Why do your joints chronically swell up? Swelling or inflammation is the body’s way to try to heal tissue and bone damage in joints. Back in the 1990s I wrote in my book the Collagen Revolution, that the body’s natural healing response is inflammation. If you stopped the inflammation process you could stop your body’s ability to heal or protect a damaged joint. Therefore you needed inflammation to heal but you needed inflammation to be controlled so that excessive swelling and chronic inflammation did not in of itself cause joint degeneration.
Over the years, our general rule in offering regenerative medicine injections is that we would want patients to discontinue the use of anti-inflammatories while receiving prolotherapy, Platelet Rich Plasma injections or bone marrow stem cell injections. I want to reiterate that this is a general rule about avoiding anti-inflammatories during regenerative medicine injection, but, it is not a 100% rule. As each patient case presents unique challenges, there are times when regenerative medicine injections may be offered when a patient is on anti-inflammatory medications. This may be times during oncological care, when immunosuppressant medications are being used, or when steroid is offered to treat a condition that may be non-related to degenerative joint damage. Sometimes, even when degenerative joint damage is being treated with an anti-inflammatory program.
At this point I want to refer to research which discusses the simultaneous use of anti-inflammatories and regenerative medicine injections.
An April 2017 paper in the The American journal of sports medicine (1) found “PRP can be clinically useful with a corticosteroid as a treatment for tendinopathy.”
A paper in the Journal of orthopaedic research (2) found that “the deleterious effect of Triamcinolone acetonide was prevented by PRP, which can be used as a protective agent for patients receiving local Triamcinolone acetonide injections.”
A 2022 study in the journal New Trends in Medicine Sciences (3) found the combination of intra-articular PRP with steroids resulted in a significantly superior clinical outcome in treating selected patoients with knee osteoarthritis. In this study patients were randomized into 2 study groups. Forty-nine patients (Group 1) received three intra-articular injections of PRP (5mL) and steroid (1 cc – 5 mgr triamcinolone). Forty-nine patients (Group 2) received one intra-articular injection of PRP/steroid (5 mL). All patients were evaluated with the VAS (0-10 pain score) score and the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales before the first treatment, at 2 and 6 months after the first injection. The KOOS Score measures pain, disability, function and quality of life through patient survey.
- Results: The combination of intra-articular PRP with steroids resulted in a significantly superior clinical outcome, with sustained lower VAS and improved KOOS subscales except for KOOS sporting activity (at 2 months), KOOS quality of life (at 2 and 6 months).
PRP and steroid combination demonstrated pain relief for advanced osteoarthritis in short-medium term
A 2020 study (4) found “the intraarticular application of PRP and steroid combination demonstrated pain relief for advanced osteoarthritis in short-medium term. Clinical effect of PRP and steroid combination could allow to increase adherence to physical rehabilitation and delay the need for total knee arthroplasty.
Intra-articular methlyprednisolone injection prior to PRP injection could result in significantly better clinical outcomes
A 2018 study (5) evaluated the clinical outcomes of intra-articular methlyprednisolone injection prior to PRP injection in comparison with single-dose methlyprednisolone and PRP injections alone in patients with knee osteoarthritis. According to this study’s results, intra-articular methlyprednisolone injection prior to PRP injection resulted in significantly better clinical outcomes compared to PRP and intra-articular methlyprednisolone injections alone in patients who had mild to moderate knee osteoarthritis.
The point of this article is to demonstrate that at times the simultaneous use of corticosteroid and regenerative medicine injection may add a benefit to treatment, and, the recent use of anti-inflammatory medication may not have a demonstrable negative impact on regenerative medicine injections.
References
1 Jo CH, Lee SY, Yoon KS, Shin S. Effects of platelet-rich plasma with concomitant use of a corticosteroid on tenocytes from degenerative rotator cuff tears in interleukin 1β–induced tendinopathic conditions. The American Journal of Sports Medicine. 2017 Apr;45(5):1141-50.
2 Muto T, Kokubu T, Mifune Y, Sakata R, Nagura I, Nishimoto H, Harada Y, Nishida K, Kuroda R, Kurosaka M. Platelet‐rich plasma protects rotator cuff‐derived cells from the deleterious effects of triamcinolone acetonide. Journal of Orthopaedic Research. 2013 Jun;31(6):976-82.
3 Turgut MC, Ayas MS, Erhan OK, YILDIRIM ÖS. Multiple Injections of PRP/Steroid Combination Result in Better Clinical Outcames in Advanced Osteoarthritis: A Prospective Randomized Study. New Trends in Medicine Sciences.;3(1):36-42.
4 Turgut MC, Okay E, Tuncer K, Yıldırım ÖS. Clinical outcomes of intraarticular PRP and corticosteroid combination in advanced osteoarthritis. Ann. Clin. Anal. Med. 2020;11:36.
5 Camurcu Y, Sofu H, Ucpunar H, Kockara N, Cobden A, Duman S. Single-dose intra-articular corticosteroid injection prior to platelet-rich plasma injection resulted in better clinical outcomes in patients with knee osteoarthritis: A pilot study. Journal of Back and Musculoskeletal Rehabilitation. 2018 Jan 1;31(4):603-10.