Is Platelet Rich Plasma Good for Pain Relief of Knee Osteoarthritis?
Osteoarthritis is a debilitating disease that tends to affect the large joints of the body, particularly the knees. The current American population trends show 35 million people (13% of the US population) are currently over the age of 65, and more than half of them have radiological findings showing osteoarthritis in at least one joint.  By the time 2030 comes around, an estimated 20% of Americans will be over the age of 65, and be at increased risk for developing osteoarthritis. That’s over 70 million people.When people develop osteoarthritis the main complaints are of pain and joint swelling. Quality of life is poor and decreased, and a progression of the disease can be extremely disabling. As for treatments? They’re not as satisfactory as one would hope.

Drug treatments for osteoarthritis focus on eliminating pain; and this is done through a variety of drugs like non-narcotic analgesics, anti-inflammatory drugs (NSAIDs), COX-2 inhibitors, topical analgesics, narcotic analgesics and injections into the joint causing joint aspiration. How a drug is chosen is based on which joint is involved, other diseases that a patient may have, other medications someone may be on and any allergies one may have.

Other treatments include steroid injections, hyaluronate and surgery. These can be costly, have adverse effects and may not guarantee pain relief. In fact, for a treatment to be considered successful physicians look for a reduction in tenderness, a reduction in pain both at rest and with motion, and improvements in night pain, stiffness, swelling and range of motion.

One of the relatively new treatments for osteoarthritis is something called platelet rich plasma. This is widely used in Europe, and is now making it’s way to North America. PRP is an injection usually offered to patients who have not responded to the usual conventional treatments (like those listed above) or who prefer not to have surgery. Thousands of patients with osteoarthritis and receiving PRP have been studied and the literature supports it as a safe alternative to both surgery and/or corticosteroids (1-4).

The big question I get asked the most is “Do Injections of PRP work?”

Many studies have looked into both the effectiveness and safety of PRP for patients with osteoarthritis of the knee. In many of these studies the osteoarthritis was in the early stages, but some have also been done on the late stages of osteoarthritis. The overall impression shows that PRP injections are quite effective for reducing pain caused by osteoarthritis of the knee. Furthermore those people also showed an increase in the function of the knee. The pain relief tends to be of a long duration (12 months or more) and these injections appear to be even more effective than steroids or hyaluronic acid. The benefit of this is also compounded by the fact that there are less adverse effects associated with the PRP injections than the corticosteroids. One study even looked at pain relief from a combination of PRP and hyaluronic acid and found that there was no difference between the combination and PRP itself (5).

As for how many PRP injections are required? Most studies show that a single injection of PRP was sufficient to relieve pain and also delayed the time that someone may need knee surgery due to their osteoarthritis. Based on these studies, PRP injections are fast becoming an effective option for patients who fail to respond to NSAIDs for pain relief.

A thorough look at current evidence suggests that PRP may have significant advantages versus the standard treatments for osteoarthritis. PRP has even been shown to benefit patients with extra-articular symptoms of rheumatic arthritis (6). And, as more studies continue to support the benefits of PRP it appears that it will soon become the treatment of choice for patients with mild-to-moderate osteoarthritis, especially if conventional treatment is no longer working.

References

1. Görmeli G, Görmeli CA, Ataoglu B, Çolak C, Aslantürk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2015 Aug 2.

 

2. Kanchanatawan W, Arirachakaran A, Chaijenkij K, Prasathaporn N, Boonard M, Piyapittayanun P, Kongtharvonskul J. Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee.Knee Surg Sports Traumatol Arthrosc. 2015 Sep 19.

 

3. Abate M, Verna S, Schiavone C, Di Gregorio P, Salini V.Efficacy and safety profile of a compound composed of platelet-rich plasma and hyaluronic acid in the treatment for knee osteoarthritis (preliminary results).Eur J Orthop Surg Traumatol. 2015 Dec;25(8):1321-6.

 

4. Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD.Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review. Arthroscopy. 2015 Sep 29.

 

5. Kilincoglu V, Yeter A, Servet E, Kangal M, Yildirim M.Short term results comparison of intraarticular platelet-rich plasma (prp) and hyaluronic acid (ha) applications in early stage of knee osteoarthritis. Int J Clin Exp Med. 2015 Oct 15;8(10):18807-12

 

6. Fernandes S, Romeu JC, da Silva JA.Platelet Rich Plasma: What should the rheumatologist expect?Acta Reumatol Port.2015 Jul-Sep;40(3):214-222.

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