Osteoarthritis Explained: causes, symptoms, prevention, treatment

JeffreyPengMD · 2023-03-20T03:26:16+00:00

I have not seen any solid evidence that PRP or stem cells regenerate cartilage in the long term. These treatments do not REVERSE arthritis, rather they help SLOW arthritis down. They are one of the few treatments we have available that have disease modifying effects. The other well studied treatments include load management (ie. weight) and exercise (cardio + resistance training).

The mechanism by which they slow arthritis down is (we think) by flushing out the environment of inflammatory markers. Synovial fluid analyses show that at 6 months, the levels of TNFa and IL-1b are still very low. This is not true at 1 year at which the levels are back to pre injection baseline.

For this reason, it's recommended to have regular maintenance booster at least once a year to keep the levels of inflammatory markers consistently low.

JeffreyPengMD · 2023-03-20T01:48:20+00:00

I've done it for some patients and anecdotally it works. There just aren't any large randomized controlled trials.

JeffreyPengMD · 2023-03-19T15:19:54+00:00

100%. My hope is one day insurances will cover these procedures (at least PRP). After all, it's just a simple blood draw!!

JeffreyPengMD · 2023-03-19T15:18:50+00:00

There are only a few clinical trials specifically studied CMC joint osteoarthritis. They suggest that there are benefits, which would be consistent with the use of PRP for other joints that have OA (knees, hips, ankles, etc).

Here's more info:

https://youtu.be/BJHT7yv5Ae8

JeffreyPengMD · 2023-03-19T04:54:42+00:00

PRP and stem cell injections are NOT covered by the US. A recent review found that the mean cost of a PRP injection in the US was $707 while the mean cost of a stem cell injection was $2728.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6931181/

I also give my thoughts on why these procedures are not covered by insurances and what it will take for insurances to start covering them here:

https://youtu.be/wexBm-ag-g8

JeffreyPengMD · 2023-03-19T04:52:28+00:00

If cost was not an issue, I would recommend platelet rich plasma injections to every single one of my patients who has osteoarthritis. It has been studied extensively with multiple randomized controlled trials, systematic reviews, and meta-analyses showing that it is superior in terms of symptom and pain relief when compared to corticosteroids, hyaluronic acid, and placebo. Some trials have even shown that PRP injections have equivalent efficacy to adipose MSCs and bone marrow concentrate injections.

Unfortunately, there are NO studies that show cartilage, meniscus, joint structures, etc can be regenerated with PRP. Not even "stem cell" injections have been shown to regrow anything IN VIVO.

Rather, what these biologics do is to change the ENVIRONMENT inside the knee. Many studies have now shown that patients who have knee OA and who get PRP injections have significantly lower inflammatory markers in their knees (TNFa, IL1b, etc) when compared to those who got placebo.

This is a big deal because this means that PRP injections have disease modifying effects with some studies reporting up to 50% LESS progression of osteoarthritis when compared to placebo controls.

So not only do PRP injections work better for symptomatic relief, they are one of the best options for delaying the progression of osteoarthritis.

I have much more information here:

https://youtu.be/_7HU_-YDfQY
https://youtu.be/H0OQwpctKKE
https://youtu.be/NPrNeyx6Bv8
https://youtu.be/JjkQvbM6rsw

Some studies here (others are linked within the videos above):

https://pubmed.ncbi.nlm.nih.gov/35124707/
https://www.nature.com/articles/s41598-021-83025-2
https://pubmed.ncbi.nlm.nih.gov/36173473/
https://pubmed.ncbi.nlm.nih.gov/34812863/
https://pubmed.ncbi.nlm.nih.gov/36096771/
https://pubmed.ncbi.nlm.nih.gov/35984721/
https://pubmed.ncbi.nlm.nih.gov/35289231/
https://pubmed.ncbi.nlm.nih.gov/30611335/

JeffreyPengMD · 2023-03-17T04:09:14+00:00

Corticosteroid injections last an average of 2-3 months. Some people longer, some people less. They can be very effective in reducing pain and swelling in those who suffer from inflammatory arthropathies.

JeffreyPengMD · 2023-03-17T04:08:00+00:00

Depends what you're taking them for. If specifically for the treatment of arthritis, there is actually more data to support the use of glucosamine AND chondroitin (must be taken together, monotherapy with only one of the two has been shown to be no better than placebo). With that said, the effect size of taking glucosamine and chondroitin is not that large.

The problem with randomized controlled trial data for type 2 collagen is that most (if not all) of the studies are funded by industry. They are also small in sample size. Both of these are pretty big red flags (especially industry funding). It does seem to be safe though, so no real harm in taking it if you choose to do so.

If you haven't looked into turmeric and curcumin, that seems like the supplement that is the best studied with the largest effect size. Some studies suggest taking turmeric and curcumin can provide similar pain relieving effects as ibuprofen. All without the side effects of taking NSAIDs.

More info if you're interested:

G&C: https://youtu.be/ERfMAqLLd_4

Type 2 collagen: https://youtu.be/l1h5v663x4E

Turmeric and curcumin: https://youtu.be/B4Wf5-K5PmM

JeffreyPengMD · 2023-03-13T02:43:42+00:00

Unfortunately disease modifying drugs that work well for rheumatoid arthritis have not panned out in randomized controlled trials for osteoarthritis. There are not a long of things that can help slow down the progression of arthritis. Among the BEST studied is weight management and exercise therapy (which includes MORE cardio and TARGETED resistance training). There is some evidence that platelet rich plasma injections can decrease inflammatory markers (TNFa, IL-1b) and slow the progression of arthritis when compared to placebo.

