• Why Should I Switch To A Natural Deodorant?

    I could write an endless list of ways to know you’re no longer a teenager. Which admittedly seems strange coming from someone who spent an entire island vacation binge-watching Austin and Ally. Despite my youthful heart (or horrific taste in television), the signs of unavoidable adult responsibility are really starting to pile up. Researching every single item and candidate on the ballot and getting ridiculously excited about a super capacity washing machine certainly don’t correlate with the teen years. But even more concerning: low cost of ownership takes the number 1 spot on my list of must-haves in a car. And also, I get super excited about an aluminum free deodorant that really works. #TimeMarchesOn

    But really everyone should get excited about an effective, aluminum free deodorant. It allows you to maintain friendships *and* avoid accelerating certain forms of mental decline. Don’t believe me? I wrote an insanely long post about the link between aluminum exposure and cognitive decline a while back, but let’s review quickly for new readers.

    Aluminum Is Everywhere, Including Antiperspirant / Deodorant

    We encounter aluminum in a variety of ways daily, because apparently it serves a myriad of purposes. Like duct tape, but way worse for your brain. Cereal, pots, pans, aluminum foil, and aluminum cans expose us to a small amount of aluminum daily. But free viagra voucher 2015 source url watch how often to take aralen bare metal stents duration of plavix ampicillin vs oxacillin get link best essay editing service cialis et diabete type 2 methocarbamol and cialis russian speech viagra sciolto in bocca viagra veny nelkul viagra 9.99 jfk most famous speech nuovo centro medico polispecialistico e fisioterapico srl flagyl pregnancy https://www.getthereatx.com/capstone/essays-about-yourself-as-a-writer/7/ follow url viagra diclofenac source site https://themauimiracle.org/bonus/you-shouldnt-take-viagra/64/ kuhs dissertation guidelines anyone on clomid after miscarriages watch https://drtracygapin.com/erections/doxycycline-pharmacy-coupons/25/ essay finder best topics to write about for college essay how to delete email contacts on your ipad diflucan rezeptfrei paypal here 4rx viagra review sites the most aggressive aluminum exposures come from antacids, allergy shots, dialysis, and industrial air.

    Aluminum salts are the active ingredient in any antiperspirant, though many people don’t count them as an exposure risk. Why? Because, and please hold your laughter, everyone knows your skin acts as a barrier. That’s its whole purpose in life. So clearly nothing gets through, because everything in this world does what it’s supposed to. Public school provides a dependable education to all. The DARE program kept kids from doing drugs. Standardized testing elevated educational standards nationwide. And nothing gets through the impenetrable barrier of your skin.

    Except drugs delivered through skin patches. Anti-histamine creams. Poison ivy. Icy Hot. And every topical skincare product on the market. In fact, this scientific publication spends an entire paragraph listing the ways skin fails as a barrier and allows topical skincare products to exert effects. So when you apply stuff to your skin, it *can* get through to your body.

    Aluminum Is Linked to Brain Malfunction

    Studies have repeatedly shown links between aluminum exposure and various brain issues. People exposed to high levels of aluminum experienced memory problems and trouble concentrating. And exposure to aluminum correlates with a higher incidence of Alzheimer’s disease. For a deep dive on this topic, you can find the big, detailed list of scary reasons we should all avoid aluminum in my other post.

    Deodorant Is The Way To Go

    You can limit your exposure to aluminum in a variety of ways, including avoiding the points of exposure I listed earlier. But today we’re focusing on antiperspirant/deodorant. Because most of us wear it every day and often slather it on multiple times a day. And no, I can’t tell you that metric tons of antiperspirant-derived aluminum pass through your skin and run rampant in your body. But for me anyway, I’d rather be cautious when it comes to things that might make my brain turn to mush faster than binge-ing Netflix. And we know that things hundreds of times bigger than the aluminum in antiperspirant routinely make it past your skin.

