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J Res Med Sci 2018,  23:50

What is the role of erythropoietin prolotherapy on pain relief of knee osteoarthritis?

Pain Research Center, Iran University of Medical Sciences (IUMS), Tehran, Islamic Republic of Iran

Date of Web Publication06-Jun-2018

Correspondence Address:
Dr. Pooya Derakhshan
Iran University of Medical Sciences, Tehran
Islamic Republic of Iran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jrms.JRMS_802_16

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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

How to cite this URL:
Derakhshan P. What is the role of erythropoietin prolotherapy on pain relief of knee osteoarthritis?. J Res Med Sci [serial online] 2018 [cited 2023 Mar 24];23:50. Available from: https://www.jmsjournal.net/text.asp?2018/23/1/50/233827


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 1: Demographic data of the patients

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Table 2: Pain scores in the two groups (a maximum visual analog scale score of 10)

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Table 3: Knee joint range of motion over time

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Table 4: Satisfaction score in the two groups

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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.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Alderman DD. Regenerative injection therapies for pain: traditional, platelet rich plasma and biocellular prolotherapy. Integr Pain Manage 2016;p.345.  Back to cited text no. 1
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.  Back to cited text no. 2
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.  Back to cited text no. 3
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.  Back to cited text no. 4
Arcasoy MO. The non-haematopoietic biological effects of erythropoietin. Br J Haematol 2008;141:14-31.  Back to cited text no. 5
Diekman BO, Guilak F. Stem cell-based therapies for osteoarthritis: Challenges and opportunities. Curr Opin Rheumatol 2013;25:119-26.  Back to cited text no. 6
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.  Back to cited text no. 7


  [Table 1], [Table 2], [Table 3], [Table 4]

This article has been cited by
1 Therapeutic Challenges for Knee Osteoarthritis
Farnad Imani,Vikram B. Patel
Anesthesiology and Pain Medicine. 2019; 9(3)
[Pubmed] | [DOI]


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