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What is the role of erythropoietin prolotherapy on pain relief of knee osteoarthritis?
Pooya Derakhshan
Pain Research Center, Iran University of Medical Sciences (IUMS), Tehran, Islamic Republic of Iran
| Date of Web Publication | 06-Jun-2018 |
Correspondence Address:
Dr. Pooya Derakhshan
Iran University of Medical Sciences, Tehran
Islamic Republic of Iran
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jrms.JRMS_802_16
How to cite this article:
Derakhshan P. What is the role of erythropoietin prolotherapy on pain relief of knee osteoarthritis?. J Res Med Sci 2018;23:50 |
Sir,
Knee osteoarthritis is one of the prevailing chronic joint diseases in the world. Doctors have always searched for the new, effective treatment methods with the least side effects. Intra-articular prolotherapy is one of the recent treatment methods to address chronic and severe pain. Using growth-stimulating substances, this method activates an inflammatory cascade and releases inflammatory factors resulting in cellular growth and accelerated cartilage building.[1],[2] Erythropoietin is a blood cell proliferation and growth-stimulant substance recently used in damaged ligaments and muscles prolotherapy.[3],[4]
Research has found that growth factors such as necrosis factor beta, erythrocytes growth factor, and the factor released from platelets (which is released from fibroblasts) result in cell proliferation increase.[3],[5] The effect of inflammatory factors on cartilage restoration has been demonstrated in different studies.[6],[7] Inflammation causes secondary growth factor production and injecting inflammatory factors without inflicting damage starts the proliferation phase. However, after discovering erythropoietin receptors outside hematopoietic system, many studies were carried out on its effects on nonhematopoietic parts.[1],[3] In many studies, the effect of erythropoietin on musculoskeletal system has been surveyed.[1],[6] It has been suggested that this hormone affects bone tissue directly (activating bone marrow cells) and indirectly (through channels transferring messages to basic cells). In the novel study conducted by Rahimzadeh et al. published in this journal, the authors planned to compare the ability of three methods of intra articular knee joint therapies with erythropoietin, dextrose, and pulsed radiofrequency. Intra-articular prolotherapy with erythropoietin was more effective in terms of pain level reduction and range of motion improvement compared with dextrose and pulsed radiofrequency [Table 1], [Table 2], [Table 3], [Table 4].[4] | Table 2: Pain scores in the two groups (a maximum visual analog scale score of 10)
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These studies suggest that increasing the administration dose of erythropoietin in future studies may lead to even better results. Considering the various beneficial effects of erythropoietin on nonhematopoietic tissues, more studies with more cases and higher administration doses are required to prove its probable beneficial effects on joint cartilage tissue.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Alderman DD. Regenerative injection therapies for pain: traditional, platelet rich plasma and biocellular prolotherapy. Integr Pain Manage 2016;p.345.  |
| 2. | Sherwood JC, Bertrand J, Eldridge SE, Dell'Accio F. Cellular and molecular mechanisms of cartilage damage and repair. Drug Discov Today 2014;19:1172-7. |
| 3. | Lamon S, Russell AP. The role and regulation of erythropoietin (EPO) and its receptor in skeletal muscle: How much do we really know? Front Physiol 2013;4:176. [ PUBMED] |
| 4. | Rahimzadeh P, Imani F, Faiz SH, Entezary SR, Nasiri AA, Ziaeefard M, et al. Investigation the efficacy of intra-articular prolotherapy with erythropoietin and dextrose and intra-articular pulsed radiofrequency on pain level reduction and range of motion improvement in primary osteoarthritis of knee. J Res Med Sci 2014;19:696-702. |
| 5. | Arcasoy MO. The non-haematopoietic biological effects of erythropoietin. Br J Haematol 2008;141:14-31. [ PUBMED] |
| 6. | Diekman BO, Guilak F. Stem cell-based therapies for osteoarthritis: Challenges and opportunities. Curr Opin Rheumatol 2013;25:119-26. [ PUBMED] |
| 7. | Ryan M, Wong A, Rabago D, Lee K, Taunton J. Ultrasound-guided injections of hyperosmolar dextrose for overuse patellar tendinopathy: A pilot study. Br J Sports Med 2011;45:972-7. [ PUBMED] |
[Table 1], [Table 2], [Table 3], [Table 4]
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