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As I discussed last week, arthritis symptoms are common. Fortunately, lifestyle choices make a big difference in your level of symptoms and your ability to stay active. The combination of an anti-inflammatory diet, daily activity, and joint supporting supplements can make a dramatic difference in staying pain-free and active.

Please click here to view Part One of Tips to Decrease Arthritis Pain, which focuses on lifestyle choices and clarifies how arthritis drugs often cause more harm than benefit.

If diet, activity, and supplements do not fully cover your pain, joint injections can be very helpful to decrease inflammation and provide pain and swelling relief for 3-12 months. Yet the surprising truth is that the most common treatment offered by physicians may be the worse option available.

Steroid (cortisone) joint injections are commonly used by doctors and they do provide arthritis joint relief for up to 3 months, but not only do they lower inflammation short-term, but they also damage the remaining cartilage and accelerate the destruction of the joint over time. If you are trying to postpone a joint replacement surgery, then it is not such a big deal to have a cortisone injection in a joint that you plan to replace in the near future, but people who hope to avoid a future joint replacement should absolutely avoid cortisone joint injections. And with the newer treatments available, many people who thought they needed a joint replacement may not really need a new joint and all the rehab that goes with it after all.

Better options for arthritic joint relief are joint injections with either PRP or hyaluronic acid injections.

Hyaluronic acid is a substance that is naturally present in the human body. It is found in the highest concentrations in fluids in the eyes and joints. The hyaluronic acid that is used in joint injections is extracted from rooster combs.

Over a decade ago, I tired a series of 3 hyaluronic acid joint injections for my right knee and noticed some modest relief, not enough that I wanted to repeat it when they offered to repeat the injections six months later.

A far better choice is PRP. Platelet Rich Plasma (PRP) is a fluid loaded with platelets that promotes healing for joints, tendons, and other tissues. Up until recently, this was a treatment limited to professional athletes who needed to heal quickly and protect their joints for the future, but more recently this treatment has been offered to anyone with arthritis. Although, the irony is that while insurance companies may cover treatment for NSAID drugs and cortisone injections, they may refuse to cover what appears to be a safer and more effective treatment with PRP.

Let me clarify how PRP works. Inside an artery when there is bleeding, platelets help form a clot to stop the bleeding. In a joint with inflammation, platelets help promote healing and normal joint fluid production. Platelets help restore health and healing wherever they are found in the body.

In a doctor’s office, a technician will draw your blood (typically anywhere from 6 to 20 tubes are collected), the blood is spun to concentrate the platelets, and then a few hours later the PRP solution can be injected back into the same person’s body. Injecting one person’s platelets into another person’s body is thereby avoided.

Within 2-12 hours of a PRP injection, the injected site will often be tender for up to 24 hours and some providers offer a pain medicine prescription to cover any discomfort during the first 24 hours—something I have learned to accept and take after an injection. (I declined to use any pain meds the first time I had my thumbs injected and I was very sorry for 12 hours).

The benefits of joint pain reduction are usually noted within a few days to a week and can last for months and sometimes even a year or more. I have tried this for several joints and noticed a 70-80% reduction in joint pain for up to one year or longer.

A recent study published in the Journal of Arthroscopy compared the effectiveness of PRP versus Hyaluronic Acid injections for subjects with knee osteoarthritis. (Jixiang Tan, Hong Chen et al. Platelet-Rich Plasma Versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis: a Meta-Analysis of 26 randomized controlled trials. Arthroscopy, July 14, 2020.)

They reviewed 26 randomized controlled trials involving a total of 2,430 patients. Those receiving PRP injections had significantly greater improvement in pain, joint stiffness, and activity levels than those receiving hyaluronic acid injections. There was no significant difference in adverse events between the two groups. The bottom line, similar to my own experience, is that PRP is far more effective in managing advanced osteoarthritis pain than hyaluronic acid.

There are some theories (and some physicians who like to claim) that annual PRP injections may slow the progression of future arthritis joint degeneration, but for now this is only speculation and remains unproven.

My hope would be that if you are one of the many people who have arthritis by following an anti-inflammatory diet, staying physically active, and taking omega-3 oil and curcumin supplements would be enough to manage your symptoms, avoid joint pain, and help you to stay active. With my arthritis, I have given up running, but thanks to following these steps, I have otherwise been able to do just about everything I want to do. When I have had a flare in my symptoms, especially related to my knee after 5 surgeries, it is nice to have a PRP joint injection as another option. It is reassuring to know that relatively safe and effective therapy options are effective for arthritis symptoms.

For more details on PRP and stem cell therapies, watch my recording with Dr. James Leiber, an expert in the field of PRP and stem cell therapy. 

Not only is a healthy lifestyle good for your heart and brain, but it is also great for your joints.

I wish you the best of health!

Steven Masley, MD, FAHA, FACN, CNS

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