What is arthritis, and what can you do about it?
Arthritis is the process of joint damage that can lead to swelling, pain, crunching, grinding, and stiffness. Another name for this process is Degenerative Joint Disease. The term “arthritis” includes problems with all the structures in the joint including damage to the cartilage, swelling of the synovium, tears of the meniscus or labrum, and excessive fluid production.
Are there different kinds of arthitis?
Yes, there are many types of arthritis. Some of these include osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, septic arthritis, and psoriatic arthritis. But no matter what the cause, arthritis leads to inflammation with pain and stiffness.
And despite many different causes, the symptoms and treatment are often the same. Pain, swelling, and stiffness are the primary symptoms of arthritis. Any joint in the body may be affected by the disease, but it is particularly common in the knee, hip, shoulder, hands, and feet.
What are the signs of arthritis?
The most common symptoms of arthritis are:
- pain
- swelling
- stiffness
- difficulty moving a joint
- crunching of grinding with movement
- angulation, like bowing of the knees
Do I need X-rays or an MRI for arthritis?
Yes, a full evaluation should include X-rays for arthritis. Advanced studies like an MRI or CT scan may be needed sometimes. But usually, X-ray is the best way to diagnose arthritis. So even if you already had an MRI, we may still need X-rays at our office. And we often require specialized views or angles, so we may need to get additional X-rays during your visit to offer the best care possible.
We do have full X-ray services at the Bone and Joint Specialist office at 152 Linden Drive. So getting X-rays before your appointment is not necessary.
Common signs of arthritis on X-rays and MRIs include loss of joint space, growth of bone spurs (aka osteophytes), and even wearing away of the bone.
An MRI will often show the process of arthritis in greater detail. Common findings include damage to the cartilage, meniscus, and labrum. There may be cysts in the bone or soft tissue, bone edema, or osteophytes. Don’t worry though, despite the seemingly long list of things wrong, these issues all occur as part of the process of arthritis.
Autologous Conditioned Plasma (ACP) is a specialized type of PRP (platelet-rich plasma) used to treat arthritis pain. PRP treatment is a ground-breaking, non-surgical healing treatment that promotes and enhances healing in damaged tissue. Our PRP therapy consists of drawing your blood and using a centrifuge to increase the platelet concentration. This packs in mega doses of your body’s own healing factors which can help improve tissue quality, decrease pain, and improve function.
What makes ACP special?
ACP is also called LP-PRP (Leukocyte Poor PRP). The white cells in your blood can damage cartilage, so they are removed to make LR-PRP. For joints, we want to only inject pure plasma, platelets, growth factors. ACP has been shown to be much more effective for treating problems inside of joints when compared to other kinds of PRP preparations.
How do we get Autologous Conditioned Plasma?
The process begins with a simple blood draw in our office. You do not need to go to the hospital. And you can eat and drink right up to the time of the procedure. In fact, we prefer that you eat and drink normally to stay well hydrated. The syringe with your blood is then placed into a centrifuge where it is spun at high speed to separate the components of your blood into different layers in the same tube. We then draw just the plasma (along with the platelets and growth factors) into a smaller syringe for injection back into your joint.
How does Autologous Conditioned Plasma work?
ACP concentrates your body’s own growth factors, derived from the platelets and plasma. In fact, PRP can contain 1500 protein-based bioactive factors.
Platelets are part of the clot which forms at any injury. And when they clot, they release various growth factors to help start the healing process. By concentrating them we can provide that same healing response to a damaged joint.
These growth factors can help increase collagen production, decrease destructive enzyme activity in the joint, and reduce inflammation.
These growth factors include:
- Platelet derived growth factor (PDGF) - Enhances collagen synthesis, proliferation of bone cells, fibroblast chemotaxis and proliferative activity, macrophage activation
- Transforming growth factor ß (TGF-ß) - Enhances synthesis of type I collagen, promotes angiogenesis, stimulates chemotaxis of immune cells, inhibits osteoclast formation and bone resorption
- Vascular endothelial growth factor (VEGF) - Stimulates angiogenesis, migration and mitosis of endothelial cells, increases permeability of the vessels, stimulates chemotaxis of macrophages and neutrophils
- Epidermal growth factor (EGF) - Stimulates cellular proliferation, differentiation of epithelial cells, promotes cytokine secretion by mesenchymal and epithelial cells
- Insulin-like growth factor (IGF) - Promotes cell growth, differentiation, recruitment in bone, blood vessel, skin and other tissues, stimulates collagen synthesis together with PDGF
- Fibroblast growth factor (FGF) - Promotes proliferation of mesenchymal cells, chondrocytes and osteoblasts, stimulates the growth and differentiation of chondrocytes and osteoblasts
What does ACP treat?
ACP is generally used to treat arthritis of the joints. It can help provide a last effort to avoid joint replacement. It can also be used to relieve pain from arthritis for patients who are not candidates for joint replacement, or in people who do not want to have a joint replacement.
Is ACP covered by insurance?
