scholarly journals Comprehensive Review of Knee Osteoarthritis Pharmacological Treatment and the Latest Professional Societies’ Guidelines

2021 ◽  
Vol 14 (3) ◽  
pp. 205
Author(s):  
Dragan Primorac ◽  
Vilim Molnar ◽  
Vid Matišić ◽  
Damir Hudetz ◽  
Željko Jeleč ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Platelet Rich Plasma ◽  
Symptom Relief ◽  
Topical Administration ◽  
Symptomatic Therapy ◽  
Therapy Options ◽  
Professional Societies ◽  
Inflammatory Drugs ◽  
The Right

Osteoarthritis is the most common musculoskeletal progressive disease, with the knee as the most commonly affected joint in the human body. While several new medications are still under research, many symptomatic therapy options, such as analgesics (opioid and non-opioid), nonsteroid anti-inflammatory drugs, symptomatic slow-acting drugs in osteoarthritis, and preparations for topical administration, are being used, with a diverse clinical response and inconsistent conclusions across various professional societies guidelines. The concept of pharmacogenomic-guided therapy, which lies on principles of the right medication for the right patient in the right dose at the right time, can significantly increase the patient’s response to symptom relief therapy in knee osteoarthritis. Corticosteroid intra-articular injections and hyaluronic acid injections provoke numerous discussions and disagreements among different guidelines, even though they are currently used in daily clinical practice. Biological options, such as platelet-rich plasma and mesenchymal stem cell injections, have shown good results in the treatment of osteoarthritis symptoms, greatly increasing the patient’s quality of life, especially when combined with other therapeutic options. Non-inclusion of the latter therapies in the guidelines, and their inconsistent stance on numerous therapy options, requires larger and well-designed studies to examine the true effects of these therapies and update the existing guidelines.

scholarly journals The Effect of Platelet-Rich Plasma on the Intra-Articular Microenvironment in Knee Osteoarthritis

2021 ◽  
Vol 22 (11) ◽  
pp. 5492
Author(s):  
Dawid Szwedowski ◽  
Joanna Szczepanek ◽  
Łukasz Paczesny ◽  
Jan Zabrzyński ◽  
Maciej Gagat ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Operative Treatment ◽  
Animal Studies ◽  
Platelet Rich Plasma ◽  
Treatment Options ◽  
Treatment Protocols ◽  
Metabolic Functions ◽  
Inflammatory Drugs ◽  
Positive Effect

Knee osteoarthritis (KOA) represents a clinical challenge due to poor potential for spontaneous healing of cartilage lesions. Several treatment options are available for KOA, including oral nonsteroidal anti-inflammatory drugs, physical therapy, braces, activity modification, and finally operative treatment. Intra-articular (IA) injections are usually used when the non-operative treatment is not effective, and when the surgery is not yet indicated. More and more studies suggesting that IA injections are as or even more efficient and safe than NSAIDs. Recently, research to improve intra-articular homeostasis has focused on biologic adjuncts, such as platelet-rich plasma (PRP). The catabolic and inflammatory intra-articular processes that exists in knee osteoarthritis (KOA) may be influenced by the administration of PRP and its derivatives. PRP can induce a regenerative response and lead to the improvement of metabolic functions of damaged structures. However, the positive effect on chondrogenesis and proliferation of mesenchymal stem cells (MSC) is still highly controversial. Recommendations from in vitro and animal research often lead to different clinical outcomes because it is difficult to translate non-clinical study outcomes and methodology recommendations to human clinical treatment protocols. In recent years, significant progress has been made in understanding the mechanism of PRP action. In this review, we will discuss mechanisms related to inflammation and chondrogenesis in cartilage repair and regenerative processes after PRP administration in in vitro and animal studies. Furthermore, we review clinical trials of PRP efficiency in changing the OA biomarkers in knee joint.

scholarly journals Family Perspectives on Hospice Care Experiences of Patients with Cancer

2017 ◽  
Vol 35 (4) ◽  
pp. 432-439 ◽  
Author(s):  
Pallavi Kumar ◽  
Alexi A. Wright ◽  
Laura A. Hatfield ◽  
Jennifer S. Temel ◽  
Nancy L. Keating
Keyword(s):  
Propensity Score ◽  
Goal Attainment ◽  
Hospice Care ◽  
Symptom Relief ◽  
Patients With Cancer ◽  
Percentage Points ◽  
The Right ◽  
Hospice Use ◽  
Eol Care

