Letters from Clive Sinoff, MD |
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Letter
#1: Dr. Hauser and the entire publication
staff should be congratulated on achieving the publication
of this important journal. For reasons which I cannot comprehend,
Prolotherapy has been ignored and greeted with hostility.
This publication takes an important step in furthering
the knowledge and use of this highly effective therapy.
In the article by Hauser and Cukla1 the
X-ray changes are dramatic. It would be useful if the authors
could provide more detail as to how the injections were
done. What was injected and was the target directly into
the subchondral area, ligaments and/or into the joint space?
Clive Sinoff M.D.
1. Hauser RA and Cukla JJ. Standard
clinical X-ray studies document cartilage regeneration in five
degenerated knees after Prolotherapy. J
Prolo 2009;1:22-28.
Letter #2: What a tour de force! Dr. Hauser’s
review of the effects of corticosteroids was comprehensive
and thoroughly documented.1
1. Hauser RA. The deterioration
of articular cartilage in osteoarthritis by corticosteroid
injections. J Prolo 2009;2:107-123.
Letter #3: I have two questions to ask
the Prolotherapy community. Many authors, including Dr. Van
Pelt 1, recommend the use of human growth hormone (HGH) as
a growth factor. My understanding is that HGH is released in
the pituitary and acts on the liver to produce somatomedin.
Is there any evidence for a direct effect locally? It would
seem more logical to use a cytokines such as granulocyte stimulating
factor (G-CSF) or fibroblast growth factor (FGF) which have
been shown to attract inflammatory cells. Does anyone know
of scientific or clinical evidence to support such growth factors?
Clive Sinoff M.D.
1. Van Pelt RS. Hip arthritis
Prolotherapy injection technique. J Prolo 2009;1:101-103.
Letter #4: Does anyone have experience with
the use of Prolotherapy in true rheumatoid arthritis (as opposed
to osteoarthritis misdiagnosed as rheumatoid arthritis)?
Thank
you,
Clive Sinoff M.D.
22200 Halburton Rd
Beachwood, OH 44122 |
JOP
COMMENTS
Comments to Letter #1: Dear Dr. Sinoff, We at JOP appreciate your comments
and questions. To answer your questions: 2IU of HGH was injected into
the joint space. With each treatment the medial and lateral collateral
ligaments were also injected with normal Prolotherapy solution.
Comments to Letter #2: Thank you for your comments.
The treatment of osteoarthritis with corticosteroid injections has to
stop! Clearly one of the main causes of the “bone-on-bone” phenomenon
leading to hip and knee replacements is the corticosteroid injections
the patients are receiving.
Comments to Letter #3: Wow, what a topic, growth factors
and Prolotherapy! As you know the day will arrive where doctors will
inject fibroblastic growth factor or granulocyte stimulating factor into
injured structures, but unfortunately that day is not here. Here are
some items for you to ponder:
| 1. |
There are growth hormone receptors on mesenchymal cells
including human growth plate chondrocytes.1
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| 2. |
Pituitary growth hormone acts directly on many cells
in the body. As a matter of fact, most of the effects
attributed to Growth Hormone action appear to be the
result of a direct effect of GH on cells in different
peripheral tissues, including cartilage. Not on IGF-1.2
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| 3. |
Growth Hormone has direct anabolic effects on “old”cartilage
cells.3
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| 4. |
Yes, there are estrogen receptors on cartilage cells
also!4
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| 5. |
Chondrocytes (cartilage cells) can produce their own
sex hormones!5 |
What it all means is that cartilage cells are somewhat under the control of hormones.
From a Prolotherapy standpoint if we can make cartilage physiology more anabolic
there will be a good chance that the chondrocytes will make more cartilage which
will ultimately help the patient!
Comments to Letter #4: As you know, not every joint pain in
a rheumatoid arthritis (RA) patient is due to RA. From a Prolotherapy standpoint
in treating the RA patient, you should do the following: assess the condition
of their RA and evaluate the painful area like you would with any other patient.
If someone has active synovitis at the time of the Prolotherapy evaluation, we
(Caring Medical) would inject a solution of sterile water and procaine (anywhere
from a total of 0.4% to 1.0% procaine) into the painful areas to cool it off
(versus steroids) and treat the rheumatoid arthritis with a natural medicine
program. Once the RA is under control, meaning no heat in the joint, hands,
wrists, or feet, then Prolotherapy could be done to the joint or structures involved
assuming they have injuries that typically respond to Prolotherapy. As you know,
rheumatoid arthritis by definition destroys joints. What is one of the best treatments
to repair joints? Prolotherapy. So yes, Prolotherapy can be done in folks with
RA, but just make sure the RA is under good control. If you inject the typical
Prolotherapy solutions into joints with active synovitis you run the risk of
increasing the pain quite a bit, but the good news is, the increase in pain is
temporary. |
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