success rates and other data). Since the HGH molecule is very fragile this injection must be performed without any other treatment at the same time.
- The best results require avoiding weight bearing during the cartilage regrowth. Some physicians have reported good outcomes without this and there has been research that shows that RIT caused cartilage regrowth without HGH with normal weight bearing. (see www.getprolo.com for more specific data on this research by Reeves)
This treatment program combines three therapies that each promote cartilage regrowth and joint integrity. They are complementary and should be synergistic.
Some patients who have preserved cartilage, but ligamentous laxity and/or cartilage damage do not need HGH, but will respond to the RIT/Ozone treatment regimen alone.
Please read the information that we have on RIT and medical ozone and feel free to ask any questions about your specific condition.