    So I only use aluminum free deodorant, and it has been a struggle, y’all. I’ve definitely thrown out a few workout shirts since making the switch, because the washing machine was no match for their… history of cardio abuse. But, I’d rather throw away a few t-shirts than mistake my brother for Jesus and start confessing all my sins. He doesn’t need to know how often I broke curfew to stay out late working on Calculus homework. Or about that time in 5th grade when I had to take a Spanish quiz on the first day at a new school and cheated off of my neighbor. Who did. NOT. know. Spanish, y’all. #RookieMistake #IFailedThatQuiz

    It Doesn’t Have To Be A Natural Deodorant

    But most of the good ones are. The most important thing is to make sure whatever you use to control your neandrathal perfume has zero aluminum in it so you can avoid increasing your risk of brain malfunction. Now, I gave some suggestions in my previous post, but I’ve since discovered some new deodorants that basically changed my life. In a tiny tiny way, but still. And they saved a bunch of my favorite workout shirts by being wildly effective. So, check out this list of my favorite aluminum free deodorants with scores for efficacy, skin friendliness, and scent:

    1. MagSol Magnesium Deodorant | Rose
      Efficacy: 9.5
      Skin Friendliness: 9.5
      Scent: 10
      Y’all, I first tested this with a two hour cardio session, and I literally came out smelling like roses. This stuff is amazing. The only way antiperspirant outperforms it is in actually preventing sweat. Otherwise, this stuff performs identically to antiperspirant, so much so that I quadruple checked to make sure it was aluminum free. Plus, it doesn’t irritate my skin at all. Probably because it uses magnesium for its base instead of baking soda, which also provides the added benefit of helping you get to sleep every night. This is now the only deodorant I use, and it comes in a bunch of different scents. If you haven’t tried it, do.
    2. Kopari | Regular Scent
      Efficacy: 7
      Skin Friendliness: 9
      Scent: 7
      I haven’t personally tried this one, but my best friend has. She said it’s the easiest natural deodorant to put on, doesn’t irritate her skin, and maintains a pleasant scent all day long.
    3. Primal Pit Paste | Jasmine
      Efficacy: 6.5
      Skin Friendliness: 4
      Scent: 10
    4. Schmidt’s Deodorant Stick | Rose + Vanilla
      Efficacy: 7
      Skin Friendliness: 6
      Scent: 10
      Formerly my favorite deodorant but has been displaced by MagSol.
    5. Tom’s of Maine | Unscented
      Efficacy: 3
      Skin Friendliness: 10
      Scent: Neutral

    Use Aluminum Free Deodorant To Keep Your Brain Working

    as long as possible anyway. And just as a reminder, no research has yet shown a direct cause and effect relationship between aluminum exposure and Alzheimer’s. But I personally see a crap ton (yes, that’s the scientific term) of correlation, and that’s enough to keep me on the aluminum minimizing bandwagon for the foreseeable future.

    Have you tried aluminum free deodorants? Want to rant about them? Do that in the comments – that’s why they’re there! Or drop a line directly in my inbox!

    Photo by morgan sarkissian on Unsplash

  • Can Stem Cells Help Lupus?

    Y’all, I just got home from a whirlwind trip where I met some of the most interesting people! I had lunch with this serial entrepreneur who showed me a bunch of pictures of his ridiculously cool meteor collection, exchanged ideas with one of the people responsible for the first case of fully functioning 3D printed organs, and heard two of the coolest ladies ever share their personal experiences with bone marrow derived adult stem cell therapy. It surprised me when one of them said her physician came at her with a hammer, but it turns out she just has a great sense of humor. And also really appreciates shock value.

    During the course of these adventures in the snowy Pacific Northwest (no, there really wasn’t any snow but it was mid-winter weather for this native Texan), I met a number of people looking for answers to their health conditions. One such person asked me a variety of questions about systemic lupus erythematosus, aka lupus. So today I’m going to talk about stem cells and lupus, because a lot of people want to know if stem cells can help. And I’d rather they get information from some peer-reviewed, Pub Med listed sources here on ISY than Dr. Oz. Because Dr. Oz is really great on camera, but he provides about as much scientific value as an episode of Rainbow Bright.

    So let’s jump right in and see what lupus is and how stem cells can legitimately help. Or not. It’ll be a surprise!

    Lupus Makes Your Immune System A Traitor

    In a previous post I mentioned the basic functions of the immune system, but let’s review anyway. Your immune system does a million jobs, but they all come together to accomplish two broad goals: (1) distinguish between you and not you. (2) viciously attack and kill anything that is not you. But every once in a while, things get murky, much like that time Dick Cheney accidentally shot one of his friends in a hunting accident. You know, glasses get foggy, lots of things happen all at the same time, and them bam – you mistake your friend for a quail. Or your own body for an invading microorganism. It’s not intentional, but the consequences sure are serious.

