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Author Topic: Role of inflammation in cartilate healing/regeneration  (Read 888 times)

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Offline chondrocyte

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Role of inflammation in cartilate healing/regeneration
« on: March 12, 2011, 06:00:14 AM »
First post.  Hello everyone.

It's clear that inflammation has negative effects on the progression of osteoarthritis and the prospects for regeneration of articular cartilage injuries/defects.  But it is not at all clear to me what interventions one should take if regeneration is prioritized over relief from pain.  I've been going through the research literature but have so far not found a consensus view on the positive and negative roles of inflammation and what can be done to encourage the former and minimize the latter.  I'm hoping folks here have a handle on this.

The pendulum has been away swinging from RICE treatment and suppression of inflammation in cases of tendon and ligament injury, as it has become more clear that the inflammatory process is part of the healing process - suppress inflammation and the tissue may not heal.  I think this is much more clear-cut with tendons and ligaments than with cartilage, as the biomechanics of cartilage are different.  The standard prescription for osteoarthritis has been anti-inflammatory drugs.  They work great on the pain, swelling, etc. but what effect do they have on long-term prognosis?  Do they make life more comfortable but interrupt the healing process (limited as it is) inside the cartilage?  Are NSAIDs a short-term gain, long-term pain proposition?

I have some cartilage damage in my knees and ankles and have so far avoided NSAIDs because I feel that in removing the pain they encourage me to be too active and provoke "flares", which I associate with irritation of the cartilage tissue and perhaps re-injury.  I'd rather have the feedback that inflammation-associated pain provides about my activity level so I can try and ride the line between too much and too little activity.  But I wonder if anti-inflammatory drugs can help with cartilage regeneration.  Am I missing out?

If a patient's goal is to maximize all things that will encourage cartilage regeneration and minimize all things that will retard it, should NSAIDs and other anti-inflammatories be taken?  Does science understand the "bad" inflammatory products well enough to target them?  Do we really know that they are bad?  In short, I tend to trust my body's own healing response, including inflammation, but I know that my body is far from perfect and can be helped with interventions if they are the correct ones.  Can we intervene in the inflammation process with confidence that we are promoting regeneration rather than retarding it?

I'll happily take any input, answers or reading recommendations I can get.  Thanks.


Offline amoler

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Re: Role of inflammation in cartilate healing/regeneration
« Reply #1 on: March 12, 2011, 02:31:38 PM »
Didn't somebody or other post a link about how short term inflammation was good but chronic was bad and lead to worsening of OA? Sorry I can't remember where the link is.
'77- Rt knee menicus tear
'90 -2nd menscus tear
'91 -failed arthroscopy/partial menisectomy
patella dislocation 10/ 2010
Dx = grade 4 chondromalacia + synovitis + Meniscus tear + lax strained medial ligaments
Fall down the stairs 7/20/11 - mcl sprain + 2 meniscus tears

Offline marksalot

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Re: Role of inflammation in cartilate healing/regeneration
« Reply #2 on: March 13, 2011, 05:46:23 AM »
I don't know if this will help you make a decision, but from what I can tell there are still arguments both ways.

http://saveyourself.ca/articles/why-does-pain-hurt-so-much.php
Summary: Internal inflammation is not useful unless there is a risk of infection.  But it happens because the mitochondria released from broken cells "smell like" bacteria to your immune system.

http://savingmyknees.blogspot.com/2010/10/why-drugs-arent-answer-to-knee-pain.html
Summary: There have been drug trials where patients taking powerful anti-inflammatories have caused damage to their knees without knowing it.

I don't know nearly enough about what inflammation actually is though to give any advise of my own.  Neither of these articles are written by the researchers, so their conclusions could be all wrong.  But I think avoiding drugs is probably a good thing if it's possible.  I try some anti-inflammatories occasionally just to see what the difference is, and it usually isn't much.
04/10: right kneecap catching and pain during a brief bike ride, start resting
05/10: red spot on inner knee, painful sleeping, GP recommends 6 wks rest and exercise
07/10: stretching helps pain, but exercise brings it back, GP recommends knee sleeve and PT