Results from an ongoing study presented at the AAOS Annual Meeting indicate that platelet rich plasma (PRP) injections may be an effective nonsurgical treatment option for carpometacarpal (CMC) joint osteoarthritis (OA).

The study was designed to compare the efficacy of PRP injections vs. the standard treatment of corticosteroid injection(s) for pain relief, functional return, and improved range of motion in patients with CMC joint OA. The authors hypothesized that “PRP might be a bioactive substance of potential merit in this regard.” Prospective study
At the time of analysis, 28 adult patients with Eaton stage II or stage III CMC joint OA were enrolled in the study. Patients with Eaton stage I or IV OA; rheumatoid arthritis; septic, psoriatic, or gouty arthritis; thumb joint effusion; DeQuervain disease; history of CMC joint surgical reconstruction; or terminal or serious, uncontrolled associated medical conditions were excluded. The PRP cohort consisted of 20 patients (3 males, 17 females; mean age: 58 years), 14 of whom had prior CMC joint corticosteroid injection(s) without clinical benefit. Eighteen patients (90 percent) had bilateral CMC OA. The steroid cohort consisted of 8 patients (3 males, 5 females; mean age: 60 years), none of whom had received any prior injection treatment. Five (62 percent) patients had bilateral CMC OA. The patients in the PRP cohort received two intra-articular CMC joint PRP injections, administered 1 week apart. Patients in the steroid cohort received one intra-articular CMC joint corticosteroid injection. All injections were administered under fluoroscopic guidance. All patients were instructed to wear a thumb splint while sleeping for 1 month and to refrain from taking over-the-counter pain medications for 6 months after receiving injection(s). The researchers compared results for the two cohorts at baseline and at 1-, 2-, 3-, and 6-month follow-up using the following outcome measures:

• visual analog score (VAS)
• activities of daily living function questionnaire
• metacarpophalangeal (MP) thumb flexion
• interphalangeal (IP) thumb flexion
• grip, key, and pinch strengths

The primary outcome measure was VAS score at 6 months. Adverse events were assessed after injection(s) and at each study visit.

At baseline, VAS pain scores, function scores, and key and pinch strengths were similar between the two cohorts. Duration of symptoms was significantly longer in the PRP patients. Steroid patients had reduced MP and IP joint flexion, but higher grip strength. VAS pain scores were significantly lower in the PRP patients at each follow-up visit (Fig. 1). At 6-month follow-up, patients in the PRP group showed a 90 percent decrease in pain from baseline, while the steroid group showed an 8 percent increase. The PRP group also had significantly better function scores (P < 0.001) and increased MP joint flexion, grip strength, and pinch strength at 6 months, compared to the steroid group. No differences in IP joint flexion were found between the groups, and no serious adverse events occurred in any of the patients.  Fig. 1 VAS scores at 6-month follow-up.
Courtesy of Marie Badalamente, PhD

Based on the results, the authors conclude that PRP injections may be a useful treatment option for CPC joint OA.

“Our findings showed that PRP injections were associated with pain relief; increased function in activities of daily living; increased grip, key, and pinch strengths; and increased MP joint flexion, compared to corticosteroid injection,” said coauthor Marie Badalamente, PhD. “The regenerative action of growth factors, contained in platelet alpha granules, upon articular chondrocytes may be a potential mechanism for these positive effects.” Dr. Badalamente's coauthor of “A Comparative Study of Platelet Rich Plasma (PRP) vs. Corticosteroid Injections in Patients with Carpometacarpal Joint Osteoarthritis” is Samantha Muhlrad, MD. Details of the authors' disclosure as submitted to the Orthopaedic Disclosure Program can be found in the Final Program; the most current disclosure information may be accessed electronically at www.aaos.org/disclosure Maureen Leahy is assistant managing editor of AAOS Now. She can be reached at leahy@aaos.org

Bottom Line

• The study compared the efficacy of PRP injections vs. corticosteroid injection(s) for pain relief, functional return, and improved range of motion in patients with CMC joint OA.
• The primary outcome measure was VAS scores at 6-month follow-up.
• At that time, patients in the PRP group showed a 90 percent decrease in pain from baseline; patients in the steroid group showed an 8 percent increase in pain from baseline.
• The researchers conclude that, compared to corticosteroid injection, PRP injections show merit for treatment of CMC joint OA.