Can Curry Cure Knee Arthritis?

It sounds like a plot for a silly Bollywood movie, but published data actually supports the idea that one of the key components of curry powder can help alleviate pain for patients with knee arthritis.

Curcumin, a bright yellow spice found in curry powder, recently was found to have the same efficacy as ibuprofen (the active ingredient in Motrin and Advil) for patients with knee arthritis.  In a recently published study of 367 knee arthritis patients, researchers found 1500 mg of Curcuma domestica extract had the same effectiveness in terms of pain reduction as 1200 mg of ibuprofen at four weeks (Kuptnirataikul et al). Importantly, the curcumin treated patients had less episodes of abdominal pain or discomfort compared to the ibuprofen patients.  Importantly, another published study of of the same dosage of curcumin (1500 mg) was found to have significant improvements in terms of pain and physical function when compared to placebo at six weeks (Panahi et al).   Curcumin has been noted to block several substances involved in the inflammatory pathway and also inhibits activation of free radicals.  This could help explain why the spice works to reduce pain in arthritis patients.  

So next time your knee starts to hurt, put down the ibuprofen and hobble over to your favorite Indian or Thai restaurant for a tasty curry meal.  It may just help your knees feel better.

On a more serious note, the published data supports trying a curcumin supplement 1500 mg per day divided in three doses for 4-6 weeks for patients with knee arthritis.  (See chart below)

AM
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Pain Reduction in Patients with Knee ArthritisKuptnirataikul et al

Platelet Rich Plasma beats Cortisone for Plantar Fasciitis

In a paper presented today at the American Academy of Orthopedic Surgery Meeting in San Francisco, platelet rich plasma was found to be a significantly better treatment for plantar fasciitis when compared to the standard treatment of cortisone.  See the details outlined below in the abstract presented by Dr. Monto. 

Raymond R. Monto, MD, Nantucket, Massachusetts, United States

INTRODUCTION Chronic plantar fasciitis is a common but sometimes difficult condition to successfully treat. Platelet rich plasma (PRP), a concentrated bioactive component of autologous blood that is rich in cytokines and other growth factors, was compared with cortisone injection in the treatment of severe cases of plantar fasciitis resistant to traditional non-operative paradigms. METHODS Thirty-six patients (16 males, 20 females) with severe chronic plantar fasciitis who had failed traditional non-operative treatment (rest, heel lifts, PT, NSAIDS, cam walker immobilization, night splinting, local modalities) were randomized into two study groups and evaluated prospectively. All patients had pre-treatment MRI and ultrasound studies consistent with plantar fasciitis. Group 1 was treated with a single ultrasound-guided injection of 40 mg methylprednisolone at the injury site and Group 2 was treated with a single ultrasound-guided injection of un-buffered autologous PRP at the injury site. All patients were then immobilized fully weight bearing in a cam walker for two weeks, started on eccentric home exercises and then allowed to return to normal activities as tolerated and without support. RESULTS Group 1 had an average age of 59 (24-74) and had failed 5.4 months (4-24) of standard non-operative management and had pre-treatment AOFAS scores of 52 (24-60). The PRP group had an average age of 51 (21-67) and had failed 5.7 months (4-26) of standard non-operative management and had pre-treatment AOFAS scores of 37 (30-56). Post-treatment AOFAS scores in Group 1 initially improved to 81 (60-90) at three months but decreased to 74 (56-85) at six months and dropped further to 58 (45-77) at 12 months follow up. Post-treatment AOFAS scores in Group 2 improved to 95 (84-90) at three months and remained excellent at 94 (87-100) at six months and stayed at 94 (86-100) at 12 months follow up (CI 95% P=0.001). No patients were lost to follow up. DISCUSSION AND CONCLUSION This study suggests that platelet rich plasma injection is significantly more effective and durable than cortisone injection for the treatment of severe chronic plantar fasciitis refractory to traditional non-operative management. AM Total Tendon

AAOS Platelet Rich Plasma Symposium

The American Academy of Orthopaedic Surgeons (AAOS) will be holding its annual meeting this week in San Francisco.  The AAOS is sponsoring a symposium on Platelet Rich Plasma on Wednesday Feb. 8th at 10.30 am PST.  This will feature talks about the use of PRP in the office or operating room for achilles tendonitis, rotator cuff tears, tennis elbow, ligament injuries, and knee osteoarthritis among others.  Leading experts will debate its value.