Purpose To determine whether hospice use by patients with cancer is associated with their families’ perceptions of patients’ symptoms, goal attainment, and quality of end-of-life (EOL) care. Methods We interviewed 2,307 families of deceased patients with advanced lung or colorectal cancer who were enrolled in the Cancer Care Outcomes Research and Surveillance study (a multiregional, prospective, observational study) and died by 2011. We used propensity-score matching to compare family-reported outcomes for patients who did and did not receive hospice care, including the presence and relief of common symptoms (ie, pain, dyspnea), concordance with patients’ wishes for EOL care and place of death, and quality of EOL care. We also examined associations between hospice length of stay and these outcomes among hospice enrollees. Results In a propensity-score-matched sample of 1,970 individuals, families of patients enrolled in hospice reported more pain in their patient compared with those not enrolled in hospice. However, families of patients enrolled in hospice more often reported that patients received “just the right amount” of pain medicine (80% v 73%; adjusted difference, 7 percentage points; 95% confidence interval [CI], 1 to 12 percentage points) and help with dyspnea (78% v 70%; adjusted difference, 8 percentage points; 95% CI, 2 to 13 percentage points). Families of patients enrolled in hospice also more often reported that patients’ EOL wishes were followed (80% v 74%; adjusted difference, 6 percentage points; 95% CI, 2 to 11 percentage points) and “excellent” quality EOL care (57% v 42%; adjusted difference, 15 percentage points; 95% CI, 11 to 20). Families of patients who received > 30 days of hospice care reported the highest quality EOL outcomes. Conclusion Hospice care is associated with better symptom relief, patient-goal attainment, and quality of EOL care. Encouraging earlier and increased hospice enrollment may improve EOL experiences for patients with cancer and their families.

scholarly journals Ultrasound-guided injection of platelet-rich plasma in a patient with an ischeotibial muscle injury (Inyección guiada por ultrasonido de plasma rico en plaquetas en un paciente con lesión en el origen de la musculatura isquiotibial)

Retos ◽  
2021 ◽  
pp. 209-213
Author(s):  
Lina Andrea Gomez ◽  
Javier Fernando Bonilla Briceño ◽  
Angélica Patricia Martinez Vasquez ◽  
Ana Luisa Muñoz
Keyword(s):  
Muscular Strength ◽  
Platelet Rich Plasma ◽  
Cost Effective ◽  
Sports Activity ◽  
Calidad De Vida ◽  
Application Techniques ◽  
Autologous Platelet Rich Plasma ◽  
The Right ◽  
Autologous Platelet

  Platelet-rich plasma (PRP) is a platelet concentrate that is obtained after centrifugation and may influence tissues healing by growth factors released after platelet degranulation. This treatment has been used for the management of muscles, ligaments, and tendinopathy injuries with promising results, there is still limited clinical evidence for its use. In this study we present the report of a case of a 50-year-old soccer player who presented an injury at the origin of the ischeotibial muscles of the right thigh. On day 13, after the injury, autologous Platelet Rich Plasma (APRP) was applied under ultrasound (US) guidance. The control by US and Nuclear Magnetic Resonance (NMR) was performed two weeks after the PPR application, which show resolution of the hematoma, and tissue regeneration. The patient returned to his sports activity at week 12 after the PRP treatment, without pain and with improvement in muscular strength The PRP treatment could be an option to avoid surgical procedures in athletes because it could improve muscular strength and healing, added it is easy to obtain and apply. Further studies are necessary to reach a consensus regarding clinical indications, processing and PRP application techniques that rebound in alternatives to improve the quality of life of patients in a cost-effective way, as well as shortening the recovery time of athletes.  Resumen. El plasma rico en plaquetas (PRP) es un concentrado de plaquetas que se obtiene después de centrifugación y puede influir en la curación de los tejidos por los factores de crecimiento liberados después de la desgranulación de las plaquetas. La terapia con PRP ha sido utilizada para el manejo de lesiones de tejidos blandos, como músculos, ligamentos y tendones con resultados prometedores. aunque la evidencia clínica actual para su uso es limitada. En este estudio presentamos el reporte del caso de un jugador de fútbol de 50 años que presentó lesión en el origen de la musculatura isquiotibial del muslo derecho. El día 13, después de la lesión, se le aplicó Plasma Rico en Plaquetas Autólogo (PRPA) guiado por ultrasonido (US). El control por US y resonancia magnética nuclear (RMN) se realizó dos semanas después de la aplicación del PRP, mostrando recuperación de la lesión y resolución del hematoma. El paciente volvió a realizar actividades deportivas en la semana 12 después del tratamiento, sin dolor y con mejoría de la fuerza muscular. El tratamiento con PRP podría ser una opción para evitar procedimientos quirúrgicos mejorando la fuerza muscular y la curación de la musculatura isqueotibial, adicionalmente el PRP es fácil de obtener y aplicar. De igual manera se necesitan más estudios para llegar a un consenso sobre las indicaciones clínicas, el procesamiento y las técnicas de aplicación de PRP que redunden en alternativas para mejorar la calidad de vida de los pacientes de una manera costo-efectiva, así como acortar el tiempo de recuperación de los atletas.

