Frequently Asked Questions

What is Osteoarthritis (OA)?

Osteoarthritis (OA) is the most common joint disorder, primarily due to aging and normal wear and tear. Other factors may also contribute to OA, including familial traits, obesity, joint fractures, injuries to cartilage and ligaments, and labor intense working environment, high impact sports, and other activities that involve direct impact on the joint. With nearly 30 Million Americans suffering from OA, the US Medical Expenses exceed $185.5 Billion dollars spent annually on treating conditions associated with Osteoarthritis, including knee pain, back pain, Post Traumatic OA, and many other joint conditions. Though many non-surgical Osteoarthritis (OA) treatment options show potential to offer temporary symptomatic relief, however, they have side effects and are ineffective at treating the root cause of OA. The progression of OA is associated with the up-regulation of inflammatory mediators and proteases. 1 Therefore, to successfully stop OA, the biochemical processes of cartilage damage must be addressed. Interventions targeting these proteases can potentially stop these negative events and preserve joint health.

 

What Causes Osteoarthritis (OA)?

Osteoarthritis develops when the cartilage, the smooth covering that protects the bones in the joint, breaks down. The surface of the bones becomes damaged, causing pain, swelling, stiffness, and disability. 3 classes of proteins generally referred to as proteases, cause the breakdown of cartilage and lead to the inflammation and pain associated with an arthritic state. The inflammatory response caused by cartilage breakdown accelerates the progression OA and overpowers the body’s natural defenses; the biological mediators intended to protect your joint.

 

What are proteases?

Proteases are enzymes that break down proteins. The proteases that cause cartilage breakdown, joint pain, and Osteoarthritis include 3 proteases classes (Cytokines, MMP’s and ADAMTS Degradation Proteases). The proteases function by breaking down the cartilage cells; causing inflammation, swelling, and pain.

 

What are protease inhibitors?

Protease inhibitors are protein molecules that serve as biochemical mediators to inhibit proteases. Protease inhibitors stop the damaging affects of proteases by binding to and capturing the proteases in the joint and neutralizes their degenerative effect.  Protease inhibitors, specifically Alpha-2-Macroglobulin (A2M), inhibit all known causes of cartilage breakdown.

 

What is Alpha-2-Macroglobulin (A2M)?

A2M is a Broad Spectrum Multi-Purpose Protease Inhibitor with a “bait and trap” mechanism found naturally in the blood. This “bait and trap” mechanism captures and inactivates the proteases damaging the cartilage in your joint. Once these bad proteases are trapped by the A2M, their ability to damage the cartilage is neutralized and the body eliminates them through natural mechanisms. A2M’s protective characteristics designate this vital protein as the human body's own defense against Osteoarthritis (OA).

 

Where does Alpa-2-Macroglobulin (A2M) come from?

A2M is produced in the liver and found in high concentrations in the blood. Similar to your body increasing white blood cells in response to infection, A2M is unregulated in response to a cartilage injury. The high quantities of A2M found in blood are too large to transport into the joint to provide joint protection from OA. Therefore, supplemental injection of concentrated A2M has the therapeutic potential to stop cartilage breakdown, decrease inflammatory factors, and inhibiting protease activity. 

 

What is APIC?

The APIC System was specifically designed to concentrate the A2M found naturally in your blood to deliver high concentrations in your joint space to protect your joint from the destructive proteins that cause OA.  Injections of concentrated A2M is expected to be the first treatment for OA that can inhibit all causes of cartilage breakdown and thereby prevent cartilage loss, reduce pain, and stop the progression of OA.

 

What are platelets?

Platelets are small cells found in the blood that play an instrumental role in the normal healing response via the local secretion of growth factors and recruitment of reparative cells.

 

How does APIC differ from conventional PRP?