I will be sending out live updates via my twitter account:  @BloodCure

Follow if you would like to view them in real time.  

This symposium will present some of the latest research on the topic of PRP for musculoskeletal injuries and disorders.

AM

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AAOS Now Reports on Platelet Rich Plasma

AAOS NOW just published a discussion about what's behind the hype of platelet rich plasma  Read an excerpt below:  
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"Dr. Mishra also presented a concise classification system for PRP formulations (See Video of PRP Classification) to help compare data from various studies. The system takes into account the inclusion of white blood cells, the addition of a thrombin activator, and the final concentration of platelets.

He noted that PRP is “autologous engineering” a way to help maximize how the body helps heal itself. Stem cells and bone marrow are other examples.

“Patients are seeing elite athletes, like Tiger Woods and Raphael Nadal, being treated with some form of PRP and are asking their orthopaedic surgeons to give them ‘what Tiger got.’ The problem is that we don’t know ‘what Tiger got,’ what happened to him before or afterwards, or what was used, and no one is publishing that data,” noted Dr. Mishra.

“But all three major sports organizations—the National Football League (NFL), Major League Baseball, and the National Basketball Association—as well as the World Anti-Doping Agency, have declared that PRP is a reasonable treatment, despite the fact that we may all agree that there’s limited research to support the efficacy of its use,” he continued.


Read the full article.
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Clearly, PRP needs more evidence to be fully validated.  This will require investigation of specific PRP formulations and specific indications with important but expensive large randomized trials.  Athletes in general, however, do not wait until there is definitive proof.  They are constantly searching for the best ways to recover from injuries and PRP has increasing evidence that it may help.

AM
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Platelet Rich Plasma Classification Video

This is a Platelet Rich Plasma Classification System proposed by Dr. Allan Mishra at the American Academy of Orthopedic Surgery (AAOS) in San Diego Feb. 2011



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Platelet Rich Plasma Forum at AAOS

The American Academy of Orthopaedic Surgery and AAOS Now will be conducting a Platelet Rich Plasma Forum on February 14, 2011 just prior to the Annual Meeting in San Diego.  Participating in this meeting are an elite group of clinicians and researchers including but not limited to Dr. James Andrews, Dr. Steven Arnoczky, Dr. Terry Canale, Dr. William Clancy, Dr. Freddie Fu, Dr. Taco Gosens, Dr. Elizaveta Kon, Dr. Nicola Maffulli, Dr. Robert Marx, Dr. Allan Mishra, Dr. Pietro Randelli, Dr. Scott Rodeo, and Dr. JR Woodall.

This group along with several others has been tasked with evaluating the state of platelet rich plasma.  It will be the most comprehensive discussion of the topic with regard to orthopedics and sports medicine.  The goal is to hopefully make some sense of how to best evaluate and potentially use PRP.

Stay tuned for details.

AM

American Academy of Orthopedic Surgery Article

Dr. Mishra's recent trip to Europe was featured in the American Academy of Orthopedic Surgery's Magazine: AAOS Now. The article titled "AAOS fellow takes European PRP Tour" was feature in the Jan. 2008 issue. The picture above is Dr. Mishra assisting on a platelet rich plasma enchanced achilles tendon repair in Sweden.


Click here to view AAOS Platelet Rich Plasma view article

Another sports medicine meeting in Chamonix France focusing on PRP will take place at the end of Jan 2008. Details of both meetings will be posted here soon.

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