Unfortunately, most private insurers and Medicare do not cover any form of PRP. But Worker’s Comp insurance frequently does. For all other insurers this is an out-of-pocket treatment for patients. We are always conscious of the cost of care to our patients, so we offer this treatment for around $500 instead of thousands like you may see elsewhere.
Surgeons Providing PRP Injections
PRP – platelet rich plasma – is a special preparation of your own blood used to treat soft tissue injuries. A special centrifuge allows us to extract the plasma with its platelets and growth factors from your own blood. For injuries to muscles, tendons, and ligaments, we also include concentrated white blood cells to promote healing, reduce pain, and improve function.
Many famous athletes — golfer Tiger Woods, tennis star Rafael Nadal, and several others — have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition.
What makes LR-PRP special?
For soft tissue injuries and tendinitis, we use LR-PRP, meaning Leukocyte Rich PRP. Leukocytes are white blood cells, and seem to help promote healing of the soft tissues when concentrated and injected as part of a PRP preparation.
How do we get PRP?
The process begins with a simple blood draw in our office. You do not need to go to the hospital or fast before the procedure. In fact, we prefer that you eat and drink normally to stay well hydrated. The syringe with your blood is then placed into a centrifuge where it is spun at high speed to separate the different components of your blood into different layers in the same tube. The specialized centrifuge then uses photon cytometry to selectively remove the plasma, platelets, and white cells from this syringe and collect them for re-injection into the damaged tissue.
How does it work?
PRP concentrates your body’s own growth factors, derived from the platelets and plasma. In fact, PRP can contain 1500 protein-based bioactive factors.
Platelets are part of the clot which forms at any injury. And when they clot, they release various growth factors to help start the healing process. By concentrating them we can provide that same healing response to a damaged joint.
The white cells in LR-PRP also seem to play a beneficial role in processing the injured tissue and speeding healing.
Growth factors in PRP can help increase collagen production, decrease destructive enzyme activity in the joint, and reduce inflammation.
These growth factors include:
- Platelet derived growth factor (PDGF) - Enhances collagen synthesis, proliferation of bone cells, fibroblast chemotaxis and proliferative activity, macrophage activation
- Transforming growth factor ß (TGF-ß) - Enhances synthesis of type I collagen, promotes angiogenesis, stimulates chemotaxis of immune cells, inhibits osteoclast formation and bone resorption
- Vascular endothelial growth factor (VEGF) - Stimulates angiogenesis, migration and mitosis of endothelial cells, increases permeability of the vessels, stimulates chemotaxis of macrophages and neutrophils
- Epidermal growth factor (EGF) - Stimulates cellular proliferation, differentiation of epithelial cells, promotes cytokine secretion by mesenchymal and epithelial cells
- Insulin-like growth factor (IGF) - Promotes cell growth, differentiation, recruitment in bone, blood vessel, skin and other tissues, stimulates collagen synthesis together with PDGF
- Fibroblast growth factor (FGF) - Promotes proliferation of mesenchymal cells, chondrocytes and osteoblasts, stimulates the growth and differentiation of chondrocytes and osteoblasts
What does PRP treat?
LR-PRP is generally used to treat both acute and chronic injuries to tendons, ligaments, and muscles. Some of the most common applications include
- Tennis Elbow
- Golfer’s Elbow
- Patellar Tendonitis
- Achilles Tendonitis
- Muscle Tears
Typically, we use PRP as a final treatment option for these conditions before attempting surgery. But because it is usually an out-of-pocket expense, not everyone is willing to try it. But if you are not a candidate for surgery, and have had no luck with other treatments, it may be one additional option.
Like any treatment for these conditions, it doesn’t work for everybody. And because it works by stimulating your own healing mechanisms, it takes 3-6 weeks to see improvement, and up to a few months for maximum benefit.
Generally, we see little benefit to adding PRP at the time of surgery.
Is it covered by insurance?
Unfortunately, most private insurers and Medicare do not cover any form of PRP. But Worker’s Comp insurance frequently does. For all other insurers this is an out-of-pocket treatment for patients. We are always conscious of the cost of care to our patients which is why we charge far less than other providers closer to the big cities. While we can’t provide specific numbers online, our rates are usually a fraction of what we’ve seen other physicians charge.
Surgeons Providing PRP Injections
Steroid injections are a mainstay of orthopedic management.
They can be used to treat pain from arthritis, tendonitis, bursitis, and many other problems. Your surgeon may recommend a steroid injection as the intitial treatment for many of these conditions.
Aren’t steroid injections just a temporary “band-aid”?
While steroid injections may provide temporary relief for some problems, they may allow for a cure in other situations. Steroids are a strong anti-inflammatory medication. And many orthopedic problems come from inflammation that has outlived its original purpose. So sometimes we have to break that cycle of inflammation by chemical means, such as a steroid injection.
Other times, temporary relief from steroids can allow for the time needed for other treatments to work their magic. This is why steroid injections can often improve the results from physical therapy. By providing temporary relief of inflammation, we allow the therapy to progress without any thing holding it back.
How often can I get a steroid injection?
Steroid injections can lead to problems if used to often. In general, it is safe to provide asteroid injection once every three months.
Are steroids bad for my joints?