    When this happens in the immune system, there are fewer late night talk show jokes and more long term repercussions. Depending on how generalized this confusion is, the immune system may attack one specific tissue or many different ones. With lupus, the confusion seems fairly general affecting a variety of body systems including joints, skin, kidneys, blood cells, the brain, heart, and lungs.

    Doctors Use Steroids to Treat Lupus

    When the immune system goes full Benedict Arnold like this, it can cause massive inflammation in the affected tissues. Remember in my last post how I said corticosteroids (cortisone shots) chew up cartilage and joints? And that you definitely shouldn’t get them unless your life depends on it? Well lupus happens to be one of the times you might really need steroids. Because steroids can quickly control systemic inflammation. But at what cost?

    Well, those high doses of corticosteroids can lead to a condition called osteonecrosis. And if you think that sounds like dead bone, you’re absolutely correct. The steroids kick off a process that makes blood vessels retreat from bone. And then that bone basically starves and starts dying. Which is not only gross but super painful as well and can lead to joint replacement.

    But what if you don’t want to be Terminator 0.0 with a titanium hip?

    Bone Marrow Can Treat Osteonecrosis

    Even in lupus. I’ve posted about osteonecrosis before, but I didn’t discuss a study that came out this past July. No, I’m not just lazy. Though I do sometimes binge-watch The Great British Baking Show for hours without moving from the best spot on the couch. Mary Berry is the best, y’all. But I digress. I didn’t cover this study before on account of already having waaaaaay too much information in that post. But now that we’re on the topic of lupus we can dive in.

    Researchers in Japan have been treating lupus patients’ osteonecrosis with concentrated bone marrow since the early 2000s. In this study, 52 lupus patients with 92 cases of hip osteonecrosis were treated with their own concentrated bone marrow. Physicians first did a core decompression. You can learn about that procedure from this uncomfortably narrated video. I think whoever made that video wanted any watcher to feel as uncomfortable listening to it as a patient with osteonecrosis feels. And they were successful in that endeavor.

    Oh no y’all, I just go to the middle of that video where the narrator enunciates “Or. A. Deceased. Donor.” And I can’t stop laughing. Please ignore that comment, and focus only on the part where they show you the decompression. Everything else in that video is marginally incorrect and seems to have been written by a robot with no experience communicating with humans.

    Back to this study. After decompressing the osteonecrotic bone, the physician(s) injected concentrated bone marrow (not deceased. donor. tissue.). And then the mesenchymal and hematopoietic stem cells in that bone marrow got to work. They hoped that the concentrated bone marrow treatment would prevent these patients from needing a hip replacement.

    Only 27 of 92 treated hips ended up needing a hip replacement, which the authors noted was fewer than in other reported studies. It was also higher than several of the other studies I’ve discussed, which makes sense. This study population all had lupus, and other studies would have excluded patients with lupus.

    So the same type of technique used in patients without lupus also seems to work in patients with lupus, just not quite as well. Some studies have found that mesenchymal stem cells in lupus patients behave differently than those from non-lupus patients. Which may play into the reduced efficacy we see here. Either way, concentrated bone marrow does seem to improve outcomes for lupus patients with osteonecrosis.

    But what about stem cells actually treating lupus, not just its side effects?

    Adult Stem Cells Have Treated Lupus

    Sort of. At least a couple of times anyway. Since I don’t want to write an entire encyclopedia (and you probably wouldn’t read one anyway), I’m only going to cover the most recent study today. In February of this year, researchers in China published this study in which drug-resistant lupus patients were treated with donor mesenchymal stem cells (MSCs). Their thinking in choosing MSCs from donors came down to previous studies in which using the patient’s own MSCs did not work out well. Given the fact that lupus patients’ MSCs do seem to behave oddly in some circumstances, and the objective here was immune suppression, it makes sense that they chose donor cells.

    22 patients in this study were treated with MSCs from healthy donors, and the remaining 59 received MSCs from umbilical cords. All of the patients received the cells via IV infusion.

