Platelet Rich Plasma Therapy, once reserved for elite athletes, continues to gain popularity among the general public. Research
is also overwhelmingly positive in the treatment of numerous musculoskeletal complaints. The following article shows the potential
for PRP to improve knee osteoarthritis also known as degenerative joint disease. This is especially exciting because medical
treatment for osteoarthritis is mostly inadequate. If you or someone you know is suffering from knee pain, or other joint pains,
PRP may be an effective treatment option for you. If you have any questions, you can contact me either via email or call the clinic.
Platelet-rich plasma (prp) treatment shows potential for knee osteoarthritis
Date: February 12, 2013
Source: Hospital for Special Surgery
Summary: A new study has shown that platelet-rich plasma (PRP) holds great promise for treating patients with knee osteoarthritis. The treatment improved pain and function, and in up to 73% of patients, appeared to delay the progression of osteoarthritis.
A study by researchers from Hospital for Special Surgery has shown that platelet-rich plasma (PRP) holds great promise for treating patients with knee osteoarthritis. The treatment improved pain and function, and in up to 73% of patients, appeared to delay the progression of osteoarthritis, which is a progressive disease. The study appears online, ahead of print, in the Clinical Journal of Sports Medicine.
“This is a very positive study,” said Brian Halpern, M.D., chief of the Primary Care Sports Medicine Service at Hospital for Special Surgery, New York City, and lead author of the study.
Several treatments for osteoarthritis exist, including exercise, weight control, bracing, nonsteroidal anti-inflammatories, Tylenol, cortisone shots and viscosupplementation, a procedure that involves injecting a gel-like substance into the knee to supplement the natural lubricant in the joint. A new treatment that is being studied by a small number of doctors is PRP injections. PRP, which is produced from a patient’s own blood, delivers a high concentration of growth factors to arthritic cartilage that can potentially enhance healing.
“You take a person’s blood, you spin it down, you concentrate the platelets, and you inject a person’s knee with their own platelets in a concentrated form,” said Dr. Halpern. “This then activates growth factors and stem cells to help repair the tissue, if possible, calm osteoarthritic symptoms and decrease inflammation.”
In the new study, researchers at Hospital for Special Surgery enrolled patients with early osteoarthritis, gave them each an injection of PRP (6-mL), and then monitored them for one year. Fifteen patients underwent clinical assessments at baseline, one week, and one, three, six, and 12 months. At these time points, clinicians used validated tools to assess overall knee pain, stiffness and function, as well as a patient’s ability to perform various activities of daily living. At baseline and then one year after the PRP injection, physicians also evaluated the knee cartilage with magnetic resonance imaging (MRI), something that has not previously been done by researchers in other PRP studies. The radiologists reading the MRIs did not know whether the examination was performed before or after the PRP treatment.
“The problem with a lot of the PRP studies is that most people have just used subjective outcome instruments, such as pain and function scores,” said Hollis Potter, M.D., chief of the Division of Magnetic Resonance Imaging at Hospital for Special Surgery, another author of the study. “But even when patients are blinded, they know there has been some treatment, so there is often some bias interjected into those types of studies. When you add MRI assessment, it shows you the status of the disease at that time, regardless of whether the patient is symptomatic or asymptomatic or they have good or poor function in the knee. You find out what the cartilage actually looks like. We can noninvasively assess the matrix or the building blocks of cartilage.”
While previous studies have shown that patients with osteoarthritis can lose roughly five percent of knee cartilage per year, the HSS investigators found that a large majority of patients in their study had no further cartilage loss. “The knee can be divided into three compartments, the medial compartment, the lateral compartment and the patellofemoral compartment,” said Dr. Halpern. “If we look at these compartments individually, which we did, in at least 73% of these cases, there was no progression of arthritis per compartment at one year. That is very significant, because longitudinal studies suggest a four to six percent progression of arthritis at one year.”
Treatment with PRP was also useful in improving pain, stiffness and function. The investigators found that pain, measured by a standard test called the Western Ontario and McMaster Universities Arthritis Index, significantly improved with a reduction of 41.7% at six months and 55.9% at one year. On a pain scale commonly used by clinicians called the Visual Analog Scale, pain was reduced by 56.2% at six months and 58.9% at one year. Functional scores improved by 24.3% at one year. Activity of Daily Living Scores also showed a significant increase at both six months (46.8%) and one year (55.7%).
“We are entering into an era of biologic treatment, which is incredibly ideal, where you can use your own cells to try to help repair your other cells, rather than using a substance that is artificial,” Dr. Halpern said. “The downside is next to zero and the upside is huge.” Dr. Halpern pointed out, however, that the study is a small case series and PRP needs to be pitted against a traditionally treated group in a randomized, controlled trial.
