BY TIM FOX

BLOOD PLATELETS, PRODUCED BY BONE MARROW, WORK AS CLOTTING AND HEALING AGENTS.

Image courtesy of Science Photo Library

The platelets in our blood are best known as clotting agents, but they are great healing agents, too. “Platelets don’t just clot. They also help structures to regrow and remodel,” explains Jeremy Hartman, MD, Washington University orthopedics specialist at Barnes-Jewish Hospital.

Hartman and his Washington University orthopedics colleagues make the most of platelets’ healing qualities through platelet-rich plasma therapy. This treatment involves injecting a patient’s own plasma, containing a high concentration of platelets, directly into an area of the body affected by arthritis, such as the knee or hip. To collect the platelets needed for this therapy, Hartman draws blood from the patient, then uses a device called a centrifuge that separates platelets from the other materials in the blood. At the same time, Hartman also uses technology that reduces the number of red and white blood cells in the blood sample, which contribute to inflammation.

Though the treatment itself is relatively simple, the body’s response to the injection is quite complex.

“When you cut yourself, the damaged tissue releases chemical signals that attract platelets in your blood,” says Hartman. “The platelets release granules that contain fibrin, which helps the platelets form a plug at the injury site. Other released granules encourage the growth of new blood vessels, as well as stimulate cell growth, regenerate tissues and more.” A similar process occurs when platelets are used to treat arthritis.

Designed in the early 1980s by otolaryngologists and plastic surgeons to aid postoperative bone growth, platelet-rich plasma therapy was soon being used to treat patients requiring tissue growth or remodeling, including hair growth.

“The best candidates for this procedure are people who have arthritis, especially mild arthritis,” Hartman notes. People with this condition tend to have a sufficient level of cartilage cells in the afflicted joint, which works with the therapy to help decrease inflammation. “And people who are active tend to see better results than those who are less active,” Hartman adds.

Washington University orthopedics specialists at Barnes-Jewish Hospital have established protocols for rehabilitation after treatment, which helps patients make the most of the therapy’s benefits. The use of advanced imaging technology also helps ensure people treated with platelet-rich plasma experience the best results possible. “We use high-frequency, musculoskeletal ultrasound technology to help target the best area for injection,” Hartman says.

Unfortunately, many health insurers don’t cover platelet-rich plasma therapy because it is, to date, considered by the U.S. Food and Drug Administration to be an investigational treatment. Hartman notes, however, that the status may change as more studies publish the results of the treatment’s efficacy.

Hartman and colleagues are working to further refine the treatment for those looking for pain relief associated with mild arthritis. And he says the future looks promising: Other new, injectable therapies to treat joint pain are part of ongoing research, including those that use fat and bone marrow tissues. “I’m excited about platelet-rich plasma therapy—and new options being developed—that will help us improve quality of life for the people we treat.”