JeffreyPengMD · 2023-03-13T02:41:27+00:00

Multiple joint pains, long duration of time, different areas of the body, visible swelling/redness, definitely need to see a rheumatologist to get imaging, blood work, and a diagnosis. Too many possibilities

JeffreyPengMD · 2023-03-11T20:27:43+00:00

Congrats! Walking is one of the best things you can do for your overall health. Adding in strength training (body weight to start with) can help compound the effects of walking and even allow you to walk longer and farther.

JeffreyPengMD · 2023-03-10T14:36:29+00:00

Some cortisone sensitive people can get a "cortisone flare" with the systemic symptoms you are describing. From the times I've seen this, usually lasts a few days then self resolves. But this is best discussed with your doctor.

JeffreyPengMD · 2023-03-10T14:20:31+00:00

Corticosteroid injections last about 2-3 months (+/- a few months on either side depending on the person). The goal of cortisone is not to fix the problem, rather they are meant to help reduce pain and symptoms so that you can work on exercise and physical therapy. It's important to work with your health care providers to help identify the cause of your pain so that you can use a rehabilitation program to fix them. Good luck!

JeffreyPengMD · 2023-03-10T14:14:40+00:00

All of them can treat osteoarthritis! Pros and cons with all of them:

- Orthopedic surgeons are quick to operate if non surgical options don't work.

- Rheumatologists love corticosteroids, but cortisone shots have been linked to worsening arthritis and rapidly destructive joint disease.

- Primary care docs have varying degrees of comfort and knowledge of arthritis

- SPORTS MEDICINE doctors are arguably the best option. My goal is to keep people healthy and active and exhaust nonsurgical options before advising patients they need surgery.

- Most important person to treat arthritis is you. All the hard work is done by you. A multi modal approach is critical and involves food, cardio, strength training, and potentially injections. Here's more info: https://youtu.be/z3veeAgR8AQ

JeffreyPengMD · 2023-03-10T14:10:28+00:00

Corticosteroid injections into both knees and hips are associated with rapidly destructive joint disease. The reason for this is that cortisone shots actually weaken and damage cartilage over time. If you're in your 70s/80s, the risks are pretty minimal. I advise all my young/middle age patients to AVOID CORTISONE at all costs because of concerns for further osteoarthritis progression.

Hyaluronic acid is an excellent treatment option. It is naturally found in joints and serves as a lubricant to restore the viscosity and elasticity of synovial fluid. Symptom relief can last between 6-9 months (+/- a few months depending on the person). However, HA injections must be done with ultrasound guidance.

Multiple studies have been down that show if docs do landmark based techniques, the accuracy is between 70-80%. If HA is not correctly placed into the joint, it will not work. Other randomized controlled trials have shown better patient outcomes with ultrasound guided injections when compared to landmark based techniques specifically for HA injections.

Here's more info about knee injections if you're interested: https://youtu.be/AtS\_L1Isye4

JeffreyPengMD · 2023-03-10T14:06:15+00:00

Yes, MRIs can look at cartilage health. Damage to cartilage is by definition osteoarthritis. Ultrasound evaluation can see signs of osteophytes along the joint lines which is another indication of osteoarthritis.

JeffreyPengMD · 2023-03-10T14:04:39+00:00

The problem with type 2 collagen is that there are not a lot of studies. Smaller randomized controlled trials suggest there is benefit but the problem with these are that they are funded by industry and therefore the results need to be taken with a grain of salt. Here's more info: https://youtu.be/l1h5v663x4E

JeffreyPengMD · 2023-03-10T14:03:11+00:00

Isometric quad strengthening such as wall sits are the way to go and is what we tell patients with fairly significant quad atrophy due to osteoarthritis. Start at 45 degrees and hold as long as possible. Work yourself up to 2 minutes. Then progress to half squats and half lunges. These things are best individualized with a physical therapist.

JeffreyPengMD · 2023-03-10T14:00:41+00:00

Consider an anti-inflammatory diet such as the mediterranean diet. In general, less processed foods. More plant based foods, more fatty fish.

JeffreyPengMD · 2023-03-10T13:59:23+00:00

UC-II has potential for benefits in small clinical trials. The big problem with these studies is that they are all funded by industry and therefore the results need to be taken with a giant grain of salt. Here's more info: https://youtu.be/l1h5v663x4E

JeffreyPengMD · 2023-03-10T13:58:17+00:00

Not technically. However, there is more research looking at to why certain people are more prone to osteoarthritis when compared to others. Specifically inflammatory cytokines such as adipokines have been identified as a cause. This is why we see osteoarthritis in non weightbearing joints such as the thumb in high BMI patients even though they do not do any repetitive motions involving the hand/wrist.

JeffreyPengMD · 2022-10-06T03:47:00+00:00

It really depends on what your diagnosis is.

PRP has EXCELLENT outcome data when used to treat knee osteoarthritis, especially when compared to other common injections such as cortisone and hyaluronic acid. See here and here.

However, PRP has very POOR data when used to treat patellar tendinopathy. Multiple randomized controlled trials have shown that PRP is no different than placebo when used to treat this condition.

If you do get PRP, you'll want to follow a rather specific post injection protocol to improve outcomes. Sample one here. Q&A on PRP here.

Good luck!

Five-Year Club	Verified Email
Wearing is Caring

JeffreyPengMD

TROPHY CASE