Is platelet-rich plasma (PRP) a valid treatment for severe arthritis of the thumb carpometacarpal joint?

Platelet-Rich Plasma for Severe Thumb Carpometacarpal Joint Arthritis

Based on current evidence, platelet-rich plasma (PRP) cannot be recommended as a valid treatment for severe arthritis of the thumb carpometacarpal joint due to inconsistent research findings and lack of standardization in preparation methods. 1

Current Evidence and Guidelines

• The 2020 VA/DoD Clinical Practice Guideline for osteoarthritis evaluated PRP for knee and hip OA and found mixed results with some studies showing no benefit while others showed small benefits, leading to an inability to recommend for or against its use 1
• The International Society on Thrombosis and Haemostasis (ISTH) notes that the field of PRP therapy is plagued with poor standardization and variability in preparation methods, terminology, purity, content, and quality of products utilized 1
• PRP's mechanism of action involves delivering multiple growth factors that promote local angiogenesis, stem cell homing, cell migration, proliferation, and differentiation, potentially aiding tissue regeneration 1
• Despite its increasing popularity in orthopedic applications, the ISTH emphasizes that clinical trials have been conducted without clear definition or quantification of PRP biological properties, leading to varying efficacies and outcomes 1

Preparation Variability and Impact on Efficacy

• Multiple commercial PRP preparation devices exist, resulting in significant variation in product content and biological properties 1
• Differences in preparation techniques (including g-force, centrifugation time, activation method) result in significant differences in platelet yields, concentration, purity, viability, and activation status, affecting clinical efficacy 1
• PRP products have varying concentrations of blood cells (platelets, leukocytes, red blood cells), plasma, and fibrinogen, impacting their potential effectiveness 1
• The ISTH recommends standardization of methods for generating platelet-rich preparations and evidence-based guidelines for future clinical trials 1

Specific Evidence for Thumb Carpometacarpal Joint

• Limited research exists specifically for PRP use in thumb carpometacarpal joint arthritis compared to knee and hip OA 1
• A 2023 retrospective study of 19 patients who received PRP for thumb CMC osteoarthritis reported moderate or excellent symptom improvement in 68.8% of injected joints with a mean benefit duration of 15.6 months 2
• A 2023 systematic review and meta-analysis on autologous substances (including PRP) for trapeziometacarpal OA showed promising results with mean pain reduction of 2.4-3 points on visual analog scale and improvement in hand function 3
• Case reports have documented potential benefits, including one of a professional pianist who returned to previous performance level after PRP treatment for thumb CMC OA 4

Treatment Algorithm for Thumb Carpometacarpal Joint Arthritis

• First-line treatment should include conservative management such as activity modification, education, heat application, topical NSAIDs, oral analgesics, and exercise regimens for range of motion and strengthening 5
• Second-line options include corticosteroid injections for painful flares 5
• Third-line surgical options should be considered when patients have marked pain and/or disability after conservative treatments have failed 5
• PRP should not be routinely recommended due to inconsistent evidence and lack of standardization, though it may be considered in research settings or as part of clinical trials 1

Ongoing Research

• A 2024 randomized controlled trial protocol aims to evaluate high-concentration PRP versus placebo for thumb base osteoarthritis, which may provide more definitive evidence in the future 6
• This study will assess pain relief and functional improvement at 3,6, and 12 months post-injection with a planned sample size of 90 patients 6

Conclusion and Recommendations

• Current guidelines cannot recommend for or against PRP for osteoarthritis treatment, including thumb carpometacarpal joint arthritis 1
• If considering PRP, patients should be informed about the limited and inconsistent evidence, variability in preparation methods, and potential for varying outcomes 1
• Traditional treatment approaches with stronger evidence should be prioritized before considering experimental treatments like PRP 5