drusso favorite new Guidelines(Hint not pro PRP)

[lonelobo]

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Thoughts?

 

[Ferrismonk]

Interesting read. Here's my observations.

1. Osteoarthritis is outside the scope of Rheumatologists. It is not an autoimmune issue. Anecdotally, every rheumatologist I've had the pleasure to work with has been very against everything we do, preferring to place people on long-term steroids or biologics. I've had them refuse to share imaging to prevent me from doing lumbar MBB (in a patient with Ankylosing spondylitis). They're okay with me taking over opiates however.

2. Regarding PRP and Stem Cell therapies, this is the only comment:

"Platelet-rich plasma (or Stem Cell Injections) treatment is strongly recommended against in patients with knee and/or hip OA. In contrast to intraarticular therapies discussed above, there is concern regarding the heterogeneity and lack of standardization in available preparations of platelet-rich plasma, as well as techniques used, making it difficult to identify exactly what is being injected."

a.k.a. They didn't really look at what's out there, especially for PRP and knee OA.

 

[interjectionreflection]

I still don't get the statement by ACR and their stance against PRP. I have seen level 1 studies with large metal analyzes that demonstrate PRP is better than HA or steroids but the ACR position had me a bit confused as it said the evidence is not good quality. Anyone have a different insight?

 

[Dr. Ice]

I find rheumies to be..dare I say..a pretty worthless speciality. They can only offer biologics, and many patients don’t want it. I also find it ridiculous that they have a 2 month waiting list. How do they make money? Are they all hospital employed SOS ******?

 

[maxxor]

I find rheumies to be..dare I say..a pretty worthless speciality. They can only offer biologics, and many patients don’t want it. I also find it ridiculous that they have a 2 month waiting list. How do they make money? Are they all hospital employed SOS ******?

Biologics operate like the medonc chemo model.

 

[drusso]

GIGO.

 

[deleted875186]

I agree with everything above

I don’t understand how PRP for knee OA can still be called experimental and “strongly recommend against” in the guidelines above. If I had knee OA I would want a PRP injection.

 

[Ducttape]

one of the issues pointed out is that each individual study has a different dosage, different ways of harvesting, and sometimes different ways of giving the treatment. in addition, every patient's PRP will be different in terms of efficacy (which we have no control over). they are saying that it is impossible to make a recommendation because there is no standard.

in a way, they are correct.


set a standard dose for every PRP at a specific site. do randomized double blind prospective studies of that dose against placebo. establish a standard for injectionists to give. you can test that standard dose against higher or lower doses.

 

[drusso]

one of the issues pointed out is that each individual study has a different dosage, different ways of harvesting, and sometimes different ways of giving the treatment. in addition, every patient's PRP will be different in terms of efficacy (which we have no control over). they are saying that it is impossible to make a recommendation because there is no standard.

in a way, they are correct.


set a standard dose for every PRP at a specific site. do randomized double blind prospective studies of that dose against placebo. establish a standard for injectionists to give. you can test that standard dose against higher or lower doses.

But that's not the way Regen works. It's autologous...your body is the factory.

The truth of the matter is that insurance will never cover Regen because it's a square peg and our health care system is a round hole. That's fine. Poor people and pensioners will continue to get steroids until their arms and legs fall off and people with other forms of financing for health care will have options to treatments not covered by insurance. Doing "science" will never fix that. It's not a scientific problem. And, that's okay...

 

[lobelsteve]

But that's not the way Regen works. It's autologous...your body is the factory.

The truth of the matter is that insurance will never cover Regen because it's a square peg and our health care system is a round hole. That's fine. Poor people and pensioners will continue to get steroids until their arms and legs fall off and people with other forms of financing for health care will have options to treatments not covered by insurance. Doing "science" will never fix that. It's not a scientific problem. And, that's okay...

Maybe it will get covered. But only in the HOPD so the SOS will squeeze out the lysate.

 

[Doctodd]

the animals who have had PRP from vets over the past 20+ years must be malingering too....personally im fine with so many naysayers

 

[bedrock]

the animals who have had PRP from vets over the past 20+ years must be malingering too....personally im fine with so many naysayers

Big difference is that people are used to paying out of pocket for vet bills. A $500 vet bill is common, but if you suggest a $500 cash PRP, then people often get upset, though somehow many of them spend that much money on their dogs with no hesitation.

 

[drrosenrosen]

the animals who have had PRP from vets over the past 20+ years must be malingering too....personally im fine with so many neighsayers

Fixed it

 

[drusso]

Big difference is that people are used to paying out of pocket for vet bills. A $500 vet bill is common, but if you suggest a $500 cash PRP, then people often get upset, though somehow many of them spend that much money on their dogs with no hesitation.

Have you tried "buy one, get one free" for your patients and their pets?

 

[Status Sciaticus]

Have you tried "buy one, get one free" for your patients and their pets?

I thought that deal was only for Ivermectin?