What is "PRP" and How Does it Work - Will it Help Me?

One exciting approach to wound healing, variously described as "regenerative medicine" or "tissue engineering" has been the use of platelet rich plasma (PRP) either alone or in conjunction with stem cells.

PRP got recent notoriety when it was mentioned that Hines Ward, the Pittsburgh Steeler's star wide receiver had received this treatment for an injury prior to the Super Bowl.

As it turns out, PRP has been used for quite some time now, particularly at our center, to help accelerate the healing of conditions such as tendonitis, ligament strains, muscle strains, arthritis, synovitis (inflammation inside the joint), and cartilage defects.

Platelet rich plasma is employed as a matrix graft, often referred to as an autologous tissue graft. This platelet-rich plasma (PRP) matrix is defined as a "tissue graft incorporating autologous growth factors and/or autologous undifferentiated cells in a cellular matrix where design depends on the receptor site and tissue of regeneration." (Crane D, Everts PAM. Practical Pain Management. 2008; January/February: 12- 26) 2008)

The reason PRP is so useful is that platelets, which are a normal blood cell, contain multiple growth factors that stimulate tissue growth. In particular, PRP stimulates the growth of collagen which is the main component of connective tissue such as tendons and cartilage. These factors include transforming growth factor-Β (TGF-B), fibroblast growth factor, platelet-derived growth factor, epidermal growth factor, connective tissue growth factor, and vascular endothelial growth factor.

These growth factors recruit undifferentiated cells to the site of injury and stimulate their growth. Another constituent of platelets, stromal cell derived factor I alpha causes newly recruited cells to adhere to the area.

In addition, when used with stem cells harvested from the patient's bone marrow, PRP "fires off" the stem cells to multiply quickly. This inflammatory response is what drives healing.

To use an analogy, PRP- particularly when used in conjunction with stem cells- sends the healing process into "warp drive."

PRP needs to be prepared in a way to ensure a maximal amount of platelets along with a high concentration of growth factors. Obviously, the more growth factors that can be delivered to the site of injury, the more likely tissue healing takes place.

This regenerative approach is diametrically opposite to the traditional method of healing tissue injuries which has been to use non-steroidal-anti-inflammatory drugs as well as steroid injections, which, while reducing inflammation, also markedly impede the healing process.

PRP is often used in conjunction with percutaneous tenotomy. This is a procedure where there is purposeful needle irritation of the affected area using ultrasound guidance after which PRP is then slowly injected into the site.

The use of diagnostic ultrasound has revolutionized the field of musculoskeletal medicine in allowing tissue healing procedures like tenotomy which often prevent the need for open surgical procedures with their attendant morbidity and mortality. In the successful use of PRP and/or stem cells in tissue engineering, is imperative that diagnostic ultrasound be used to guide the "needling" as well as the placement of the PRP.

The PRP is prepared by drawing 20 cc's of whole blood from the patient and then spinning the blood in a special centrifuge that layers out the platelets. This 20 cc's of whole blood generally yields about 2-10 cc's of platelet rich plasma.

Contraindications to the administration of PRP include platelet dysfunction, low platelet count, infection, anemia.

The average number of treatments required is two to three separated by four to eight week intervals. The need for another treatment can be determined by using Doppler ultrasound to see if the area remains inflamed (good) or has gone "cold" (bad).

Prior to a PRP procedure, a patient needs to hold their non-steroidal anti-inflammatory drugs for at least 3-4 days. They may resume them one week after. Also, patients with rheumatoid arthritis should hold their methotrexate for at least one week before and one week after the procedure. Patients on biologic medicines may need to hold their medicines longer, particularly when it comes to adalimumab (Humira), and infliximab (Remicade) because of the long half life of these drugs.

Following the procedure, patients must rest the affected area to prevent leakage of the PRP from the site.

Pain at the injection site is common for a 1-2 day period following the procedure.

For more information on platelet rich plasma (PRP) and stem cells, call the Arthritis Treatment Center at (301) 694-5800

Nathan Wei, MD, FACP, FACR is a nationally known board-certified rheumatologist with extensive experience in the use of platelet-rich plasma and stem cells. For more information: Arthritis Treatment and Arthritis Treatment Center

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