    Side Note: IV Infusion Doesn’t Entirely Make Sense

    I discuss this fact with physicians all. the. time. The marketing machine of pseudo regenerative medicine popularized the idea that you can mainline stem cells right into a vein and get them to the whole body efficiently. But science says otherwise. In a well-known study (and several others), researchers demonstrated that upwards of 80% of infused MSCs get stuck in the lungs. The first time they see them. So before that blood ever goes to the rest of the body, almost all of the cells accumulate in the lungs.

    Which is great if you want to get cells to the lungs. But not so great if you want to send cells all over the body. Now, in a similar study, researchers saw that after a few hours those cells ended up in other places like the kidneys, liver, and spleen. So IV infusion of cells does get them into the body and into some organs, but it doesn’t necessarily distribute them evenly throughout every tissue.

    Using IV infusion in an effort to sprinkle MSCs into every single tissue doesn’t make all the sense in the world, but we do lack other options. So a lot of people do it anyway. And in this lupus study, it did seem to have a positive effect.

    End: IV Infusion Side Note

    So after receiving an IV infusion of either donor or umbilical cord MSCs, 27% of treated patients reported complete remission at five year follow-up. In older studies using the patient’s own hematopoietic stem cell (HSC) transplant, only 21% of patients experienced complete remission. And HSC transplants carry a lot of additional risk. Scary amounts of additional risk.

    The simple take home message from this study comes directly from the authors:

    [donor MSC transplant] had at least comparable if not better clinical efficacy than [HSC transplant], but with fewer adverse events and significantly lower cost in treating drug-refractory active [lupus] patients

    Stem Cells Are Not Clinically Available for Lupus*

    Outside of a study. So even though the study above and others have gotten promising results, your local physician shouldn’t offer them at this point. The scientific community still needs to learn a few more things before broadly launching this type of treatment. This way you and your doctor can have some reassurance of safety and efficacy when the time comes. And if you do find a local practitioner offering stem cells for lupus, definitely make sure it’s through a study. A legitimate, clinical study.

    *With the exception of bone marrow concentrate for osteonecrosis. That’s legit and available all over the US.

    Want to join a study? Antidote matches patients to appropriate clinical trials, and Smart Patients helps you find clinical trials for your condition.

    The moral of this story:

    Bone marrow concentrate can treat osteonecrosis, though less effectively in lupus patients than non-lupus patients – now (currently available in the US). And donor mesenchymal stem cells may one day help treat lupus as a whole.

    Not sure if your doctor is part of a study? Confused by my affinity for tangents and appalling run-on sentences? Feel free to let me know in the comments, or drop a a line directly in my inbox!

    Photo by Tiago Muraro on Unsplash

  • Why Shouldn’t I Get Steroids for My Joint Pain?

    The other night at handstands class (yes, that’s my favorite weeknight activity, and no, I am not aggressively too old for it), several of my fellow handstanders discussed the merits of getting a shot of steroids for knee pain. I think. Some sort of joint pain for sure. One person shared their experience of dramatic pain relief as a result of a similar treatment and encouraged the questioner to go ahead with it.

    Throughout this discussion I sat silently, keeping the information in this post to myself. Because no one likes a know-it-all, and nobody ever likes someone telling them not to get quick pain relief. In Texas, “shoot the messenger” is not a metaphor, and this definitely qualifies as a messenger shooting situation.

    Today I feel kind of bad about it though, but not bad enough to try to contact this person. I have just enough guilt to write this post instead of the other ones I had planned, and I think both my grandmas would agree that’s just about the perfect amount of guilt. #ThanksGrandma

    So, now that I’ve admitted to a grandma sanctioned guilt complex, let’s talk about steroids and why you should probably never get them. For joint pain.

    Steroids Treat Joint Pain

    for short periods of time.

    Doctors started using corticosteroids, to treat joint pain somewhere between the hay days of the T-Rex and the velociraptor, because they work well for a percentage of patients. But, the pain relief is fairly short-lived. In a review of 28 studies involving 1973 patients, corticosteroid joint injections relieved pain more effectively than a placebo injection for time periods of weeks, not months. In another review of 312 patients who received corticosteroids for their painful knees, pain relief lasted for a period of 3-4 weeks. The pain relief usually falls within the range of 75% at the maximum relief point and then climbs back up over time.

