Understanding Osteoarthritis Treatments
There are different types of arthritis that can affect individuals, and each person can have more than one type. The main types of arthritis include osteoarthritis (OA) and autoimmune/inflammatory arthritis. Both types lead to pain and in some cases difficulty with mobility, but the causes are different. In the former, cartilage (the cushion in between the joints) is worn away usually because of overuse. Genetics, obesity, previous trauma, hormonal factors also play a role. Once the protective cartilage is worn away, the joint space narrows and the bones that make up the joint space are more vulnerable to friction and damage. Nerves in the bones are exposed and pain can result.
The most important part of osteoarthritis treatment is conditioning the muscles that surround the joint so that these muscles can take on the load of day to day activities. Oral pharmacologic therapies are options for pain relief as are certain topical medications. Local injection treatments are also an option to help with pain and functioning. These local treatments include:
Glucocorticoid (steroid) injections, Hyaluronate (HA) injections also known as gel injections, and Platelet-rich plasma (PRP) injections.
Recent studies have reported that knees treated with steroid injections may be at a higher risk of osteoarthritis progression. But a limitation of these observational studies was that patients who receive steroid injections often have more advanced knee OA which itself is a risk factor for disease progression. A better way to assess this would be to compare steroid injections to hyaluronate injections, as similar types of patients may be offered these therapies. Hyaluronate is a natural component of joint spaces that lubricates joints. When injected, it can act as a temporary “cushion.” Hyaluronate injections have not been associated with increased risk of osteoarthritis progression. Not all patients are candidates for hyaluronate injections however. The purpose of a recent study published in the journal Arthritis and Rheumatology was to compare knee OA progression and knee replacement risk in patients receiving steroid injections and those receiving HA injections. This study showed that the rate of disease progression among knees receiving steroid injections was not different from the rate of progression among those receiving HA injections. The results from the study provides some reassurance that the risk of osteoarthritis progression is likely from the advanced osteoarthritis condition itself rather than from the steroid injections.
The purpose of platelet-rich plasma (PRP) injections is to harness an individuals ( own natural growth factors to heal itself. In PRP therapy, tube(s) of blood are removed and then centrifuged. The resulting concentration of platelets are injected back into diseased or injured body tissues such as torn tendons. While PRP therapy has been used to aid healing in tendonitis, torn tendons and tendon ruptures, there have been some patients who have received PRP for joint osteoarthritis such as knee osteoarthritis. However, a rigorous study from JAMA, The RESTORE randomized controlled trial, showed that PRP was not effective for knee osteoarthritis. There was similar clinical benefit in terms of pain when comparing patients who received saline (placebo) injections and PRP; there was also no benefit of PRP over saline in terms of cartilage thinning over 12 months.
We would love to answer your questions regarding osteoarthritis. Feel free to contact Magnolia Rheumatology.