The Role of PRP in Treating Arthritis – VIVAA Bellevue

PRP Can Be Used to Treat Arthritis

Five Key Points:

• PRP uses concentrated platelets from a patient’s own blood to promote tissue repair, reduce inflammation, and improve joint function.
• Studies show PRP can improve pain and mobility in knee OA for several months, though cartilage regeneration is not guaranteed.
• Preparation methods vary widely, affecting platelet concentration, white blood cell content, and effectiveness.
• PRP has fewer systemic side effects than corticosteroids or NSAIDs and can be combined with hyaluronic acid for greater benefit.
• Limitations include variable results, lack of insurance coverage, and potential side effects like pain, stiffness, or rare complications.

Osteoarthritis (OA) affects more than 500 million people worldwide. The disease's progressive nature, characterized by cartilage degeneration, can lead to debilitating pain and stiffness and a significant decline in quality of life. Without significant therapy options, joint replacement often becomes inevitable. Current treatment options for OA focus on symptomatic control.

Orthobiologics, including platelet-rich plasma (PRP), may positively affect joint longevity due to their disease-modifying and regenerative potential. A growing number of people are turning to PRP injections to treat an expanding list of orthopedic conditions, including osteoarthritis. Doctors most commonly use platelet-rich plasma injections to treat knee osteoarthritis, but it can also be used for other joints.

Can PRP Help Arthritis?

When treating patients with osteoarthritis, PRP injections have three main goals:

1. To reduce pain
2. Improve joint function
3. Slow, halt or even repair osteoarthritis cartilage damage

Researchers are unsure how PRP therapy alleviates arthritis symptoms and other orthopedic conditions. However, they theorize that PRP appears to do the following:

• Inhibits inflammation and slows disease progression
• Stimulates the formation of new cartilage
• Increases the production of natural lubricating fluid in the joint, thereby easing chronic pain
• Contains proteins that alter pain receptors and reduce pain sensation

Knee Osteoarthritis Treated with PRP

Researchers studying PRP and osteoarthritis often work with patients who have knee OA, a condition that will affect nearly half of all Americans during their lives.  A study published in 2013 showed that patients who received one or two PRP injections realized a reduction in pain and stiffness, along with improvement in knee function at six weeks and three months following injection. Positive results declined after six months, although pain and function remained improved compared to before platelet-rich plasma treatment.

A second study followed patients with mild to moderate knee pain for an average of 14 months. Each arthritic knee underwent an MRI to evaluate joint damage and receive a single injection. Patients also received a second MRI one year after treatment. Researchers discovered that patients had less knee osteoarthritis pain than they did the previous year, although pain did not disappear completely. Knee cartilage did not appear to regenerate, but halting the progression of arthritis seems significant.

PRP injections delivered into and around the center of the problem can relieve pain. By placing the PRP treatment near the afflicted area, your body’s natural healing process activates to provide long-lasting relief. Performed safely in our office, these injections will give you relief without having to undergo invasive orthopedic surgery, experience side effects from anesthesia or remain in the hospital for a prolonged period for recovery. You can often return to work and other activities immediately after your appointment.

Most patients find relief with the first treatment, but some require multiple injections of platelet-rich plasma before realizing a reduction in pain. The ultimate goal of PRP therapy is to achieve pain relief through healing in the affected areas, leading to long-term results. As your injured tissue heals, your pain lessens. Pain eases gradually as the platelet-rich plasma begins to do its job. Several scientific studies have shown that PRP therapy relieves pain from soft tissue injuries, so patients can quickly resume their normal life patterns. After examining these tissues via ultrasound and MRI following treatment, healing is generally confirmed. By treating diseased or injured tissues before arthritis becomes advanced, deterioration is halted, forestalling or eliminating the need for orthopedic surgery.

How Platelet-Rich Plasma (PRP) is Made

We create platelet-rich plasma from a sample of your own blood. Plasma is your blood's liquid component. It contains the red and white blood cells and other material traveling in the bloodstream. Platelets are blood components. They secrete growth factors and other factors regulating cell division, stimulating tissue regeneration and more to promote healing.

Variations in PRP occur due to the following factors:

• The patient's blood composition
• How the blood is centrifuged and filtered
• Some doctors include additives that may enhance the PRP healing process

How production and composition affect PRP's effectiveness is not well understood. In addition to blood composition, you'll find no standardized approach for formulating and preparing PRP solutions. All preparation is somewhat similar, starting with taking a sample of a patient's own blood and placing it in a centrifuge where it spins at high speed. The spinning causes the blood to separate into three layers. Platelets are part of the thin middle layer, comprising less than 1% of the centrifuged blood. Once the process is completed, we will remove the vial and prepare the PRP solution for injection. Centrifuge time and speed can vary and affect the PRP's composition. No consensus is yet available on which centrifuge process produces the best platelet-rich plasma for treating arthritis.

What Is in a Platelet-Rich Plasma Injection?

Because of the previously mentioned factors, all PRP injections are not the same. PRP's makeup depends on variables, including the concentration of platelets and white blood cells, plus the use of additives.

Platelet Concentrations

Normal blood has 150,000 to 450,000 platelets per microliter (μL); the concentration in platelet-rich plasma therapy can vary from 2.5 to nine times that amount. Concentrations depend on the concentration of platelets in platelet-rich plasma, which can range from 2.5 to 9 times that. Concentration levels depend on the individual's blood, how much blood was drawn, the centrifuge process, and other clinical preparation methods.