Osteoarthritis, which causes pain and joint stiffness, impacts over 27 million Americans and is a leading cause of disability. According to statistics from the Centers for Disease Control and Prevention, overall osteoarthritis affects 13.9% of adults aged 25 and older and 33.6% of those older than 65. The disease is characterized by degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth. Disease onset is gradual and usually begins after the age of 40.
Other HSS investigators involved in the study include Salma Chaudhury, M.D., Ph.D, Scott Rodeo, M.D., Catherine Hayter, MBBS, Eric Bogner, M.D., and Joseph Nguyen, MPH.
The above story is based on materials provided by Hospital for Special Surgery.Note: Materials may be edited for content and length.
- Brian Halpern, Salma Chaudhury, Scott A. Rodeo, Catherine Hayter, Eric Bogner, Hollis G. Potter, Joseph Nguyen. Clinical and MRI Outcomes After Platelet-Rich Plasma Treatment for Knee Osteoarthritis. Clinical Journal of Sport Medicine, 2012; 1 DOI: 10.1097/JSM.0b013e31827c3846
A colleague and someone that I learned directly from, Jeff Patterson DO, co-authored a recent blinded trial of dextrose prolotherapy vs. placebo injection or exercise therapy. The results suggested that prolotherapy is an effective solution for knee osteoarthritis with reductions in pain and stiffness and an increase in range of motion and function. Prolotherapy can be extremely beneficial for numerous types of joint pain and musculoskeletal complaints. Dr Glen Jarosz is a skilled practitioner of prolotherapy as well as numerous other regenerative injection therapies. Please contact him for a free consultation to see if you may benefit from these types of therapies.
June 04, 2013
Dextrose Prolotherapy Can Improve Knee Osteoarthritis
(HealthDay News) – For adults with knee osteoarthritis, dextrose prolotherapy is associated with greater improvements in pain, function, and stiffness compared with saline injections or at-home exercise, according to a study published in the May/June issue of the Annals of Family Medicine.
David Rabago, MD, of the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues conducted a three-arm blinded, randomized controlled trial involving 90 adults with ≥3 months of painful knee osteoarthritis. Participants were randomized to receive blinded injection (dextrose prolotherapy or saline) or at-home exercise. Injections were provided at weeks one, five, and nine, with additional treatments at weeks 13 and 17, as needed. An exercise manual and in-person instruction were provided to exercise participants.
The researchers found that all groups reported an improvement in composite Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores from baseline to 52 weeks. The improvement in WOMAC scores at 52 weeks was significantly more for the dextrose prolotherapy group compared with the saline or exercise groups, after adjustment for age, sex, and body mass index. In the prolotherapy group, the individual knee pain scores also improved more. High satisfaction was noted with prolotherapy and there were no adverse events reported.
“Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises,” the authors write.
The Abstract From the Recent Study:
Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial
- David Rabago, MD1⇑, Jeffrey J. Patterson, DO1, Marlon Mundt, PhD1,Richard Kijowski, MD2, Jessica Grettie, BS1, Neil A. Segal, MD, MS3 andAleksandra Zgierska, MD, PhD1
- 1Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- 2Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- 3Departments of Orthopaedics & Rehabilitation, Epidemiology, and Radiology, The University of Iowa, Iowa City, Iowa
- CORRESPONDING AUTHOR: David Rabago, MD, Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53715,email@example.com
PURPOSE Knee osteoarthritis is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a 3-arm, blinded (injector, assessor, injection group participants), randomized controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis.
METHODS Ninety adults with at least 3 months of painful knee osteoarthritis were randomized to blinded injection (dextrose prolotherapy or saline) or at-home exercise. Extra- and intra-articular injections were done at 1, 5, and 9 weeks with as-needed additional treatments at weeks 13 and 17. Exercise participants received an exercise manual and in-person instruction. Outcome measures included a composite score on the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100 points); knee pain scale (KPS; individual knee), post-procedure opioid medication use, and participant satisfaction. Intention-to-treat analysis using analysis of variance was used.
RESULTS No baseline differences existed between groups. All groups reported improved composite WOMAC scores compared with baseline status (P <.01) at 52 weeks. Adjusted for sex, age, and body mass index, WOMAC scores for patients receiving dextrose prolotherapy improved more (P <.05) at 52 weeks than did scores for patients receiving saline and exercise (score change: 15.3 ± 3.5 vs 7.6 ± 3.4, and 8.2 ± 3.3 points, respectively) and exceeded the WOMAC-based minimal clinically important difference. Individual knee pain scores also improved more in the prolotherapy group (P = .05). Use of prescribed postprocedure opioid medication resulted in rapid diminution of injection-related pain. Satisfaction with prolotherapy was high. There were no adverse events.