Steroids can harm cartilage and tendons if injections are performed at high doses or if given too frequently. But given as a single dose they rarely cause any problems.
What are the alternatives to steroid injections?
Steroids are the most commonly used injections. But there are alternatives. Toradol is a strong NSAID that can be given via injection. Platelet-rich plasma is another injectable treatment derived from your own blood that can help your body heal itself. And viscosupplementation is a way restoring the natural lubrication for arthritic joints.
What is Durolane?
Durolane is a synthetic form of the natural hyaluronic acid that your body uses to lubricate your joints. Hyaluronic acid is a molecule found naturally throughout the human body. It is an important component of joint fluid, called synovial fluid, which provides lubrication and cushioning for normal, healthy knees.
What is Durolane used for?
Like other synthetic hyaluronic acids, such as Gel One TM, Durolane is used to reduce pain and improve the function of knees with arthritis. Hyaluronic acid injections are often referred to as viscosupplementation, joint fluid replacement, or joint lubrication injections. Some people still refer to them as “chicken comb” injections because the original brands were derived from chicken combs, although Durolane is not derived from any animal sources.
How does Durolane work?
When you have osteoarthritis of the knee, the hyaluronic acid breaks down and becomes diluted, reducing its natural elastic properties, which can further degrade cartilage tissue and cause increased joint pain. The hyaluronic acid in Durolane has the same composition as the natural hyaluronic acid your body produces, but it’s in a highly concentrated formulation that’s been uniquely stabilized to help resist the degradation caused by osteoarthritis. DUROLANE increases the level of healthy hyaluronic acid in the affected joint.
How is Durolane administered?
Durolane is given as a single injection into the knee joint. Ultrasound can be used to assure proper placement of the injection into the knee joint.
Who is a candidate for Durolane?
Durolane is approved for people with knee arthritis. It is not approved for use in other joints. It can be administered in arthritic hips and shoulders but this is considered an off-label application and insurance usually will not pay for the cost of the injection in these cases. People with early arthritis tend to respond better to Durolane. Medications like Durolane can be administered as often as every six months, although they may give relief for longer periods of time.
Is this a new product?
Although this may be the first time you are hearing about it, these kinds of medications have been used for decades. Durolane has been on the market since 2001.
What is Gel-One?
Gel-One Hyaluronate is an injectable “joint fluid replacement” gel. It is approved for the treatment of osteoarthritis (OA) of the knee that does not respond to other conservative treatments. It is the first low-volume viscosupplement available in a single-injection formula.
Unlike other viscosupplement treatments, highly purified Gel-One Hyaluronate requires only one injection for months of pain relief. It is a safe and effective treatment of knee arthritis pain. And even better, it has no allergic or inflammatory side effects.
What Is Gel-One used for?
Gel-One is a single-injection treatment for pain from knee arthritis. It is frequently used after failure of other conservative methods, such as NSADIS, physical therapy, or steroid injections.
What Is hyaluronate?
Hyaluronate is a supplement for the joint fluid. Hyaluronic acid is a protein in normal joint fluid that helps to cushion and lubricate the joint. But when you have arthritis, the natural hyaluronic acid becomes damaged and less effective. Gel-One and other hyaluronate products can be used to help restore the cushioning and lubrication provided by natural hyaluronic acid.
Is Gel-One covered by insurance?
When used for arthritis of the knee, Gel-One may be covered by insurance. Some insurances do not cover Gel-One but will cover other hyaluronate injections. Unfortunately, hyaluronate injection, including Gel-One are not covered for use in other joints such as hips or shoulders.
Some insurance companies allow us to provide this injection for your arthritic knee on the day your doctor orders it. But other insurances require pre-authorization – in that case we handle all the paperwork for you but will have to set up a second appointment about a week later for the injection.
When does it start working? How long does it last?
Gel-One takes longer to begin working that standard steroid injections. You may start to see benefits as early as three weeks after injection. And it can last for weeks to months. It can be given every six months if needed but many patients see benefits longer than that.
Medical problems like vascular disease and diabetes also play an important role in the success of any joint replacement and must be evaluated on an individual basis.
How can arthritis be treated?
The most important thing to us is that we treat YOU and not just your X-Rays. So we make sure to help you choose the treatment options that best fit your needs. We take into account your goals, pain, function, and lifestyle to help select the right care for you.
Treatment options for arthritis include:
- Physical Therapy and Occupational Therapy
- Bracing
- Steroid Injections
- Anti-Inflammatory Oral Medications or Injections
- Viscosupplementation
- Platelet-Rich Plasma Injections
- Arthroscopic Debridement
- Joint Replacement including Outpatient Joint Replacement
Services Related To Arthritis
- Outpatient Joint Replacement
- Anterior Hip Replacement
- Hip Replacement
- Knee Replacement
- Shoulder Replacement
- Reverse Total Shoulder Replacement
- Elbow, Wrist, and Hand Joint Replacements
- ACP™ Autologous Conditioned Plasma
- Gel One ™
- Viscosupplementation
- FlowerAmnioFlow™
- Oxford™ Partial Knee Replacement
- Steroid Injections
- Physical Therapy
