Platelet-Rich Plasma For Arthritis

Platelet-rich plasma in Halifax

Platelet-rich plasma (PRP) is a therapy which uses a component of a person’s own blood to treat their osteoarthritis. PRP is a safe treatment which often gives significant benefit to people suffering from osteoarthritis including improvements in stiffness, pain and mobility.

Growth Factors Promote Repair

PRP injections contain a high concentration of your own platelets. These platelets contain a large amount of growth factors, including platelet-derived growth factor (PDGF), transforming growth factor beta (TGF-β), insulin-like growth factor (IGF), epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF)1.

Table 1. Growth factors involved in tissue repair2.

Growth FactorEffect on Tissue Repair
EGFStimulates cellular proliferation
IGFMediates growth and repair of skeletal muscle
PDGFEncourages proliferation of fibroblasts, enhances collagen synthesis
TGF-βStimulates fibroblast proliferation, formation of collagen, and extracellular matrix components
VEGFPromotes angiogenesis

These growth factors trigger tissue repair in our natural healing and recovery process. When a high concentration of these growth factors is introduced into the area of an injured or arthritic joint the healing process is jump-started.

Some research has suggested that PRP improves the integrity of the joint cartilage by increasing the amount of cartilage producing cells (chondrocytes) and by decreasing their rate of cell death (apoptosis)3. This would conceivably lead to a larger number of chondrocytes actively producing healthy cartilage within the joint and a healthier joint as a result.

How Is Platelet-Rich Plasma Prepared?

Platelet-rich plasma treatment
PRP is prepared by drawing and centrifuging a small sample of your own blood on the day of treatment. A centrifuge is a device which rapidly rotates, spinning a blood sample at a high speed causing it to separate into layers based on weight. After centrifugation the blood sample separates into a top layer of plasma which is transparent yellow in color (mostly water with some dissolved proteins) and a bottom thick, red layer (red blood cells). At the junction of the plasma and red blood cell layers sits a dense concentration of platelets. This platelet-rich layer of the plasma is the portion of the blood which is collected and used for injection.

How Is Platelet-Rich Plasma Administered?

Platelet-rich plasma hip injection
PRP is given by injection into the affected site or the site of injury. For example, in cases of tennis elbow the PRP injection is made at the site of the affected common extensor tendon on the elbow and in plantar fasciitis the injection is given at the site of the damaged plantar fascia insertion on the heel of the foot. In the case of osteoarthritis the “injury” includes two entire joint surfaces. An osteoarthritic joint is treated by injecting PRP into an affected joint space. Since a joint is a closed compartment the PRP fluid stays within the joint, coating the affected joint surfaces and exerting its effect on them through its rich concentration of growth factors.

Effectiveness Of Platelet-Rich Plasma For Osteoarthritis

Knee osteoarthritis stages
Many studies have been performed on PRP injections for osteoarthritis and the results have been near-unanimously positive, showing a reduction in pain and improvement in mobility among the people receiving the treatment. In total, 47 studies have investigated PRP as a treatment for osteoarthritis and all 47 of these studies have found that this treatment was beneficial4-50.

Some research has found that 3 PRP injections, with 1 month between each injection, is more effective and gives longer lasting results than only one or two injections31.

Platelet-rich plasma vs hyaluronic acid

  • Nineteen studies have compared PRP treatment to injections of hyaluronic acid for osteoarthritis.32-50
  • Fifteen of these 19 studies found PRP was a better treatment than hyaluronic acid35-49.
  • Three of these 19 studies found that PRP is as good as hyaluronic acid treatment32-34.
  • One of these 19 studies found that hyaluronic was a better treatment than PRP50.


Which Joints Are Helped?

Most PRP for osteoarthritis research has been on the knee. To date 37 studies have examined PRP’s effect on knee osteoarthritis while the temporomandibular joint has 4 studies, the hip has 3 studies, the ankle has 2 studies and the thumb has 1 study.

Figure 1. Number of studies (by joint) examining platelet-rich plasma for osteoarthritis. Most research performed on knee joint.
PRP for arthritis joint distribution: knee, TMJ, hip, ankle and thumb
Although the studies have yet to be done I have also seen good results with osteoarthritis of other joints including the shoulder, wrist and other hand joints.

Safety

PRP injection treatments are quite safe, having very little in the way of reported adverse effects50. While most treatments for pain involve a synthetic medication-based therapy, PRP simply uses a component of a person’s blood. PRP therefore carries very little risk of causing an allergic reaction. The most common adverse effect of PRP is discomfort at the site of treatment for 1-3 days. This is a common reaction as the mechanism of action of PRP involves a short-term inflammatory phase after treatment which can contribute to discomfort temporarily. As with any injection there is a small chance of infection. There is also a small chance of allergic reaction to the local anesthetic (numbing agent) which is used at the site of the injection.

What to Expect

PRP treatment can provide lasting results for people with osteoarthritis including reduced pain and improved mobility. Typically 3 treatments will be required to attain maximum benefit from PRP. PRP injections can be done 2-4 weeks apart without issue.