CONCLUSIONS Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises.
For full text of this research study: http://www.annfammed.org/content/11/3/229.full
Several studies found an inverse correlation between Zinc (↓) and toxic metals (↑) in arthritis patients. Taking antioxidant micronutrients, particularly a zinc supplement, may protect against the development of rheumatoid arthritis.
In addition to giving focused nutrients to reduce abnormal biochemistry and inflammation, you also have to remove the undesirable elements. In this case, there is more toxic metals like lead, arsenic and cadmium in patients with arthritis than in the average person.
Chelation is a very effective and safe process practiced since the 1940’s to remove undesirable metals from the body, which usually improves more than only the targeted disease.
In this instance, lead, arsenic and cadmium are known mitochondrial energy production inhibitors, linked to chronic fatigue syndrome, cardiovascular disease, auto-immune disease, thyroid and other hormone problems.
Action item: If you have rheumatoid arthritis, ensure you take appropriate, condition focused nutrients AND ask a board certified natural or integrated doctor to test if you have excessive toxic metals in your system that can fuel the disease along.
This August is Psoriasis Awareness Month, and a good time to become more familiar with this diagnosis which affects millions of Americans. Despite being a relatively common condition, many of us hold onto the false assumption that it is only skin deep. Psoriasis, in all of its forms, actually goes much deeper, to the level of the immune system. Interested in knowing more? Read on for an introduction to this autoimmune disorder, related health concerns, and how it can be treated.
Psoriasis – An Immune System in Distress
Like other Autoimmune (AI) diseases, Psoriasis is a chronic inflammatory condition caused by a dysfunctional immune system. Though psoriatic presentations may differ, they are caused by the same underlying imbalances that exist within all AI diseases.
Our immune systems are designed to create antibodies which tag harmful foreigners such as viruses & bacteria so that our white blood cells know where to attack. In AI disease, the body loses the ability to differentiate between a true foreigner, and our own tissues. As a result, antibodies toward our own cells are produced, directing our immune system to target tissues and organs. Inflammation develops, followed by tissue destruction and dysfunction within the body.
While there is no single cause for AI disease, there are suspected triggers that may lead to development of auto(self)-antibodies. Additionally, there can be a genetic predisposition to developing an AI disease. Common triggers that may increase the risk for autoimmune disease include:
Chronic Infections (viral, bacterial, fungal & parasitic)
Continuous Allergen Exposure (including food sensitivities)
Chronic Heavy Metal Toxicity
It is especially important to limit these potential triggers in your daily life if you have a known family history of autoimmune diseases.
Psoriasis In Its Many Forms
The most common form – Plaque psoriasis occurs when overactive inflammatory immune cells create cytokines (proteins that act as immune cell signals) which target keratinocytes in the skin. The result is an inflammatory, raised plaque which appears red and exhibits a silvery build up of dead cells. When removed, pinpoint bleeding known as Auspitz’s Sign is seen. Plaques tend to arise on the outer aspects of joints (knees, elbows) but can occur anywhere on the body. They may also arise in areas of recent skin trauma.
Approximately 30% of patients with Psoriasis will develop a type of Psoriatic Arthritis. This painful and debilitating condition is categorized as a spondyloarthropathy, meaning it is similar in symptoms and presentation to arthritis disorders such as Ankylosing Spondylitis, & Reactive Arthritis. The joints may become very swollen, red & extremely tender to palpate. The arthritis may develop on one or both sides of the body, and may affect the spine. Types of psoriatic arthritis include Symmetric, Asymmetric, Distal Interphalangeal predominant (joints closest to the fingertips), Spodylitis (affecting the spine) and Arthritis Mutilans (rare, but severely debilitating).
Though plaque psoriasis is more commonly seen, individuals may also be diagnosed with:
Guttate Psoriasis (thinner, smaller lesions that are greater in number)
Inverse Psoriasis (red, smooth lesions that arise in body folds)
Pustular Psoriasis (red, non-infectious pustules develop on the skin)
Erythrodermic Psoriais (widespread, poorly defined red lesions with pain & peeling)
How is Psoriasis Diagnosed?
Diagnosis of psoriatic skin lesions can be based on appearance, and may include biopsy for confirmation. Additional testing for other psoriatic presentations may include X-rays or synovial fluid testing for joint symptoms, and blood tests to assess for inflammation (ESR, CRP) or a genetic component (HLA-B27). Further testing may be recommended to effectively rule out other potential causes.