Conventional PRP therapies have a magnitude of limitations, most notably the lack of clinical evidence and wide range of separation techniques available with inconsistent biological components.  The APIC System’s exclusive filter technology allows for selective filtration, making APIC the only plasma concentrate that has the capability to concentrate A2M. Conventional PRP systems function by means of centrifugation alone, which leads to a high concentration white blood cells. White Blood cells concentrated with conventional PRP preparations increase the inflammation within the joint.2 The APIC System is the only A2M concentration system, and also the only plasma concentrate on the market that concentrates platelets and removes white blood cells. Additionally, APIC is unlike conventional PRP therapies, where you may expect post injection inflammation and pain around the injection site, which may last from a few days to months.

 

How does APIC differ from corticosteroid injections?

Cortisone or steroid injections are intended to rapidly relieve symptoms of OA by reducing inflammation in the joint, but do not provide long term healing. Corticosteroid injections provide short-term relief, usually lasting about 4 to 6 weeks. Often, that’s long enough to get you through a flare-up of osteoarthritis until your symptoms subside naturally. However, there are many negative side affects associated with corticosteroid injections. Scientific studies have shown that long-term cortisone injections may actually weaken tissue. Contradictory to the side effects of corticosteroid injections, injection of concentrated A2M protects the joint, and delivers the therapeutic properties to stop cartilage breakdown, decrease inflammatory factors, and inhibiting protease activity.

 

Is APIC right for me?

If you have Osteoarthritis, a tendon or ligament injury, or degenerated joints, and traditional methods have not provided lasting relief, then APIC therapy may be the solution. The procedure is less aggressive and less expensive than surgery. The proteins concentrated in the APIC system have been clinical shown to alleviate pain and scientifically proven to prevent further degeneration of the tissues, leading to OA. Dr. Scuderi will discuss all of your treatment options, including if APIC is a viable option for your condition.

 

Who should not have this procedure?

Patients with bleeding disorders or on anticoagulant therapy do not qualify for this procedure.

 

What can I expect during treatment?

The APIC treatment begins with a full medical examination and diagnostic workup. If you are a candidate for APIC a treatment plan tailored to your needs, as well as the associated risks and benefits will be reviewed and discussed. The APIC procedure begins with a blood draw. The blood is processed in a centrifuge to separate the plasma from the red and white blood cells. The plasma is transferred to a filtration device, which concentrates the A2M and growth factors up to 600%. The concentrated A2M is then injected into the affected joint, protecting the joint and significantly strengthening the body’s natural healing signals.

 

How long does the procedure take?

The APIC procedure takes appoximately 45 minutes. Most patients may resume regular activity immediately following the procedure. 

 

Can I take any medications before or after treatment?

Patients taking anticoagulant medications for clotting disorders, such as pulmonary embolism or DVT, are not recommended to undergo the APIC injections in most cases. Patients taking anticoagulants for previous cardiac surgery or other medical problems should temporarily suspend their anticoagulant therapy for 5 days prior to your APIC treatment. Check with your prescribing physician before making any changes to your medication intake.

 

Are there any risks or side effects?

APIC is safe, because the patient’s own blood is being used and there is no risk of transmission of blood-borne diseases, side effects or allergic reactions from steroids or other injectable medications. As with any technique that is invasive to the body, there is a slight risk of infection, but this is rare.

 

Does APIC hurt?

No, APIC is specifically designed to remove the pro inflammatory components of your blood and therefore it is unlikely to experience post injection pain.

 

What can I expect after the treatment?

Regular activities may be resumed immediately following the APIC treatment. For many cases, patients see pain relief within 48 hours of their first APIC injection. Pain and functional recovery will be assessed 1 week following the APIC injection to determine further therapy needs.

 

How many treatments will I need?

The longevity of pain relief varies based on the individual and level of disease. Following your first treatment, the A2M continually protects your joint from the damaging chemicals that cause OA and remains active in the joint for an extended period of time. Clinical evidence supports the pain relief seen after an A2M injection lasts about 5x to 10x longer than pain relief seen with corticosteroid injections. Since A2M is safe for the treatment of OA, there are no limits to the number of treatments you can have.

 

Palm Beach Sports Injury Institute, 210 Jupiter Lakes Blvd., Suite 3102, Jupiter, FL  33458      (561) 747-9334