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Ankylosing Spondylitis, Hip Pain, PRP treatment

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A fairly common question I get asked by colleagues is how do I use regenerative medicine treatments in the setting of my autoimmune and inflammatory patients. It’s a great question and I have a case that I think helps to explain and give some details in that regard. Specifically a man with Ankylosing Spondylitis and treating his right hip pain with platelet rich plasma.

 


I have a patient who is in his early fifties, he is a gentleman that has Ankylosing Spondylitis. In patients that have systemic inflammatory issues, meaning inflammation throughout the body, that have joint issues, my first take is always if they have total body inflammation you really need a solution that’s total body. And that generally does not mean injectable option into a specific joint or tendon. So things you can consider, you can certainly consider things like over the counter supplements like omega-3 curcumin glucosamine. As well as dietary changes which can be helpful. For most of these people though, they end up requiring medication to control their overall symptoms. And rather than using just anti-inflammatory medications it’s more medications that work on the immune system to help calm things down and modulate it. So that’s always first line. For some of these people they do great. They don’t need anything else.

For a lot of these people, however they may still have some residual joint issues. If somebody has one or two joint issues you can still treat that with some of the regenerative treatments rather than relying on steroid injections or anti-inflammatory medications or chronic narcotics. In the case of my patient, he has Ankylosing Spondylitis. In general he is doing quite well with overall control of his condition with medication. He does, however, still have some residual hip issues. He has pain in the right hip along the side of the hip that also goes down the leg. On his imaging he has very mild arthritic changes in the right hip. The most important thing in his imaging is that he has fused SI Joints on both sides.

The sacroiliac joints sit in between and connect the pelvis to the lumbar spine, is a key support in the pelvis, offers significant stability, and offloads the stress that goes through the hip and the pelvis. So if somebody has a fused SI Joint they’re prone to not only lower back pain they can also be prone to hip pain as well. In this gentleman’s case, my sense has been that a lot of his pain is actually coming from his SI joint being fused and then secondarily developing stress in the hip. Not only the hip joint, but also the hip ligaments and the hip tendons as well. That is based on clinical examination, diagnostic ultrasound, and clinical feel and experience.

In this case what I recommended was platelet-rich plasma where we’re taking a sample of his blood, concentrating into a high concentration of his own platelets called platelet-rich plasma, and then injecting that into the hip joint. Specifically injecting 14 times concentration platelet-rich plasma into the hip joint then injecting platelet lysate into the hip joint as well and ligaments around the hip. He also has hip flexor symptoms as well and I injected platelet-rich plasma into the hip flexor tendons. And then lastly also injecting around the ligaments of the SI joints. You can not actually inject into his SI Joints in this case because the joint is fused. I can, however, inject into the SI ligaments improving support and stability, which will then also help his overall pain symptoms.

So that is how I would approach someone who has an autoimmune or inflammatory condition. Control the systemic issues and then start dealing with the residual remaining things as well to get somebody better. Hopefully he gets a good result and hopefully that’s gives you a better sense for how to treat these kinds of situations.

 


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