Yesterday we had a patient in our office who came in with hand osteoarthritis. She told us that her surgeon said that there was no evidence to support PRP in the hands. Fortunately, Evans et al recently published a systematic review and meta-analysis on platelet rich plasma for treating hand osteoarthritis and foot osteoarthritis.

What is hand osteoarthritis?

Osteoarthritis is the most common form of degenerative joint disease, and is the breakdown of joint cartilage resulting in pain, stiffness and the loss of function. There are no curative medications, and is a progressive disease meaning that over time the cartilage will continue to wear down.

How is hand osteoarthritis traditionally treated?

Conservative treatment typically focuses on symptoms including non-steroidal anti-inflammatory drugs, topical capsaicin, heat and steroid injections. In large joint replacements are common, but surgical interventions for small foot and hand osteoarthritis remain meager and fusion comes at the expense of function. Platelet rich plasma is an exciting option to manage pain and carries a possibility for enhancing chondrocyte activity and is most pronounced in small joints.

What is platelet rich plasma?

Platelet rich plasma (PRP) uses a patient’s own blood, which is separated into different cellular layers. The final PRP preparation is a concentration of platelets and growth factors. There are many different protocols for preparing PRP, but studies show that to be effective the PRP has to concentrate platelets greater than 5 times normal blood.

In joints and osteoarthritis, PRP acts predominately by anti-inflammatory cascades to reduce pain. The data suggests that PRP may be superior to other intra-articular injections in improving pain and function in small joint osteoarthritis (Evans et al, 2020).

What is the evidence?

Loible et al. (2016)

In this small pilot study of 10 patients, the patients had 2 PRP injections into the trapeziometacarpal joint over 4 weeks for wrist arthritis. Patients had improvement in pain and function at the 6-month follow up.

Mayoly et al. (2019)

In a small case series, 3 patients with severe arthritis were injected with PRP and micro-fragmented adipose tissue into the wrist and 2 of the 3 patients had a significant improvement in function at the 1-year follow up.

Malahias et al. (2018)

In this randomized controlled study, 33 patients with osteoarthritis of the TMC joint received 2 intra-articular PRP injections versus patients with 2 steroid injections. At the 12-month follow-up the PRP group had significant improvement in pain, function and satisfaction compared to steroid injections.

While additional studies are needed there is level 1 evidence showing PRP is a better long term option compared to steroid injections.

References

1. Evans A, Ibrahim M, Pope R, Mwangi J, Botros M, Johnson SP, Al Kassis S. Treating hand and foot osteoarthritis using a patient's own blood: A systematic review and meta-analysis of platelet-rich plasma. J Orthop. 2020 Jan 28;18:226-236.
2. 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.
3. Malahias MA, Roumeliotis L, Nikolaou VS, Chronopoulos E, Sourlas I, Babis GC. Platelet-Rich Plasma versus Corticosteroid Intra-Articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial. Cartilage. 2021 Jan;12(1):51-61.
4. Mayoly A, Iniesta A, Curvale C, Kachouh N, Jaloux C, Eraud J, Vogtensperger M, Veran J, Grimaud F, Jouve E, Casanova D, Sabatier F, Legré R, Magalon J. Development of Autologous Platelet-Rich Plasma Mixed-Microfat as an Advanced Therapy Medicinal Product for Intra-Articular Injection of Radio-Carpal Osteoarthritis: From Validation Data to Preliminary Clinical Results. Int J Mol Sci. 2019 Mar 5;20(5):1111.