Does Intra-Articular Injection of Platelet-Rich Plasma Have an Effect on Cartilage Thickness in Patients with Primary Knee Osteoarthritis?

2021 ◽  
Vol 17 ◽  
Author(s):  
Noha M Abdel Baki ◽  
Zeinab O. Nawito ◽  
Nehal M. S. Abdelsalam ◽  
Dina Sabry ◽  
Hossam Elashmawy ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Platelet Rich Plasma ◽  
Womac Score ◽  
Cartilage Thickness ◽  
Condylar Cartilage ◽  
Knee Oa ◽  
Group I ◽  
Grading Scale ◽  
Inflammatory Drugs ◽  
Group Ii

Objectives: To determine the effect of intra-articular injection of platelet-rich plasma (PRP) in patients with primary knee osteoarthritis (OA) by clinical evaluation and ultrasonographic (US) assessment of cartilage thickness. Patients and Methods: A total of 100 patients with mild to severe primary knee OA using the Kellgren-Lawrence (K-L) grading scale were included and divided into two groups. Group I included 50 patients who were given two intra-articular knee injections of PRP, 1 week apart; Group II included 50 patients who received non-steroidal anti-inflammatory drugs (NSAIDs) and chondroprotective drugs. Functional assessment of all OA patients done using the basal WOMAC score, at 2 and 6 months.US assessment of femoral condylar cartilage thickness was conducted basally and at 6 months. Results: Improvement of WOMAC score was observed at 2 and 6 months in Group I following PRP injection compared to Group II (p values < 0.001), The improvement of WOMAC in Group I occurred in all severity degrees of OA (p < 0.001). Moreover, a significant increase in cartilage thickness at the intercondylar area (ICA) at 6 months relative to baseline assessment by US in Group I (p = 0.041) was found. Conclusion: Treatment with PRP injections can reduce pain and improve knee function in patients with various degrees of articular degeneration. Further studies are needed to clarify the anabolic effect of PRP on the articular cartilage.

scholarly journals Platelet-Rich Plasma Combined with Hyaluronic Acid versus Leucocyte and Platelet-Rich Plasma in the Conservative Treatment of Knee Osteoarthritis. A Retrospective Study

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 232
Author(s):  
Michelangelo Palco ◽  
Domenico Fenga ◽  
Giorgio Carmelo Basile ◽  
Paolo Rizzo ◽  
Bruno Cavalieri ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Knee Osteoarthritis ◽  
Repeated Measures ◽  
Platelet Rich Plasma ◽  
Clinical Effectiveness ◽  
High Concentration ◽  
Negative Effect ◽  
And Function ◽  
Change In Mean

