Health Problem: Spinal discs and the cartilage that covers mobile joints can become damaged by chronic strain, overuse, trauma, and diseases such as osteoarthritis (OA) and rheumatoid arthritis (RA) causing pain and disability.

Technology Description: Stem cells used for treatment of joint pain can be harvested from iliac crest bone marrow, adipose tissue, or peripheral blood, and some protocols involve culturing of stem cells to increase their numbers available for injection. Patients may receive their own stem cells (autologous stem cells) but in some cases cultured stem cells obtained from unrelated donors (allogeneic stem cells) are used. Use of donor stem cells avoids the need for harvesting and processing cells from each patient but raises the possibility that the foreign cells will trigger an immunological reaction that could destroy cells or cause rejection of the tissues they form or infiltrate. Regardless of the source, the stem cells are injected into affected joints or spinal discs alone or in combination with materials such as hyaluronic acid that increase joint lubrication or fibrin glue that promotes localized adherence of the cells to the damaged joint.

Controversy: Stem cell differentiation into the types of cells needed in the damaged joint may provide limited or no benefit because it requires special microenvironments or conditions that are not present or severely depleted, such as a particular layer of tissue for cell adherence and specific signals from surrounding cells.

Key Questions:

  • How does stem cell therapy for knee, hip, shoulder, and spinal disc pain compare with other treatment options with respect to clinical outcomes and quality-of-life measures?
  • Are improvements observed after stem cell therapy durable over time?
  • Does stem cell therapy for joint pain pose any safety problems?
  • Have definitive patient selection criteria been established for stem cell therapy for joint pain?

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