The highest platelet counts don't necessarily achieve better results. One study suggested that plasma with concentrations 2.5 times that of normal blood was ideal, and higher concentrations might limit cell growth factors.

White Blood Cell Count

The role of white blood cells is to fight infection, but what it does in PRP therapy is unclear. Some experts believe they promote inflammation, while others think they may not aid in tissue regeneration but have no adverse effects. The number of white blood cells in PRP also depends on your own blood and clinical preparation methods.

Additives in PRP Preparations

When added to PR, thrombin and calcium chloride artificially activate platelets, stimulate clotting and may enhance platelet-derived growth factor to aid regeneration. Future research may indicate that the preparation and composition of PRP injections should be tailored to specific medical conditions. For example, one formulation may be suitable for symptomatic knee OA, while another may be better suited for treating tendonitis.

Classifying PRP formulas

Because the preparation and ingredients of PRP injections are so variable, it isn’t easy to evaluate PRP's efficacy. To that end, some scientists have called for a classification system to distinguish between various formulations of platelet-rich plasma. Such a system could help researchers determine whether these differences matter and, if so, what preparation and formulation of platelet-rich plasma work best.

PRP Injection Administration

We administer PRP injections directly into the affected joint area, sometimes using ultrasound imaging to ensure precision. To alleviate discomfort, local anesthesia may be applied to the site prior to PRP treatment. Researchers believe this direct administration of PRP to the affected area makes this therapy effective for knee osteoarthritis and other painful conditions.

Post Treatment

Success varies among patients. Many patients report sustained relief for several months. Factors influencing the longevity of pain relief include the severity of the arthritic condition, along with the patient's general health and adherence to lifestyle changes. PRP therapy to treat arthritis typically requires several sessions to achieve optimal outcomes. The frequency and total number of sessions depend on the condition's severity and the patient's response to the initial treatment.

PRP for Arthritis vs. Traditional Therapies

Conventional therapies include corticosteroid injections, hyaluronic acid injections, and nonsteroidal anti-inflammatory drugs (NSAIDs) to provide symptomatic relief. All have considerable drawbacks. Corticosteroids are effective in reducing inflammation and pain, yet their benefits decline with repeated administration and can contribute to joint damage and elevated blood sugar. Hyaluronic acid (HA) injections have variable efficacy in lubricating joints and improving mobility. Although NSAIDs have pain-relieving and anti-inflammatory properties, they pose issues such as gastrointestinal, cardiovascular, and renal adverse effects when used long-term. PRP therapy has a reduced risk of side effects compared with the previously mentioned treatments, which can impact the body more broadly. You may also get injections of platelet-rich plasma combined with other therapies.

Research suggests that combining HA with PRP may treat arthritis more successfully. These treatments showed a greater improvement in pain, function and stiffness when compared to only HA. Several other studies support this research, with some demonstrating reduced pain and function after 12 months. PRP injections may aid with physical therapy for some arthritic conditions.

Other Clinical Uses for PRP Injections

Many sports medicine doctors recommend PRP for acute muscle and ligament injuries. Professional athletes who have suffered knee sprains, pulled hamstrings, and common joint injuries have found relief through PRP. Contemporary research also suggests that chronic tendon injuries, especially tennis elbow, can benefit from PRP. The ability of platelet-rich plasma therapy to accelerate wound healing prompts some surgeons to recommend this therapy to speed healing after surgeries on the knees and shoulders. Platelet-rich plasma is also commonly used in oral surgeries.

Limitations of PRP Therapy

PRP therapy may not be effective for all patients and conditions, and results can vary. However, more studies on platelet-rich plasma therapy are necessary, as there is no consensus on how it affects long-term clinical outcomes. Nevertheless, PRP injections challenge traditional approaches for limiting arthritis progression and improving joint longevity. Patients should also be aware that most insurance companies do not cover the cost of platelet-rich plasma injections.

Risks and Side Effects of PRP Treatment

Platelet-rich plasma injections are generally considered safe, as the therapy uses the patient's own blood. However, as with any procedure, side effects can occur. The most common ones involve discomfort, pain or stiffness at the injection site. Other potential side effects include infection, nerve damage, tissue damage, and, in rare cases, more severe reactions like nodule formation.

Some factors can increase the risks of side effects during PRP therapy. You may not be a candidate if you smoke heavily, take blood-thinning medications, abuse drugs or alcohol, or have one of the following conditions:

• Underlying health conditions, like low platelet count, platelet dysfunction or sepsis
• Some types of cancer, such as bone cancer
• Anemia
• Chronic or acute infections
• Skin disease
• Liver disease
• Metabolic disorders
• Systemic disorders

Speaking with your doctor about PRP therapy before starting treatment is essential. During your appointment, discuss all your medications, including supplements and herbs. Certain medications, such as NSAIDs taken within 48 hours of PRP therapy or certain steroid injections received within two to four weeks of your appointment, can increase the risk of side effects.

Is Platelet-Rich Plasma Treatment Right for Your Arthritis?

Platelet-rich plasma PRP injections can change your life. To learn more about the treatment of knee osteoarthritis, contact the staff at VIVAA today. We will gladly set up an evaluation and discuss the procedure with you. Call us at 425-250-9999 or use our online schedule a consultation form.