Case Study :Osteoarthritis

Case Study for OA B/L knee with Vitiligo:
02.10.2013
A 48 years old lady from Mumbai was admitted to our hospital for treatment of OA of knee with Vitiligo.
Diagnosis: OA of B/L knee with Vitiligo
Clinical history: K/C/O of knee arthritis with vitiligo (white patchy skin), ligament pull, deficiency of calcium.
Associated complaints: Difficulty in walking, no squatting, climbing staircase, sometimes pain in feets and ankles, white patchy skin, patches have increased.
Presently on tab cartigen and pigmento for skin.
N/H/O: TB/HTN/DM
Radiological findings:
• X-ray for both knees show osteopenia and osteoarthritis in bilateral knee joints.
• USG whole abdomen shows mild liver hepatomegally with mild fatty change.
Investigations:

vitiligo treatment

vitiligo case study

In OA of knee factors responsible are:
The development of OA is dependent to interactions between several factors and so this process may be considered the product of interplay between systemic and local factors. This progressive and disabling disease can be resulted from a combination of risk factors, including advancing age, genetics, trauma, knee malalignment, increased biomechanical loading of joints through obesity, augmented bone density and an imbalance in physiological processes.
In Vitiligo factors responsible are:
• Stress
• Hormonal
• Trauma
• Genetic tendency
• Occupational and drugs

The stem cell plays a major role for cure due to their basic correctors of Angiogenesis & Differentiation, so the below protocol was adopted for treatment.
Cellular therapy includes:
• Bone marrow transplant
• Adipose transplant (fat derived)
• Platelet rich plasma (PRP)
Procedure:
Stem cells exist in all tissues in human body and classified as totipotent, pluripotent, multipotent depending on tissue type.
Stem cells are classified as Adult stem cells and embryonic stem cells, which are further classified according to the way they are derived and sources tissues like, Mesenchymal stem cells(MSC’s), Haematopoietic stem cells(HSC’s) and induced pluripotent stem cells(iPS)cells are the major types of stem cells.
Autologous stem cells are derived from patient’s own body and can be obtained from bone marrow, adipose tissue and Peripheral blood.
We use Mesenchymal stem cells derived from bone marrow, adipose tissue, which are self renewing cells derived from adult tissues that can from a number of cells or tissues.
The major advantage of using MSC’s is the ease of harvest and lack of immunoreactivity since they are derived from autologous sources.
There is no risk of a rejection reaction, it is safe and effective and the most important thing is that the stem cells treatment has a very measurable, positive effect. These are then processed in tissue culture lab to isolate stem cells which are then given intra-articularly at site of joint injury (bilateral knees) and for vitiligo local application of cells were given on the skin (Melanocyte transplantation) , under general anaesthesia (mild sedation).

Following supplements were advised for the patient for OA knee arthritis:
• Omega-3 fatty acids are healthiest fats for people with osteoarthritis that decrease the inflammation by suppressing the production of cytokines and enzymes that breakdown cartilage.
• Anti-oxidant vitamin C necessary for cartilage development.
• Vitamin D helps prevent the breakdown of cartilage, decrease the risk of joint space narrowing.
• Beta-Carotene another powerful antioxidant helps destroy free radicals before they cause excessive damage to joints.
Following supplements were advised for patient with Vitiligo:
• Citrus fruits and juice should be restricted
• One should not take medicines containing Amla
• Oily and spicy food should be lowered
• Milk and milk products should be lowered
Patient showed good improvement symptomatically.
• Pain in both knee has reduced. It increases if patient walks for more than 30 mins continuously.
• Patient had swelling in ankle for 2 days.
• Patient used walker for walking but post treatment she isn’t using.
• Skin colour has changed to light brown.
• Patient is stable, taking all the medicines
• Patient is feeling good and positive.
Patient is advised to follow the diet plan and exercises advised by the physiotherapist with life style modifications regularly.
The patient is still under observation and follow up for full recovery.

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