Background and objectives: Knee osteoarthritis (KO) is one of the most common joint diseases, determining knee pain and reduction of mobility, with a negative effect on quality of life. Intra-articular injections of different formulations of platelet-rich plasma (PRP) are an increasingly common non-surgical treatment for KO. Recently, in order to combine the anti-inflammatory effect of platelet rich plasma and the viscosupplementation effect of hyaluronic acid, a formulation of PRP combined with hyaluronic acid (PRP + HA) has been proposed. The purpose of this study is to retrospectively compare the effectiveness of plasma with high concentration of platelets and leukocytes (L-PRP) with PRP + HA in patients with mild to moderate (Kellgren–Lawrence scale II-III grade) KO. Materials and Methods: Among the 51 patients included, 28 have been treated with L-PRP, while 23 with PRP + HA. A retrospective evaluation at baseline (T0), after 3 months (T1) and 1 year (T2) has been performed. The outcome analyzed are the Knee Society Score (KSS), the Visuo Analogic Scale (VAS) (at T0, T1, and T2) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) (T0 and T2). We evaluated change in mean scores within and between groups among different time points using repeated measures ANCOVA. Results: Although the two treatments have been both effective in reducing VAS, the group treated with PRP + HA showed a significantly lower KSS. Conclusions: Our results show that the use of both treatments may help to reduce pain in patients with mild to moderate KO. PRP + HA showed better results in improving knee mobility and function. These results should be considered only preliminary: Further research is needed to completely describe the clinical effectiveness of these formulations.

scholarly journals An Innovative Bioceramic Bone Graft with Platelet-Rich Plasma for Rapid Bone Healing and Regeneration in a Rabbit Model

2021 ◽  
Vol 11 (11) ◽  
pp. 5271
Author(s):  
Syamsiah Syam ◽  
Chun-Wei Chang ◽  
Wen-Chien Lan ◽  
Keng-Liang Ou ◽  
Bai-Hung Huang ◽  
...  
Keyword(s):  
Bone Graft ◽  
Maxillary Sinus ◽  
Bone Healing ◽  
Platelet Rich Plasma ◽  
Rabbit Model ◽  
Graft Material ◽  
Computed Tomographic ◽  
Hematoxylin And Eosin ◽  
The Right

This study aimed to investigate the effect of combining an innovative bioceramic α-calcium sulfate hemihydrate (α-CSH, CaSO4⋅0.5H2O) bone graft and platelet-rich plasma (PRP) to accelerate bone healing and regeneration in a rabbit model. The bone graft material was implanted bilaterally on rabbit’s artificially maxillary sinus defects: the right maxillary sinus received α-CSH, while α-CSH combine with PRP (α-CSH/PRP) was grafted in left site. The quantity and quality of bone formation after implantation were analyzed radiographically and histologically at 1, 2, and 3 weeks. The micro-computed tomographic results indicated that the bone density of sinus implanted with α-CSH increased and defect volume decreased most after 2 weeks. In histological analysis, both hematoxylin and eosin and Masson trichrome staining of α-CSH/PRP displays better bone healing and regeneration progress than α-CSH after 2 weeks implantation. Therefore, the innovative α-CSH combined with PRP was revealed to be useful in accelerating bone healing and regeneration for the successful defect treatment.

scholarly journals A Systematic Review of Current Clinical Practice Guidelines on Intra-articular Hyaluronic Acid, Corticosteroid, and Platelet-Rich Plasma Injection for Knee Osteoarthritis: An International Perspective

2021 ◽  
Vol 9 (8) ◽  
pp. 232596712110302
Author(s):  
Mark Phillips ◽  
Mohit Bhandari ◽  
John Grant ◽  
Asheesh Bedi ◽  
Thomas Trojian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Clinical Practice ◽  
Knee Osteoarthritis ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Platelet Rich Plasma ◽  
Symptom Relief ◽  
Current Evidence ◽  
Knee Oa

Background: There are many clinical practice guidelines (CPGs) for the prevention, diagnosis, and treatment of knee osteoarthritis (OA). They differ by region, considering local health care systems, along with cultural and economic factors. Currently, there are conflicting CPG recommendations across the various publications, which makes it difficult for clinicians to fully understand the optimal treatment decisions for knee OA management. Purpose: To summarize the current published CPG recommendations for the role of injections in the nonoperative management of knee OA, specifically with the use of intra-articular hyaluronic acid (IA-HA), intra-articular corticosteroids (IA-CS), and platelet-rich plasma (PRP). Study Design: Systematic review. Methods: A comprehensive search identified all nonoperative knee OA CPGs within the ECRI (formerly Emergency Care Research Institute) Guidelines Trust database, the Guidelines International Network database, Google Scholar, and the Trip (formerly Turning Research Into Practice) database. Guideline recommendations were categorized into strong, conditional, or uncertain recommendations for or against the use of IA-HA, IA-CS, or PRP. Guideline recommendations were summarized and depicted graphically to identify trends in recommendations over time. Results: The search strategy identified 27 CPGs that provided recommendations. There were 20 recommendations in favor of IA-HA use, 21 recommendations in favor of IA-CS use, and 9 recommendations that were uncertain or unable to make a formal recommendation for or against PRP use based on current evidence. Most recommendations considered IA-HA and IA-CS use for symptom relief when other nonoperative options are ineffective. IA-CS were noted to provide fast and short-acting symptom relief for acute episodes of disease exacerbation, while IA-HA may demonstrate a relatively delayed but prolonged effect in comparison. The CPGs concluded that PRP recommendations currently lack evidence to definitively recommend for or against use. Conclusion: Available CPGs provide recommendations on injectables for knee OA treatment. General guidance from a global perspective concluded that IA-CS and IA-HA are favored for different needed responses and can be utilized within the knee OA treatment paradigm, while PRP currently has insufficient evidence to make a conclusive recommendation for or against its use.

