Administration can be done in the knees, ankle, shoulder, or spine (paravertebral infiltrations). The most commonly used substances for infiltration administration are corticosteroids and hyaluronic acid-containing vascoelastic substances. The latter are recommended for intra-articular injection, most commonly in the knee, hip, shoulder and ankle.
INTRA-ARTICULAR INFILTRATIONS
Infiltrations are the administration of drugs by injection, either into the joints or into the soft tissues around the joints.
INTERVENTIONS
CORTICOSTEROID INFILTRATIONS
Arthrosis is a chronic degenerative process with continuous evolution and which presents inflammatory, painful outbreaks throughout the evolution. The most commonly used product in corticosteroid infiltrations is Dexamethasone. It has a rapid pain and inflammation reducing effect.
Recommendations:
- During painful outbreaks to temporarily reduce inflammation. The duration of the therapeutic result depends on several factors (evolutionary stage of degeneration, associated joint pathology - autoimmune inflammatory diseases, the patient's daily activity), but it is transient and limited in time, which is why infiltrations with
corticosteroids must be supplemented with other joint therapies
Adverse effect:
- Infections or soft tissue injuries
- Joint corticosteroids have minimal systemic effects, but require caution in patients with hypertension or diabetes (a temporary hypoglycemic and hyposodemic regimen is required).
INFILTRATIONS WITH VASCO-ELASTIC SUBSTANCE (HYALURONIC ACID)
After corticosteroid infiltrations and the disappearance of pain, many patients are tempted to resume physical activity. But it is very likely that the patient will experience recurrence of joint pain while walking, a natural progression of symptoms in this case. The solution to this situation is infusions with vasco-elastic substances, which contain hyaluronic acid.
Recommendations:
- In the treatment of pain in early or moderate arthrosis, and for advanced arthrosis (with reduced efficacy) only for patients who cannot or do not want surgery. The duration of the therapeutic effect depends on the type of product used and the physiological characteristics of the targeted joint. At Cronos Med Clinic we use products whose therapeutic effect can last between six and 10 months. The procedure is relatively simple, with minimal discomfort for the patient.
Adverse effect:
- Adverse effects are rare and can be easily removed by ensuring strict asepsis and the experience of the physician who can use the ultrasound for fidelity
intra-articular administration of the product.
INFILTRATIONS FOR REGENERATIVE PURPOSES AT JOINT LEVEL
PRP (platelet enriched plasma) INFILTRATIONS
Platelet-rich plasma (PRP) therapy has been used successfully in recent years and is becoming an increasingly common treatment for joint pain from degenerative diseases, ligament, tendon and cartilage damage.
PRP is beneficial for those who wish to postpone surgery or for athletes who wish to avoid it. Obtaining PRP is relatively simple and painless. Blood is centrifuged and depending on the molecular weight, layers with circulating elements are chosen.
Once centrifuged, platelet-rich plasma is extracted and administered by intra-articular injection.
Recommendations:
- PRP infiltrations are based on triggering an automatic immune response to limit, heal and repair the damage caused by degeneration.
- After PRP therapy the patient may experience joint discomfort, mild tension or pain lasting for a few days. This phenomenon is natural in this case and represents the reparative inflammatory process.
- Unlike corticosteroid and hyaluronic acid infiltrations, PRP infiltrations have a reparative purpose, slowing the progression of arthrosis.
- PRP infiltrations are used alongside corticosteroids and hyaluronic acid, increasing the intensity and duration of the therapeutic effect.
Adverse effect:
- Normally, PRP therapy has no side effects
CYTOKINE THERAPY - ACRS (autolog cytokine rich serum)
Another therapy that uses the patient's own cells is that with serum enriched with growth factors along with pro-regenerative inflammatory cytokines. At the systemic level, there are two types of inflammatory processes with different pathways and outcomes:
- Degenerative inflammation: induced by aging or autoimmune pathologies, resulting in
cellular and tissue destruction. This can manifest itself at any level: skin (wrinkles, loss of skin
elasticity and lightness) or joints (arthrosis, osteoarthritis and loss of function) - Inflammation with regenerative role: initiated by the body immediately after trauma, injury, degeneration.
ACRS is obtained from a small amount of blood collected by venipuncture and transferred into a container. The blood container is stored for three hours in a constant temperature environment, during which time a markedly higher number of growth factors and repair cytokines are obtained.
The significant advantage is the decrease in degenerative inflammatory processes with the induction of regenerative inflammation.
ACRS therapy is justified both in degenerative joint pathology (arthrosis) and in inflammatory autoimmune pathologies with musculoskeletal (joint) involvement.
Like PRP therapy, ACRS infiltrations are safe for the patient. Infiltrations with ACRS are combined with those with a palliative role (corticoids and hyaluronic acid) to increase the intensity and duration of the therapeutic effect.
