Pulsed Radiofrequency and Platelet Rich Plasma in Degenerative Joint Arthritis: Two Case Reports and Literature Analyses

(1) Background: Osteoarthritis (OA) is a debilitating joint disease. The are several therapies available for OA. According to current knowledge, the combination of Platelet-Rich Plasma (PRP) and Pulsed Radiofrequency (PRF) can be applied in the treatment of pain of nociceptive origin due to peripheral tissue damage. (2) Methods: We performed a narrative review identifying the articles by searching electronic databases. A retrospective analysis of patients with OA treated with PRF and PRP in "Vito Fazzi" Hospital (Lecce, Italy) was performed. (3) Results: A total of four publications on the use of PRP and PRF in degenerative joint arthritis were included in our review. In our experience, two patients with OA were treated with PRP and PRF after unsuccessful conservative treatment. Patient pain score, daily activity ability, active range of activity, and muscle strength improved after treatment. Patients reported a higher level of satisfaction. No major adverse events were reported. (4) Conclusions: The goal of the combined application of the two treatments is to make full use of the analgesic effect of PRF and the repairing effect of PRP. At present, the therapeutic potential of PRP and PRF in OA remains unmet.

Phenotype of patients responsive to occipital nerve stimulation for refractory head pain

Occipital nerve stimulation (ONS) has been employed off-label for medically refractory head pain. Identification of specific headache diagnoses responding to this modality of treatment is required. Forty-four patients with medically refractory head pain and treated with ONS were invited to participate in a retrospective study including a clinical interview and, if necessary, an indomethacin test to establish the headache phenotype according to the International Classification of Headache Disorders, 2nd edn (ICHD-II). We gathered data from questionnaires before implantation, at 1 month after implantation, and at long-term follow-up. Twenty-six patients consented and were phenotyped. At 1 month follow-up and at long-term follow-up a significant decrease in all pain parameters was noted, as well as in analgesic use. Quality of sleep and quality of life improved. Patient satisfaction was generally high as 80% of patients had ≥ 50% pain relief at long-term follow-up. The overall complication rate was low, but revisions were frequent. After phenotyping, two main groups emerged: eight patients had 'Migraine without aura' (ICHD-II 1.1) and eight patients 'Constant pain caused by compression, irritation or distortion of cranial nerves or upper cervical roots by structural lesions' (ICHD-II 13.12). Overuse of symptomatic acute headache treatments was associated with less favourable long-term outcome in migraine patients. We conclude that careful clinical phenotyping may help in defining subgroups of patients with medically refractory headache that are more likely to respond to ONS. The data suggest medication overuse should be managed appropriately when considering ONS in migraine. A controlled prospective study for ONS in ICHD-II 13.12 is warranted.

Effect of psychological stress on salivary interleukin-1beta in psoriasis

BACKGROUND

Psoriasis is a chronic inflammatory skin disease in which several Th1 cytokines such as interleukin-1 beta (IL-beta) have been shown to play a pivotal role. Psychological stress has also been implicated in triggering or exacerbating the disease.

METHODS

Salivary IL-1beta and cortisol levels of 25 patients with psoriasis were compared with those of 50 age- and sex-matched healthy controls under basal conditions and after a standardized stressful procedure including mental arithmetics and the Stroop Color-Word Naming Test.

RESULTS

At baseline, mean IL-1beta levels were higher in patients with psoriasis than controls (p <0.001), whereas mean cortisol levels did not differ significantly between groups. Although IL-1beta levels increased after stress among controls, they did not increase among patients with psoriasis, with a significant group-by-time interaction (p <0.01). After stress, cortisol levels were significantly increased in both groups as compared with baseline (p < or =0.001), without any group-by-time interaction. Perceived stress was similar among psoriatic patients and controls. There was no significant correlation between changes in IL-1beta and changes in cortisol.

CONCLUSIONS

The higher basal IL-1beta levels among psoriatic patients suggest that its production is increased. Changes in proinflammatory cytokine activity in psoriatic skin may play an important role in propagating inflammation. The blunted response of IL-1beta to stress observed in psoriatic patients may reflect a "ceiling effect", or be ascribed to a defective response of the immune system to adrenergic stimuli.

Cardiovascular Reactivity to Experimental Stress in Psoriasis: a Controlled Investigation

A defective response of psoriatic skin to beta-adrenergic stimulation has been implicated in the pathophysiology of psoriasis. A psychophysiological study was planned to investigate whether the beta-adrenergic receptor hyporesponsiveness found in psoriatic skin can also be detected in other systems. Twenty-five psoriatic patients and 50 healthy controls were submitted to a standardized stressful procedure (mental arithmetic and the Stroop Colour-Word Naming Test) to trigger the activation of the sympathetic nervous system, and their haemodynamic responses were compared. While there were no differences between groups in perceived stress, a blunted increase in heart rate and a sharper increase in diastolic blood pressure was observed in psoriasis patients compared with controls. The psychophysiological reaction pattern observed in psoriatic patients might be explained by lower reactivity of heart beta1-adrenergic receptors and arteriolar walls beta2-adrenergic receptors. While this study suggests that beta-adrenergic receptor hyporesponsiveness might have a systemic expression in psoriatic patients, it needs support from future studies exploring beta-adrenergic function in psoriatic patients more directly.