Amniotic injections not current standard of care for arthritis


Dear Doctor: I am 79 years old and have pain in both shoulders. X-rays show I have arthritis and that it is bone-on-bone. What is happening? Do you think that amniotic injections would help me? I am trying to avoid having surgery.

Dear Reader: Arthritis is a general term that refers to pain or disease that occurs in the joints. The word comes from the Greek words “arthro,” which means joint, and “itis,” which refers to inflammation. More than 100 different conditions and disorders fall under the umbrella of arthritis, and with an estimated 54 million diagnosed cases, it’s a major source of disability in the United States. Symptoms include stiffness, aching, pain and swelling in or around the joints. Rheumatoid arthritis, which is an autoimmune disease, can affect organs as well.

The most common type of arthritis, particularly among older adults, is osteoarthritis. That’s what your X-rays have revealed. It’s an often-painful degenerative disease that occurs when the protective cartilage at the ends of bones and within the joint capsule becomes damaged, usually from wear and tear. In addition to being somewhat springy, which provides a cushioning effect, this type of cartilage is also slick and slippery. It minimizes friction so that bones can move freely within the joints.

When someone has osteoarthritis, the loss of cartilage can range from minimal, which results in mild pain and discomfort, to the challenging bone-on-bone situation that your doctors have found. Shoulder arthritis is commonly treated with physical therapy that focuses on strength training, flexibility and range of motion, as well as oral and topical NSAIDs, and modification of daily actions and activities that cause pain. Medical interventions range from steroid injections, which provide temporary pain relief, to the surgery you want to avoid. This includes shoulder arthroscopy, a minimally invasive procedure in which the joint is cleared of debris, and partial or total shoulder replacement.

Elizabeth Ko, MD and Eve Glazier, MD

Some arthritis patients have found pain relief with injections of hyaluronic acid, a sugar that’s a component of the lubricating fluid in the joints. Results have been mixed, particularly in older adults with more severe osteoarthritis. However, new products are in continuous development, making this an avenue of treatment with future potential.

Regarding amniotic injections, these are not part of the standard of care at this time. They fall into an emerging area of study known as orthobiologics, which is the use of biological substances in the treatment of musculoskeletal injuries. The amniotic membrane contains a variety of bioactive molecules. This includes several types of growth factor, which are signaling proteins that stimulate cell growth. Amniotic membrane is collected from donors and processed into an injectable compound.

Although amniotic tissue derivatives have yielded positive effects in some animal studies, clinical trials into their efficacy have been limited and have had mixed results. And, while it’s true that some clinics now offer amniotic injections to treat osteoarthritis, at this time there is little oversight of either the products or the specific treatment methods. We urge you to consult with your doctor if you decide to explore this area of treatment.

(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)