The most commonly treated joint in my practice are knees. Knees out number hips and low backs by at least two to one. Unfortunately our knees are one of the most abused joints of the body from wear and tear as well as injury from slips and falls on ice through to car accidents and sports injuries.

Diagnostic Ultrasound onsite

One of the most common questions I am asked by patients is what are my options other than cortisone injections for pain management? I always run through the various treatment options. Acupuncture, massage therapy, physio, proper nutrition etc… However, a study released just a month ago was conducted specifically on knee arthritis, both stage 3 and 4 (stage 4 is your most advanced stage of arthritis). This study compared the effectiveness of a single platelet rich plasma (PRP) injection to that of a steroid cortisone injection. It found that a single PRP injection improved activities of daily living and quality of life in patients with advanced osteoarthritis. Specifically in patients aged 67 years or older it found that a single PRP injection yielded similar results to that of a single cortisone injections.

Since PRP injections are now showing equal to if not superior results for knee arthritis than ultimately PRP injections are preferred. The reason PRP is preferred over cortisone is that the side effects of PRP injections are minimal and you can receive an infinite amount of PRP injections to your knee regardless of the stage of arthritis. Most doctors will limit the amount of cortisone injections into a joint unless the joint has reached stage 4 arthritis.

Arthritis of the human knee joint

 

Check out this article written by Nikole MacLellan- B.Comm, BSc AHN, RD, ND Intern, CISSN which discusses PRP treatment for osteoarthritis versus conventional treatment.

PRP Over Conventional Tx For Osteoarthritis

 

It started off slow, just some achy joints as you woke up in the morning, but now the pain has progressed. It has started making its way into other joints, your ability to move is not what is use to be and it’s on the decline. You stopped doing some of the things you once loved. Your doctor has given you the diagnosis of Osteoarthritis and you’re left thinking now what?

 

Osteoarthritis is the most common joint injury in the world and none of us are resistant to it. I know this doesn’t help your pain, but keep reading, that part is coming. The disease wears away the cartilage between bones; it is cartilage that allows the easy gliding motion at joints and is like a pillow between your bones. Without cartilage your bones are left to essentially grind on themselves and grow abnormally, which is the cause of all your pain and stiffness. Eventually oral anti-inflammatories are not cutting it and although your bone health supplement is beneficial, it too has ceased to take the edge off. What is your next step?

 

A conventional intervention for pain reduction is corticosteroid injections. These injections provide some short-term relief of about 1-2 weeks. The substance injected is a steroid, which mimics what some of the hormones in our body do. Adding more steroids to the body results in decreasing inflammation. Repeat injections can have some damaging effects on skin and bone but trials show safety up to the 2 year mark. Many doctors limit patients to 3-4 injections per year due to potential negative side effects. Research looking at saline (salt water) injections versus steroid injections for knee osteoarthritis showed benefit in pain management but no difference in progression or slowing down the disease.

 

Another prevalent intervention is hyaluronic acid injections. Hyaluronic acid is naturally found in cartilage and is like a lubrication fluid. No evidence has shown regression of the disease or regrowth of joint tissue although some patients find their pain has reduced.

 

New research shows Platelet Rich Plasma (PRP) injections may come out on top as a better intervention for osteoarthritis.  Our blood contains platelets, which are full of tiny proteins called growth factor. As you could imagine by their name, growth factors help with regrowth and healing of tissues.  Injecting PRP is essentially injecting your own super concentrated healing platelets into areas where you need them to work their magic. Research has shown that just one PRP injection is on par with corticosteroid injections and superior to hyaluronic acid injections for pain management. PRP reduces pain and lasts longer than hyaluronic acid injections. The research also shows quality of life and patients perceived general health was reported higher with PRP over corticosteroid injections.

The most promising aspect of PRP is the research is showing increased cartilage thickness. This means PRP is showing benefit to not only alleviate pain but mitigate some of the damage caused by Osteoarthritis.

 

Now that you have information on making your next move, come check out Cornerstone Naturopathic Clinic and lets start managing your pain and getting you back to the activities you love to do.

 

Nikole MacLellan- B.Comm, BSc AHN, RD, ND Intern, CISSN

 

References

 

Raynauld JP, Buckland-Wright C, Ward R, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2003 Feb;48(2):370-7. Erratum in: Arthritis Rheum. 2003 Nov;48(11):3300

 

Kon E, Mandelbaum B, Buda R, Filardo G, Delcogliano M, Timoncini A, Fornasari

PM, Giannini S, Marcacci M. Platelet-rich plasma intra-articular injection versus

hyaluronic acid viscosupplementation as treatments for cartilage pathology: from

early degeneration to osteoarthritis. Arthroscopy. 2011 Nov;27(11):1490-501

 

Joshi Jubert N, Rodríguez L, Reverté-Vinaixa MM, Navarro A. Platelet-Rich Plasma Injections for Advanced Knee Osteoarthritis: A Prospective, Randomized, Double-Blinded Clinical Trial. Orthopaedic Journal of Sports Medicine. 2017;5(2):2325967116689386

 

Kavadar G, Demircioglu DT, Celik MY, Emre TY. Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study. Journal of Physical Therapy Science. 2015;27(12):3863-3867

 

Cole BJ, Karas V, Hussey K, Pilz K, Fortier LA. Hyaluronic Acid Versus

Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial

Comparing Clinical Outcomes and Effects on Intra-articular Biology for the

Treatment of Knee Osteoarthritis. Am J Sports Med. 2017 Feb;45(2):339-346

 

Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ : British Medical Journal. 2004;328(7444):869.

 

Pin It on Pinterest