scholarly journals Effectiveness of platelet-rich plasma (PRP) on pain, function and quality of life in knee osteoarthritis patients: a before-and-after study and review of the literature

2018 ◽  
Vol 1 (3) ◽  
Author(s):  
Marcos Edgar Fernández-Cuadros ◽  
Olga Susana Pérez-Moro ◽  
María Jesús Albaladejo-Florín ◽  
Beatriz Entrambasaguas-Estepa ◽  
Rubén Algarra-López
Keyword(s):  
Quality Of Life ◽  
Knee Osteoarthritis ◽  
Platelet Rich Plasma ◽  
Review Of The Literature ◽  
Before And After ◽  
Before And After Study

scholarly journals Effectiveness of plasma with low concentration of platelets combined with hyaluronic acid compared with platelet rich plasma in the conservative treatment of knee osteoarthritis. A retrospective study

2020 ◽  
Author(s):  
Michelangelo Palco ◽  
Domenico Fenga ◽  
Paolo Rizzo ◽  
Bruno Cavalieri ◽  
Demetrio Milardi ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Knee Osteoarthritis ◽  
Functional Status ◽  
Repeated Measures ◽  
Platelet Rich Plasma ◽  
High Concentration ◽  
Low Concentration ◽  
One Year ◽  
Change In Mean

Abstract Background: Knee osteoarthritis (KO) is one of the most common joint diseases, often determining knee pain and reduction of mobility with impact on the overall quality of life of the patients. Intra-articular injections of different formulations of platelet rich plasma (PRP) are an increasingly common non-surgical treatment for KO. Recently, in order to combine the antinflammatory effect of platelet rich plasma and the viscosupplementation effect of hyaluronic acid, a formulation of plasma with relatively low concentration of platelets and very few leukocytes combined with hyaluronic acid (PRP+HA) has been proposed. The purpose of this study is to retrospectively compare the effectiveness of plasma with high concentration of platelets and leukocytes (L-PRP) with PRP+HA in patients with mild to moderate (Kellegren-Lawrence scale II-III grade) KO.Materials and Methods: Among the 51 patients included, 28 have been treated with L-PRP, while 23 with PRP+HA. A retrospective evaluation at baseline (T0), after 3 months (T1) and 1 year (T2) has been performed. The outcome analyzed are the Knee Society Score(KSS), the Visuo Analogic Scale (VAS) (at T0,T1 and T2) and the Knee injury and Osteoarthritis Outcome Score(KOOS) (T0 and T2).We evaluated change in mean scores within group among different time points using repeated measures ANOVA or paired t-test. Comparison between different groups of treatment has been performed using mixed ANOVA.Results: The main finding is that, although the two treatments have been both effective, PRP+HA determined significantly better functional status, pain and mobility, measured with KSS.Discussion: We observed a significant effect of the two formulations in exam in all the outcomes in analysis: both treatments were effective in improving pain, knee functional status and symptoms, and the benefits persisted after 3 and 12 months from the infiltrative therapy. Nevertheless, patients who received PRP+HA injections presented higher knee mobility and better function (measured by KSS score) after one year.Conclusions: This work compares clinical outcomes of L-PRP and PRP+HA treatment in patients with KO. Our results encourage the use of one of the two treatments in patients with mild to moderate KO. When possible, we suggest to the use of PRP+HA formulation, because it may determine better results in improving knee function and mobility.

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