Treatment – Conventional & Alternative Approaches
Conventional treatments for psoriasis are primarily suppressive, meaning they cover symptoms by blocking the activity of the inflammatory cells without addressing the underlying causes for immune dysfunction. For skin changes, these treatments usually consist of topical creams, whereas systemic immunosuppressive drugs are more commonly prescribed for arthritic symptoms. These medications can be of great value for symptom relief and interruption of tissue destruction, but it is equally important to treat the underlying imbalance.
An in-depth investigation of potential triggers is often indicated, followed by avoidance of those which are found to be significant. Even the basic removal of dietary and environmental allergens can help to decrease symptoms and decrease the number and duration of treatments needed. In addition to the chronic infections, allergens and heavy metals noted above, you should also speak with your healthcare provider about mental & emotional stressors, gastrointestinal dysbiosis, medications, and nutrient deficiencies. Each of these may contribute to auto-immune activity and aggravation of your psoriatic symptoms.
Potential treatments worth investigating for longer-lasting relief and healing include:
Heavy metal testing & Chelation therapy (when indicated)
Food allergy elimination diets (based on diagnostic test findings)
Essential macro & micro nutrient supplementation (to reverse deficiencies)
Diagnosis & treatment for chronic infections
Gastrointestinal support (including diagnostic testing for SIBO, leaky gut syndrome, & more)
Ozonotherapy IV’s & topicals (to modulate inflammation & decrease immune dysfunction)
Low Dose Naltrexone (to modulate inflammation & decrease autoimmune activity)
Questions about treatments for Psoriasis and other autoimmune disorders? Contact Dr. Kaley at Restorative Health Clinic (503) 747-2021.
Dr. Kaley Bourgeois
National psoriasis foundation. (n.d.). Retrieved from https://www.psoriasis.org/
Blauvelt, MD, A. (July). Pathophysiology of psoriasis. Retrieved from http://www.uptodate.com/contents/pathophysiology-of-psoriasis
More and more research is being published about the benefits of prolotherapy for numerous musculoskeletal complaints, this particular one on knee osetoarthritis. Prolotherapy is a form of regenerative injection technique that is very effective at treating injuries to tendons and ligaments. It has also been shown to be beneficial for arthritis and discopathy. If you have pain or instability at or around a joint that impairs your daily activities, contact Dr Jarosz for more information.
Effect of Regenerative Injection Therapy on Function and Pain in Patients with Knee Osteoarthritis: A Randomized Crossover Study.
Dumais R, Benoit C, Dumais A, Babin L, Bordage R, de Arcos C, Allard J, Bélanger M. Pain Med. 2012 Jul 3. doi: 10.1111/j.1526-4637.2012.01422.x. [Epub ahead of print]
Dr. Georges-L.-Dumont Regional Hospital, Vitalité Health Network, Moncton, New Brunswick Centre de formation médicale du Nouveau-Brunswick, Moncton, New Brunswick Dieppe Family Medicine Unit, Dieppe, New Brunswick Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Quebec Department of Mathematics and Statistics, Université de Moncton, Moncton, New Brunswick Research Centre, Vitalité Health Network, Moncton, New Brunswick, Canada.
Objective. We assessed the effectiveness of regenerative injection therapy (RIT) to relieve pain and restore function in patients with knee osteoarthritis. Design. Crossover study where participants were randomly assigned to receive exercise therapy for 32 weeks in combination with RIT on weeks 0, 4, 8, and 12 or RIT on weeks 20, 24, 28, and 32. Patients. Thirty-six patients with chronic knee osteoarthritis. Interventions. RIT, which is made up of injections of 1 cc of 15% dextrose 0.6% lidocaine in the collateral ligaments and a 5 cc injection of 20% dextrose 0.5% lidocaine inside the knee joint. Outcome Measures. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index of severity of osteoarthrosis symptoms (WOMAC) score (range: 0-96). Results. Following 16 weeks of follow-up, the participants assigned to RIT presented a significant reduction of their osteoarthritis symptoms (mean ± standard deviation: -21.8 ± 12.5, P < 0.001). WOMAC scores in this group did not change further during the last 16 weeks of follow-up, when the participants received exercise therapy only (-1.2 ± 10.7, P = 0.65). WOMAC scores in the first 16 weeks did not change significantly among the participants receiving exercise therapy only during this period (-6.1 ± 13.9, P = 0.11). There was a significant decrease in this groups’ WOMAC scores during the last 16 weeks when the participants received RIT (-9.3 ± 11.4, P = 0.006). After 36 weeks, WOMAC scores improved in both groups by 47.3% and 36.2%. The improvement attributable to RIT alone corresponds to a 11.9-point (or 29.5%) decrease in WOMAC scores. Conclusions. The use of RIT is associated with a marked reduction in symptoms, which was sustained for over 24 weeks.