PRP Injections for Thumb CMC Osteoarthritis
The 2019 ACR/Arthritis Foundation guideline explicitly recommends AGAINST platelet-rich plasma (PRP) injections for osteoarthritis, including thumb CMC joint OA, based on insufficient evidence of benefit. 1
Guideline-Based Recommendation
The most authoritative and recent guideline addressing this question is the 2019 American College of Rheumatology/Arthritis Foundation guideline for management of hand, hip, and knee osteoarthritis. 1
- PRP injections are specifically listed among therapies recommended AGAINST for osteoarthritis management. 1
- The guideline development process involved systematic literature review using GRADE methodology and consensus from a multidisciplinary voting panel including rheumatologists, therapists, and patients. 1
- No recommendations were made FOR PRP in any osteoarthritis location, including the thumb CMC joint. 1
What IS Recommended for Thumb CMC OA
Instead of PRP, the ACR/Arthritis Foundation guideline provides clear evidence-based alternatives:
Strong recommendations (first-line):
- Hand orthoses (neoprene or rigid) specifically for first CMC joint OA 1
Conditional recommendations (second-line):
- Kinesiotaping for first CMC OA 1
- Intraarticular corticosteroid injections for hand OA (including CMC joint) 1
- Topical NSAIDs for hand OA 1
Evidence Gap for PRP in Thumb CMC OA
- The available research on PRP focuses predominantly on knee osteoarthritis, with some evidence for hip, ankle, and temporomandibular joint OA. 2
- No high-quality randomized controlled trials specifically evaluate PRP for thumb CMC osteoarthritis. 3
- A 2015 systematic review of conservative thumb base OA treatments found no studies examining PRP injections for this indication. 3
- While PRP shows some efficacy for knee OA in research studies 2, 4, 5, this evidence cannot be extrapolated to the thumb CMC joint due to different biomechanics, cartilage characteristics, and disease patterns.
Clinical Pitfalls to Avoid
- Do not offer PRP as an evidence-based treatment for thumb CMC OA - it contradicts current guideline recommendations and lacks specific supporting data. 1
- Patients may request PRP based on marketing or anecdotal reports from knee OA treatment - explain that evidence is joint-specific and guidelines recommend against it. 1
- The EULAR guidelines note that even the optimal surgical procedure for thumb base OA remains undetermined, highlighting how much more uncertain experimental treatments like PRP are for this indication. 1, 6
Treatment Algorithm for Thumb CMC OA
First-line: Hand orthoses (strongly recommended) plus patient education and activity modification 1, 6
Second-line: Add topical NSAIDs, oral analgesics, and/or intraarticular corticosteroid injections for painful flares 1, 6
Third-line: Surgical options (trapeziectomy, arthrodesis, arthroplasty) when conservative treatments fail and marked pain/disability persists 6, 7
Not recommended: PRP injections 1