Platelet Rich Therapy

I'm pleased to be able to let you know that I can now offer platelet rich plasma injections for patients with tendon or joint pain.

These injections are a highly effective and natural way of healing acute or chronic tendon, muscle and ligament injury.

The procedure involves taking a small sample of the patients own blood, spinning it down in a centrifuge inside a special syringe and then using a separate syringe to inject the plasma, platelet and buffy coat mixture back into the patient.

There's an increasing amount of research evidence available and you can read more about platelet rich plasma injections here.

Doxycycline treatment for osteoarthritis of the hip or OA knee

 

Several patients have asked me recently about using Doxycycline for osteoarthritis treatment. One man in his fifties swore that his knee felt better when he had been taking doxycycline for rosacea. I'd also read a few press reports on the topic.

 

But what's the evidence? None at all according to a new Cochrane Review of the question.

 

The initial interest in doxycycline was triggered by pre-clinical trial data suggesting that doxycycline might act as a disease-modifying agent for the treatment of osteoarthritis, with the potential to slow cartilage degeneration.

 

The Cochrane reviewers found only one randomised controlled trial that compared doxycycline with placebo in 431 obese women. After 30 months of treatment, clinical outcomes were similar between the two treatment groups, with clinically insignificant changes in both pain and function in the two groups. 

Significantly higher numbers of patients withdrew from the doxycycline group compared with placebo due to adverse events - some of them serious.

 

The researchers concluded that the symptomatic benefit of doxycycline for osteoarthritis is minimal to non-existent. There might be a very small benefit in terms of joint space narrowing but this is of questionable clinical relevance and outweighed by safety problems.

 

Doxycycline should not be recommended for the treatment of osteoarthritis of the knee or hip.

 

 

 

Frozen Shoulder Pain

Frozen shoulder causes pain and stiffness which many patients find very limiting for day to day function.

The video clip below shows what happens inside a shoulder and explains the reason why movement is limited and painful.

Click on the video to play:

Cardiovascular Risk for Rheumatoid Patients

It’s well established now, but still not widely known, that the cardiovascular risks for patients with RA are similar to that in diabetes mellitus.

Atherosclerosis, stroke and heart attack account for a 1.5 to 2.0 fold increased risk of death in these people.

Those with RA are likely to die ten years earlier than the rest of the population when all other factors are taken into account …. !

Makes you think, doesn’t it?

I for one will be checking BP and lipid profiles in all my RA patients from now on. Rheumatologists suggest that many should be on statin therapy and that the threshold for starting treatment (and end point targets) should be the same as for patients with diabetes

Glucosamine .... would you take it for your knee pain?

I've been interested for ages in the concept of dietary supplements (or what the Americans call "Nutraceuticals" ) in the treatment of joint pains, osteoarthritis in particular.
I've got several friends who are vets - all of whom are very familiar with the benefits of things like oral fish oils, oral hyaluronic acid etc for large animals - but we humans seem much more reticent about the whole issue. Glucosamine is the only one of the many available OTC compounds that has broken through into GP prescribing so far, but does it work?
A group of epidemiologists from Aberdeen have just published evidence suggesting some improvement in knee osteoarthritis symptoms with glucosamine sulphate - but the results are very modest (on paper at least)!.
They looked at randomised controlled trials that lasted longer than 12 months and tried to select only high quality studies. They found that the research available reported inconsistent conclusions with, at best, modest effects on reported pain and function. These outcome benefits were modest - and although they were present and measurable in the studies, it was unclear if these outcomes correllated with any perceived clinical benefits for the patient.
In terms of x-ray changes the effects on joint space size were more consistent, but small and of uncertain clinical significance. Previous studies have also highlighted problems with measurement errors when doing this kind of x-ray analysis.

Two studies found a reduction in the need for a knee replacement from 14.5% to 6.3% at eight years follow up but both of these were directly funded by the company who manufacture one of the main glucosamine products.

Even more interestingly, many glucosamine products combine it with chondroitin and in this research the evidence for the effectiveness of chondroitin was very inconsistent, raising doubts that it is an active product in the mixture. Beyond that, no study showed any benefit at all for glucosamine hydrochloride - leading some commenetators to suggest that it is the "sulphate" part of the molecule and not the "glucosamine" which is the active ingredient. This is possibly stating things a bit too strongly .... !

Dr Corrinda Black, the lead researcher and a consultant in public health in the University of Aberdeen warned that none of the evidence came from UK trials. She said: 'in the absence of good UK data about current referral practice, management and surgical rate, caution should be exercised in generalising these data to the UK health-care setting.'

So where does that leave us out there in GP world?

My own practice is that I dont prescribe glucosamine to patients but I don't actively discourage them if they want to try it for themselves. The main issues seem to be the wide discrepancy in costs, the duration of treatment before benefit is likely, and the vast range of different products with different strengths and different combinations.

What do you do in your practice?  Leave a comment ....

Signing up for updates

I try to publish new items on the site more than once a week. These might be a new short video, a review article, some breaking news related to joint and muscle pain or just a brief overview piece with a link to another good resource that you might find helpful. The content changes very frequently.

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Hope that helps

Gordon

Sports Injury Quiz

Want to test your knowledge of sports injury?

Take this simple video quiz. Just use the pause button to stop the video after each question, think about your answer and then click play .... or of course you could just cheat and let it play all the way through :-)