PRP Vs. Corticosteroids

First, Do No Harm: Morality Issues Regarding Corticosteroids

Primum non nocere is a Latin phrase meaning “first, do no harm.” It is a reminder to physicians that their first priority is to protect their patients. However, this rule can get pushed to the side when the complicated issue of health insurance comes into play. Despite significant and mounting evidence that corticosteroids last only a short time and can actually worsen osteoarthritis, insurance-covered corticosteroid injections are sometimes favored over the less risky and better long-term pain reducing PRP option.

About Corticosteroids

Corticosteroids (CS) are man-made drugs designed to target and mitigate inflammation in a specific area of the body by reducing the activity level of the immune system (1). Corticosteroids are administered to the body in various ways, including joint injections, eye drops, lotions applied to the skin, and can be used to treat a number of conditions, including, but not limited to, osteoarthritis (1).

About PRP

Platelet-Rich Plasma (PRP) or platelet lysate treatments are non-invasive medical procedures designed to treat injuries occurring in the body’s joints, tendons, muscles, or ligaments (2). PRP treatments use a patient’s own blood components to help reduce pain (2). Regenexx’s SCP (super concentrated plasma) procedures use only the patient’s own blood, creating PRP that is more concentrated and purer than PRP created by the automated machines used at most “so called” regenerative medicine clinics. Regenexx doctors then use precise image guidance to inject the PRP where it is needed (2). For example, in order to treat osteoarthritis in the knee, a Regenexx physician would use fluoroscopy (a sort of real-time video made from x-rays) and/or ultrasound imaging to precisely inject the patient’s PRP into the knee, stimulating the body’s natural healing process to work at a quicker rate of speed than would occur without the treatment (2).

Clinical Study: Corticosteroids vs. PRP for the Knee Joint

A recent clinical study put corticosteroids and PRP head-to-head to determine each procedure’s effectiveness in treating knee osteoarthritis. This study was designed to compare the efficacy of a single intra-articular dose of PRP compared to corticosteroids for the treatment of moderate knee osteoarthritis.

A group of patients suffering from osteoarthritis in the knee were randomized into the PRP treatment group and the corticosteroid (CS) group, and each patient’s progress was monitored upon treatment, and after treatment at one week, five weeks, fifteen weeks, thirty weeks, and one year (3).

Pain was measured by a Visual Analog Scale (VAS). The patient places a mark at a point on the line corresponding to the patient’s rating of pain intensity, with “no pain” on the far left and “the most intense pain imaginable” on the far right (5).

Both treatments were shown to be effective at reducing pain, but the participants in the PRP group reported more sustained, long-lasting pain relief (3).

The most surprising effect observed was that PRP induced pain relief just as fast as CS. In fact, a significant reduction of pain from baseline for both groups was found 1 week after treatment. (3)

The not so surprising finding in the study was that the pharmacological effect of CS seemed to disappear 15 weeks after receiving treatment, as all scores tended to worsen after this period. For instance, pain in the CS group improved rapidly but, in general, worsened after 15 weeks of treatment, and the pain steadily increased in each follow-up visit. At the same time, the PRP group resulted in a sustained improvement in pain relief up to 30 weeks, showing a small increase in pain in the 1-year evaluation follow-up (3)

Corticosteroid Complications

What is not shown in the study above is the harm that corticosteroids can do to osteoarthritis patients. We need to turn to a different clinical study for more information on the harmful effects of corticosteroids.

As shown in the chart above, in a study published in the journal Radiology and reported on CNN, researchers observed that corticosteroid injections accelerate patients’ osteoarthritis progression, subchondral insufficiency fracture, osteonecrosis, and rapid joint destruction with bone loss (6).  

Please see another of our blogs for more on this

Additionally, an array of negative side effects can occur after corticosteroid treatments, including osteoporosis, worsening of diabetes, worsening of high blood pressure, increased risk of sepsis, increased risk of blood clots, muscle weakness, and water retention (1, 4).

To be fair, the side effects listed above generally do not occur when occasional steroid injections are given for arthritis, tendonitis or bursitis. However, if steroid use involves high doses and is prolonged (for a few months to several years), an increase in the number of side effects might occur.

Morality Issues with Corticosteroids

Despite significant and mounting evidence that corticosteroids last only a short time and can actually worsen osteoarthritis, insurance-covered corticosteroid injections are sometimes favored over the less risky and better long-term pain reducing PRP option. Does this circumstance disregard primum non nocere?

Before you try a first or 2nd corticosteroid injection, and especially before you consider invasive joint replacement surgery, please see if surgery-free PRP and/or other Regenexx orthobiologic regenerative procedures might be the right step for you.

If you have joint pain and think PRP might help, find out if you’re a candidate today –Tap the “TALK TO AN EXPERT” BUTTON below.

SOURCES:

1. https://my.clevelandclinic.org/health/drugs/4812-corticosteroids
2. https://regenexxpittsburgh.com/platelet-rich-plasma/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353717/
4. The-morality-test-of-platelet-rich-plasma-vs-corticosteroids-for-knee-osteoarthritis
5. https://www.sciencedirect.com/topics/medicine-and-dentistry/visual-analog-scale
6. https://www.cnn.com/2019/10/17/health/steroid-injections-study-trnd/index.html