Dear Dr. Roach: My mother is in her mid-60s and was diagnosed with osteoarthritis of the thumb last year. She is in good health. Conventional treatment thus far has consisted of multiple injections of triamcinolone and lidocaine coupled with splinting, as well as six sessions of physical therapy. Medications taken without relief were meloxicam, Limbrel and aspirin. Surgery has been discussed. Mom does not want to have surgery, and has tried the following: curcumin, turmeric, bone broth and 13 sessions of low-level laser therapy.
Now mom is considering therapy with platelet-rich plasma by an orthopedic doctor. The therapy costs $1,200 US and is not covered by insurance. There is a list of supplements to be taken in conjunction with the PRP. The literature distributed by the doctor during his seminar 鈥� which mom dragged me to 鈥� sounds impressive; however, I鈥檓 concerned that Mom could be taking a precarious step with this treatment and procedure. What is your take on PRP for treatment of osteoarthritis?
聽聽 聽
C.D.
More trials and reviews have been published on platelet-rich plasma injections since the last time I commented on it. Obtaining PRP involves drawing the patient鈥檚 own blood and separating out various components of platelets, serum proteins and sometimes white blood cells (there are several protocols). PRP injections continue to show promise in several conditions; but specifically for degenerative arthritis, most studies have shown a benefit.
However, the benefit might not be lasting, with several studies suggesting the benefit will last about one year. Further, PRP may be most useful in younger people with early disease.
The fact that it is not covered by insurance reflects the early stage status of this therapy. The procedure appears safe, and the biggest risk probably is to her pocketbook. Several readers have written to me about their experiences, and most were favourable. I believe that PRP will become a more commonly used therapy, and that U.S. insurance companies eventually will start covering it. However, I personally am fairly conservative when it comes to adopting new treatments, and I would like to see additional studies on the long-term effectiveness and safety of PRP injections before recommending them in general.
Dear Dr. Roach: I am a 33-year-old man. I started feeling twitches in the left side of my chest. My family has a history of high blood pressure. I鈥檓 on medication for it. I had an anxiety attack back in October. An EKG was performed, and my heart rate was normal. Could it have changed?
Anon.
The likelihood that a twitching sensation represents heart disease in a 33-year-old is very, very small. Anxiety attacks certainly can cause a variety of chest symptoms. Still, I think it鈥檚 a good idea to regularly see your doctor who is prescribing the high blood pressure medicine. In my experience, people with anxiety do better with regular checkups. Certainly an EKG may change (even a glass of ice water can make the EKG look different over a few minutes), but the best evaluation remains a concerned provider who will listen to your history, do a thorough exam and perform only the necessary tests.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
