Emails from Clive Sinoff, MD

Email #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.

Email #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 Prolo2009;2:107-123.

Email #3: I have two questions to ask the Prolotherapy community. Many authors, including Dr. Van Pelt¹, 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.

Email #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 Email #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 Email #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 Email #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:

• There are growth hormone receptors on mesenchymal cells including human growth plate chondrocytes.¹
• 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
• Growth Hormone has direct anabolic effects on “old”cartilage cells.³
• Yes, there are estrogen receptors on cartilage cells also!⁴
• 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 Email #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.