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INTRO
"Of pain you could ONLY wish one thing:
that it should stop"
George Orwell.
PREPARED AND PRESENTED BY:
Name
Sara Darweesh.
Title
PREPARED AND PRESENTED BY
Product Specialist at Dubimed.
Life Goal
Changing patients' lives.
Lifelong Belief
Deserving life demands adding values and searching
for them around.
Thank you for being a special part in my journey.
Agenda
PRP TECHNIQUE (TROPOCELLS) ROLE IN IMPROVING PATIENTS' QUALITY OF LIFE
1-Osteoarthritis (Definition- Risk Factors- Grades/Stages-Signs and Symptoms) .
2-Osteoarthritis management techniques.
3-The advantages of PRP VS the other techniques.
4-Clinical trails about PRP.
5- Guidelines in osteoarthritis management.
6- (Platelets as miracle)
7-Questions.
8-Let's win the Battle.
OSTEOARTHRITIS
Risk Factors
Defination
Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of your bones wears down over time. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in your hands, knees, hips and spine.
• Older age.
• Sex.
• Obesity.
• Joint injuries/Trauma.
• Repeated stress on the joint/Overuse.
• Genetics.
• Bone deformities.
• Certain metabolic diseases.
Grades/Stages
• Grade 0 (none)
Definite absence of x-ray changes of osteoarthritis.
• Grade 1 (Doubtful)
Doubtful joint space narrowing and possible osteophytic lipping.
• Grade 2 (Minimal)
Definite osteophytes and possible joint space narrowing.
• Grade 3 (Moderate)
Moderate multiple osteophytes, definite narrowing of joint space and some sclerosis and possible deformity of bone ends.
• Grade 4 (Severe)
Large osteophytes, marked narrowing of joint space, severe sclerosis and definite deformity of bone ends.
SIGNS AND SYMPTOMS
Signs And Symptoms
• Pain.
Affected joints might hurt during or after movement.
• Stiffness.
Joint stiffness might be most noticeable upon awakening or after being inactive.
• Tenderness.
Your joint might feel tender when you apply light pressure to or near it.
• Loss of flexibility.
You might not be able to move your joint through its full range of motion.
• Grating sensation.
You might feel a grating sensation when you use the joint, and you might hear popping or crackling.
• Bone spurs.
These extra bits of bone, which feel like hard lumps, can form around the affected joint.
• Swelling.
This might be caused by soft tissue inflammation around the joint.
OSTEOARTHRITIS MANAGEMENT TECHNIQUES
Osteoarthritis Management Techniques.
B-Pharmacological Therapy
D-Replacement Surgery.
c-Intra-articular
Injections.
A- Non pharmacological
interventions.
• Patient education.
• Heat and cold.
• Weight Control.
• Exercise
• Physical therapy
• Supportive devices
• PRP (Platelet-Rich Plasma).
• Sodium hyaluronate (Hyaluronic Acid).
• Corticosteroid.
• Stem Cell (Mesenchymal Stem Cells (MSCs)).
• Prolotherapy.
• Acetaminophen
• Oral NSAIDs
• Topical NSAIDs
• Tramadol
• Duloxetine
• Glucosamine and chondroitin sulfate.
PRP VS the Non pharmacological intervention.
PRP VS THE OTHER MANAGEMENT TECHNEQES
1-Efficacy-wise
Much More effective either in pain relief or in controlling progression Targeting not only the symptoms but also the source.
2-Compliance-wise
Extra Patients' compliance.
3-Guidline-wise
According to all Guidelines Non pharmacological intervention could be effective at grade1, but it has no main role may be supportive role in grade 2 and 3 which are the most common.
PRP VS THE PHARMACOLOGICAL THERAPY
1-Efficacy-wise
Targeting not only the symptoms but also the source.
2-Compliance-wise
Extra Patients' compliance.
3-Safety-wise
All NSAIDs (Nonsteroidal anti-inflammatory drugs) have deleterious effects on blood pressure, edema, and kidney function. And all of them are contraindicated in patients with peptic ulcer and cardiovascular events.
Duloxetine was also associated with significantly more nausea, dry mouth, constipation, fatigue, and decreased appetite
PRP VS THE OTHER INTRA-ARTICULAR INJECTIONS
•Sodium hyaluronate /Hyaluronic Acid (Viscosupplementation).
1-Efficacy-wise
Although it is FDA approved as a treatment for osteoarthritis, there are most of promising clinical trails published at very trusted journals and performed at very reputable universities the main results of them demonstrate that PRP has superior effect when compared with HA and the rest demonstrate comparable outcomes between PRP and HA.
2-Compliance-wise
Almost The same ( Better at PRP because the duration of after-injection is longer with HA).
3-Safety-wise
Synthetically manufactured product not autologous.
May elicit an inflammatory response and possible effusion..
Some have the clinically distinct acute inflammatory side effect (ie, severe acute inflammatory reaction [SAIR] or HA-associated intra-articular pseudosepsis.
CORTICOSTEROID
1-Efficacy-wise
The effect may last, on average, anywhere from 4 to 6 weeks per injection, but the benefit is unlikely to continue beyond that time frame ( Short-term effect).
2-Compliance-wise
PRP is better due to the less number of injections and the wide time interval.
3-Safety-wise
Chondrotoxicity (chondrolysis) is a potential drawback.( The increased usage of corticosteroid injections can lead to cartilage breakdown in a small number of patients).
Rare soft tissue effects, such as skin depigmentation, cutaneous atrophy, and fat necrosis have also been reported in corticosteroid use.
PROLOTHERAPY
1-Efficacy-wise
Prolotherapy has not been researched extensively.
2-Compliance-wise
Very poor due to the severe side effects.
3-Safety-wise
The worst side effect is an infection at the site of an injection.
Another side effect may be temporary swelling or pain where the injection occurred. Immediately following the procedure, the affected joint may feel worse before beginning to feel better.
1-Efficacy-wise
There is a lack of strong clinical trial evidence supporting the use of MSCs in OA management.
2-Compliance-wise
Stem cell harvest is more invasive than the simple blood draw required for PRP.
3-Safety-wise
Stem cells harvest technique could increase the likelihood of infection or complications.
Note: In many cases, PRP and stem cells are injected together because they complement one another and enhance your results.