After Platelet-Rich Plasma Treatment

PRP injections are a long-term solution for osteoarthritis. While this treatment gives long term benefit some people may experience discomfort following treatment for 1-3 days. In order to deal with this possible discomfort it is best to reduce physical activity after a PRP injection to avoid additional discomfort of the region which was treated. Applying ice to the affected area will not inhibit the effectiveness of the PRP treatment and may help if the treated area is achy or sore.

The treated body part should be rested on the day of treatment and if discomfort remains then 2-3 days of avoiding heavy activity may be required to assist in recovering. Anti-inflammatories such as aspirin, ibuprofen and naproxen in general should not be taken for 2-7 days after a PRP treatment as they could theoretically dampen its effectiveness. Generally acetaminophen (Tylenol) is preferable to anti-inflammatories in this short term to manage any discomfort or pain which may be present.

Who Should Not Have Platelet-Rich Plasma?

People with active cancer or active infection are not candidates for PRP treatment. People with thrombocytopenia (low platelets) and people on blood thinners can have PRP treatment but some changes to the treatment may be required.

Platelet-Rich Plasma In Halifax

If you are interested in having PRP treatment contact MacLeod Naturopathic at 902-820-2727 to book an initial consultation with Dr. MacLeod. PRP treatment is also available at Dr. MacLeod’s location in Port Hood which can be reached at the phone number above.

References

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  2. Middleton KK, Barro V, Muller B, et al. Evaluation of the effects of platelet-rich plasma (PRP) therapy involved in the healing of sports-related soft tissue injuries. Iowa Orthop J. 2012;32:150-163.
  3. Moussa M, Lajeunesse D, Hilal G, El Atat O, Haykal G, Serhal R, Chalhoub A, Khalil C, Alaaeddine N. Platelet rich plasma (PRP) induces chondroprotection via increasing autophagy, anti-inflammatory markers, and decreasing apoptosis in human osteoarthritic cartilage. Exp Cell Res. 2017 Mar 1;352(1):146-156.
  4. Acosta-Olivo C, Esponda-Colmenares F, Vilchez-Cavazos F, Lara-Arias J, Mendoza-Lemus O, Ramos-Morales T. Platelet rich plasma versus oral paracetamol for the treatment of early knee osteoarthritis. Preliminary study. Cir Cir. 2014 Mar-Apr;82(2):163-9.
  5. Repetto I, Biti B, Cerruti P, Trentini R, Felli L. Conservative Treatment of Ankle Osteoarthritis: Can Platelet-Rich Plasma Effectively Postpone Surgery? J Foot Ankle Surg. 2017 Mar – Apr;56(2):362-365.
  6. 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. Orthop J Sports Med. 2017 Feb 13;5(2):2325967116689386.
  7. Fukawa T, Yamaguchi S, Akatsu Y, Yamamoto Y, Akagi R, Sasho T. Safety and Efficacy of Intra-articular Injection of Platelet-Rich Plasma in Patients With Ankle Osteoarthritis. Foot Ankle Int. 2017 Apr 1:1071100717700377.
  8. Chen CPC, Cheng CH, Hsu CC, Lin HC, Tsai YR, Chen JL. The influence of platelet rich plasma on synovial fluid volumes, protein concentrations, and severity of pain in patients with knee osteoarthritis. Exp Gerontol. 2017 Jul;93:68-72.
  9. Cömert Kiliç S, Güngörmüş M, Sümbüllü MA. Is Arthrocentesis Plus Platelet-Rich Plasma Superior to Arthrocentesis Alone in the Treatment of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial. J Oral Maxillofac Surg. 2015 Aug;73(8):1473-83.
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  17. Loibl M, Lang S, Dendl LM, Nerlich M, Angele P, Gehmert S, Huber M. Leukocyte-Reduced Platelet-Rich Plasma Treatment of Basal Thumb Arthritis: A Pilot Study. Biomed Res Int. 2016;2016:9262909.
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  29. Guler O, Mutlu S, Isyar M, Seker A, Kayaalp ME, Mahirogullari M. Comparison of short-term results of intraarticular platelet-rich plasma (PRP) and hyaluronic acid treatments in early-stage gonarthrosis patients. Eur J Orthop Surg Traumatol. 2015 Apr;25(3):509-13.
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Dr. Colin MacLeod ND

Dr. Colin MacLeod ND

Naturopathic Doctor at MacLeod Naturopathic
Dr. Colin is a naturopathic doctor practicing in Upper Tantallon in the Halifax Area. He was born and raised in rural Cape Breton and returned to Nova Scotia to practice after finishing his naturopathic education in Toronto. His practice focuses on pain management and maintaining health through physical activity and diet. He utilizes platelet-rich plasma, neural prolotherapy and acupuncture to keep his patients pain-free so that they can stay physically active, social and healthy.
Dr. Colin MacLeod ND

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Last updated August 31, 2017