X-ray image of a knee joint.

Treatment of Ehlers-Danlos Syndrome Using Regenerative Medicine

Ehlers-Danlos syndrome (EDS) is a genetic connective tissue disorder affecting skin, bones, joints, blood vessels and other organs of the body. Individuals with EDS have problems making the structural protein collagen.  Collagen is the framework of all connective tissue in the body providing structure, strength, and proper elasticity.  Abnormal collagen production causes skin hyper extensibility, joint hypermobility, atrophic scarring, and generalized tissue fragility.

Collagen Facts:

  • 75% of skin is made up of collagen type I and III
  • 100% of tendons are made up of collagen type I and III
  • 86% of ligaments are made up of collagen type I and III
  • 60% of cartilage is made up of collagen type II
  • Over 1/3 of healthy bone is made up of collagen

There are six main types of EDS including classic, hypermobile, vascular, kyphoscoliotic, arthrochalasis, and dermatosparaxis. Clinical diagnosis can be made with symptoms consistent with hypermobility of the joint, tissue fragility, delayed wound healing, and skin hyperextensibity especially with a family history of EDS. There is also genetic and biochemical testing that is useful to differentiate among subtypes.

This article is primarily discussing the hypermobile EDS although all types of EDS affects joints and cause an abnormally wide range of motion due to laxity of the tendons and ligaments. Hypermobile EDS is formally called EDS3, Ehlers-Danlos Syndrome type 3, Ehlers-Danlos syndrome hypermobility type, and/or hypermobile EDS.

Signs and symptoms of hypermobile Ehlers-Danlos syndrome vary but may include:

  • Joint hypermobility affecting both large (elbows, knees, spine, and hips) and small (fingers, toes) joints
  • Frequent joint dislocations and subluxations (partial dislocation)
  • Chronic musculoskeletal pain and tightness
  • Early-onset osteoarthritis
  • Headache or migraines
  • Dysfunction of the autonomic nervous system

There is no specific treatment available for EDS. Conventional treatments include physical therapy, rest, orthotics, splints and braces, heat therapy, non-steroidal anti-inflammatories, pain medications such as opioids, nerve blocks and counseling.

What Is Prolotherapy and How Can It Help My EDS?

Comprehensive prolotherapy is a type of regenerative medicine that utilizes various types of injections to induce inflammation in the joint in order to mimic an injury and bring the body’s own immune cells and healing factors to repair and rebuild injured and degenerated soft tissue or joints. The injection solution varies in its contents, but usually includes some form of dextrose, lidocaine/procaine, and sterile water. 

Prolotherapy creates an inflammatory response recruiting fibroblast, growth factors, and other collagen building precursors to the area. In turn this helps with reinforcing connective tissue resulting in ligament/tendon thickening and stability. This therapy is used for chronic myofascial pain, back pain, osteoarthritis, and ligament/tendon injuries. Prolotherapy is a great treatment for hypermobile tendons and ligaments that have a tendency towards strains and sprains. Ligamentous instability often results in areas feeling tighter or having increased pain in the area. Our muscles tighten in order to compensate for the instability. If healing does not occur as the injury or instability continue our bodies will continue compensating by increasing calcium deposits leading to bone spurs or osteoarthritis.

Conventional treatments such as splints, braces, physical therapy, orthotics, heat therapy, pain medication and anti-inflammatories are working to stabilize a painful joint, decrease pain and inflammation, increase circulation, and build strength in the joint. These are all part of the therapeutic properties of prolotherapy injections.

The goal of regenerative medicines such as prolotherapy is finding equilibrium between repair and breakdown in the body. The body has constant regenerative processes, based in the constant turnover of cells in all tissues of the body. An individual with EDS has a genetic predisposition towards breakdown of tissue, which is why regenerative medicine is such a critical treatment. The therapy allows the body to shift back towards repair finding a more natural balance between repair and breakdown.

For more information on Ehlers-Danlos Syndrome:

Reference:

“Ehlers-Danlos Syndrome (EDS).” Shibboleth Authentication Request, www.dynamed.com.proxy.heal-wa.org/topics/dmp~AN~T116705/Ehlers-Danlos-syndrome-EDS#sec-Treatment.

Prolotherapy for Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders. www.caringmedical.com/prolotherapy-news/prolotherapy-ehlers-danlos-syndrome/.

Arthur K, Caldwell K, Forehand S, Davis K. Pain control methods in use and perceived effectiveness by patients with Ehlers-Danlos syndrome: a descriptive study. Disabil Rehabil. 2016 Jun;38(11):1063-74.

Hope L, Juul-Kristensen B, Løvaas H, Løvvik C, Maeland S. Subjective health complaints and illness perception amongst adults with Joint Hypermobility Syndrome/Ehlers–Danlos Syndrome-HypermobilityType–a cross-sectional study. Disability and Rehabilitation. 2017 Oct 17

Photo © Taokinesis, available under Creative Commons CCO.

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