    So if you want pain relief for a few weeks, steroids are an ok option. As long as you read the fine print. And the fine print gets pretty hairy. In fact, the likely de-emphasized side effects of steroid injections remind me of literally every pharmaceutical advertisement I see on the gym TVs. A whispered voice or size four font appears in the last 5 milliseconds of the ad to tell you:

    “Vitallegra KP may cause sleep crime, tooth melting, fingernail reversal, circus related Tourette’s, horrifyingly realistic dreams about giant frogs, Scrabble addiction, nicotine addiction, shingles, and cheese allergies.”

    They technically told you about the side effects, but you completely miss that all important cheese allergy announcement. Nothing is worth gaining a new cheese allergy, y’all. And that’s why we’re covering these steroid side effects in black and white, slow mo, normal size font.

    Steroids May Cause Tendon Rupture

    I say that with some ambiguity, because no study confirms that steroids directly cause tendons to explode. But if you take a look at this small sampling of quotes, all from scientific publications, you’ll notice a disturbing trend.

    Glucocorticoid-induced tendon rupture is very common in clinical practice.

    Corticosteroid injection is commonly used to treat tendon injuries but is often associated with tendon rupture and impaired tendon healing

    It is clear that the local administration of glucocorticoid has significant negative effects on tendon cells in vitro.

    Serious adverse effects have been reported as a result of [corticosteroid] treatment, such as impaired tendon healing and tendon rupture.

    Every one of those quotes links out to the associated study, because references matter, y’all.

    Steroids Damage Tendon Cells

    Now that you’ve seen the headlines, let’s get a little more specific here so you can weigh the evidence properly.

    • This review of 13 studies says tendon rupture and atrophy happen more frequently after steroid injection than placebo
    • This one  says that two different types of steroids decreased the tendency of tendon stem cells to become tendon cells (that’s bad) and slowed down the rate of cell growth (also bad).
    • In this study, even the lowest steroid dose increased expression of “dormancy” genes. So basically the cells go into retirement and stop doing the thing they’ve done their whole lives. It sounds like a great vacation for those cells, but your tendon might explode as a result.
    • In this study, steroids killed human tendon cells, decreased their ability to make new cells, and slowed collagen production.
    • In this one, steroid treatment decreased live cells and collagen production for at least two weeks.

    I left a longer list of references at the end of this post. Just in case you want to really dig in to this one rabbit hole. But even if you don’t read any further, the trend should be clear. Steroid injection leads to cell damage and tendon rupture. 

    But tendons aren’t the only thing steroids mess up.

    Steroids Damage Cartilage

    These poor horses had steroids injected repeatedly for two months, and it just damaged their cartilage. The study tested the mechanical properties before and after the injection cycle. And it turns out that the steroids made the cartilage weaker, more permeable, and thinner.

    This giant study (of other studies) offered a literal smorgasbord of cartilage damage:

    • 6 studies | loss of collagen organization
    • 3 studies | collagen loss
    • 17 studies | decreased collagen production

    In another big study (of other studies), the authors had this to say about normal clinical doses of steroids :

    …corticosteroids were associated with significant gross cartilage damage and chondrocyte toxicity

    So steroids hate basically all the tissues in your joints and want them to die. That’s the moral of the story so far.

    Steroids Aren’t Worth It

    Sure you get short term pain relief. But at what cost? Is four weeks of pain relief worth speeding up the breakdown of your cartilage and tendons? Or the risk of literal tendon explosion*?

    *no, they don’t explode like fireworks. But every time I read “tendon rupture” I imagine one of those coyote and roadrunner BAM signs appearing. So I stand by my decision to call it an explosion on cartoon-related principles. #IDoWhatIWant

    Back to the ranch – are steroids worth the risk of completely messing up your joint/tendon?

    I don’t think so, and that’s why none of the people I love ever get the green light from me when they ask about steroid injections for joint pain.

    Now, qualifier: there are cases in which steroids are absolutely necessary. Sometimes inflammation gets so out of control that steroids literally save lives. But looking at your everyday average arthritis related joint pain, you should run as fast as you can in the opposite direction of steroids. Possibly in the direction of some of these joint friendly alternatives.

    There Are Steroid Alternatives

    Hyaluronic acid, platelet rich plasma, and bone marrow concentrate all have associated clinical studies that show significant pain relief. Without the tiny side effect of aggressively maiming all the cells you’re trying to fix in the process. And they take about the same amount of time as a steroid injection.

