Osteoarthritis is a very prevalent rheumatic disease that damages the joint understood as a complete organ (cartilage, subchondral bone, synovial membrane, joint capsule, menisci, bursae, ligaments, muscles and nerves).
The joints are the components of the skeleton that allow us to move and, thus, our functional autonomy and are formed by the union of two bones through the joint capsule. Inside them there is usually a fluid called synovial fluid that produces the synovial membrane. The bony ends that join to form the joint are covered by articular cartilage. In osteoarthritis, all the tissues that form it are altered to a greater or lesser extent and when the joint components are injured, pain, stiffness and functional disability occur, limiting the mobility of the person.
What is its prevalence?
In Spain, osteoarthritis affects 10% of the general population, representing almost a quarter of the total number of patients seen in the consultations of Rheumatology specialists. According to the EPISER 2016 study of the Spanish Society of Rheumatology, symptomatic knee osteoarthritis has a prevalence of 13.83% and hand osteoarthritis of 7.73%.
Other studies have revealed that about half of the adult population over 50 years of age has radiological signs of knee osteoarthritis, although it is more common in women especially from 55 years of age.
What symptoms can we detect?
It depends on the affected joint will give greater symptomatology in the localized area. Osteoarthritis is usually located in the cervical and lumbar spine, some shoulder and finger joints, the hip, the knee and the joint at the beginning of the big toe.
Initially, a mechanical type of pain is usually referred, that is to say, it is triggered by movements and improves with rest, although at specific moments there may be inflammatory crises with a sensation of swelling and heat. If no measures are taken, the pain increases, being continuous at rest and the range of motion of the joint becomes less and less, causing greater stiffness and, therefore, functional disability.
What are the main causes?
This rheumatic disease has not been related to a specific hereditary gene, but it does have a genetic risk component which, together with other factors, can make it appear more easily in people who have a family history of osteoarthritis. It is very common to observe a history of osteoarthritis of the hands. It is important to know the risk factors such as obesity, lack of physical exercise or posture alterations, which influence the faster development of the disease.
How is the diagnosis made?
The basis is always a good anamnesis, clinical history and physical examination. In addition, nowadays, thanks to new technologies, we are using less and less X-rays and more and more musculoskeletal ultrasound scans. The use of this ultrasound technology allows us to visualize and explore the joint in real time and detect any lesions it may have.
We usually also request a blood test on the first visit to make a correct differential diagnosis of other causes of joint pain such as arthritis due to crystals, rheumatoid arthritis or arthritis due to viruses, to name a few examples.
What is the treatment?
With the advance in the knowledge of the pathophysiology of this disease, the incorporation of new treatment strategies included in the prestigious international clinical practice guidelines is progressively advancing. Specifically, we are using less and less corticosteroid treatments and aggressive surgeries, giving way to multidisciplinary treatments focused on reducing inflammation and pain, delaying the progression of the disease, regenerating tissues and recovering joint mobility.
What are the benefits of PRP infiltrations?
In Regenerative Medicine we use the so-called Growth Factors or Platelet Rich Plasma (PRP) that produce anti-inflammatory, analgesic and regenerative effects.
How does PRP work?
The neurophysiological effects of this novel technique are very powerful. Several biological mechanisms are involved: proliferation of mesenchymal cells, cell differentiation, generation of blood vessels and migration of cells to the sites where regeneration needs to occur, reducing inflammation, pain and tissue injury.
What are the indications?
Treatment with growth factors is applied with the intention of reducing pain, improving function and slowing the progression of osteoarthritis of the joints. It has the advantage of being an autologous treatment, that is to say, the patient’s own, thus avoiding rejection or intolerance reactions and the long-term side effects of other types of infiltrations, such as corticosteroids. It is also used with good response in tendinitis and certain muscle injuries, where it provides an acceleration of tissue repair.
What is the procedure like?
The treatment is performed under medical prescription, in a sterile environment and without requiring anesthesia.
First, blood is drawn from the patient as if it were an analysis, then it is processed in a closed circuit using a prepared centrifuge and the portion of the plasma rich in growth factors is separated.
The PRP is then infiltrated into the area to be treated using an ultrasound-guided technique (we use a high definition HD ultrasound probe) which allows us to fine-tune and be more precise in the anatomical location. The process usually lasts about 30-35 minutes.
What care should I take afterwards?
The patient can continue his normal activity trying not to overload or make efforts during the next 2 or 3 days in the infiltrated area.
Regarding the number of infiltrations, it depends on the injury and the severity of osteoarthritis to be treated. Usually 1 to 3 sessions are performed 2 to 3 weeks apart to achieve maximum effect.