    So next time someone recommends steroids for your joint pain, ask if they have an alternative that isn’t terrible. Because getting a steroid injection for arthritic joint pain is like going to a loan shark to pay off your bookie. (Yes, y’all, I do watch a lot of CSI.) Your problem goes away temporarily, but two weeks later you’re way worse off than before.

    So why shouldn’t you get steroids for joint pain (unless you absolutely have to)? Because they literally damage your joint tissue and lead to more pain.

    Alright kids, that’s it for this soapbox. For more information, feel free to browse the list of references below. If that’s not your style, leave a comment or drop me a line.

    References No One Wants To Read

    1. Murray RC, Debowes RM, Gaughan EM, Zhu CF, Athanasiou KKA. The effects of intra-articular methylprednisolone and exercise on the mechanical properties of articular cartilage in the horse. Osteoarthr Cartil. 1998;6(2):106-114. doi:10.1053/joca.1997.0100
    2. Zhang J, Keenan C, Wang JH-C. The effects of dexamethasone on human patellar tendon stem cells: Implications for dexamethasone treatment of tendon injury. J Orthop Res. 2013;31(1):105-110. doi:10.1002/jor.22193
    3. Nuelle CW, Cook CR, Stoker AM, Cook JL, Sherman SL. In Vivo Toxicity of Local Anesthetics and Corticosteroids on Chondrocyte and Synoviocyte VIability and Metabolism.
    4. Dean BJF, Lostis E, Oakley T, Rombach I, Morrey ME, Carr AJ. The risks and benefits of glucocorticoid treatment for tendinopathy: A systematic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum. 2014;43(4):570-576. doi:10.1016/j.semarthrit.2013.08.006
    5. Spang C, Chen J, Backman LJ. The tenocyte phenotype of human primary tendon cells in vitro is reduced by glucocorticoids. BMC Musculoskelet Disord. 2016;17(1):1-9. doi:10.1186/s12891-016-1328-9
    6. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376(9754):1751-1767. doi:10.1016/S0140-6736(10)61160-9
    7. Fredriksson M, Li Y, Stålman A, Haldosén LA, Felländer-Tsai L. Diclofenac and triamcinolone acetonide impair tenocytic differentiation and promote adipocytic differentiation of mesenchymal stem cells. J Orthop Surg Res. 2013;8(1):2-7. doi:10.1186/1749-799X-8-30
    8. Yang, Shu-long, Yu-bo Zhang, Zhi-tao Jiang, Zhao-zhu Li and DJ. Lidocaine Potentiates the Deleterious Effects of Triamcinolone Acetonide on Tenocytes. Med Sci Monit. 2014;20:2478-2483. doi:10.12659/MSM.891116
    9. Chen W, Tang H, Zhou M, Hu C, Zhang J, Tang K. Dexamethasone inhibits the differentiation of rat tendon stem cells into tenocytes by targeting the scleraxis gene. J Steroid Biochem Mol Biol. 2015;152:16-24. doi:10.1016/j.jsbmb.2015.04.010
    10. Scutt N, Rolf CG, Scutt A. Glucocorticoids inhibit tenocyte proliferation and Tendon progenitor cell recruitment. J Orthop Res. 2006;24(2):173-182. doi:10.1002/jor.20030
    11. Poulsen RC, Watts AC, Murphy RJ, Snelling SJ, Carr AJ, Hulley PA. Glucocorticoids induce senescence in primary human tenocytes by inhibition of sirtuin 1 and activation of the p53/p21 pathway: In vivo and in vitro evidence. Ann Rheum Dis. 2014;73(7):1405-1413. doi:10.1136/annrheumdis-2012-203146
    12. De Mos M, Koevoet WJLM, Jahr H, et al. Intrinsic differentiation potential of adolescent human tendon tissue: An in-vitro cell differentiation study. BMC Musculoskelet Disord. 2007;8:1-12. doi:10.1186/1471-2474-8-16
    13. Zhang J, Wang JHC. Characterization of differential properties of rabbit tendon stem cells and tenocytes. BMC Musculoskelet Disord. 2010;11. doi:10.1186/1471-2474-11-10
    14. Wernecke C, Braun HJ, Dragoo JL. The effect of intra-articular corticosteroids on articular cartilage: A systematic review. Orthop J Sport Med. 2015;3(5):1-7. doi:10.1177/2325967115581163

    Photo by Justyn Warner on Unsplash