Research Tip Sheet: Knee Arthritis, In-Hospital Addiction Help

Biological Content of Blood-Derived Treatment Could Affect Common Arthritis 

Injections of platelet-rich plasma made from a patient’s own blood are increasingly used to treat knee osteoarthritis—but their use is not widely accepted and the treatment does not work for everyone. Investigators from Cedars-Sinai Health Sciences University have taken the first steps toward predicting which patients will benefit.

With further study, their findings, published in the Orthopaedic Journal of Sports Medicine, could improve patient outcomes and guide development of next-generation treatments for the debilitating condition.

During the procedure, a patient’s blood is processed in a machine that separates plasma and platelets—a blood component essential for clotting. The concentrated platelet-rich plasma (PRP) is then injected into the affected knee to promote repair.

About 60% of patients in the study experienced reduced pain and better knee function after treatment, said Dmitriy Sheyn, PhD, associate professor of Orthopaedics and Surgery and corresponding author of the study.

“We found that patients whose pain and inflammation improved after treatment tended to have lower concentrations of specific cellular and protein biomarkers in their PRP, while patients who had poorer responses to treatment had higher concentrations,” said Sheyn, also a research scientist in the Board of Governors Regenerative Medicine Institute. “This suggests that the biological makeup of platelet-rich plasma varies between individuals and might influence how well the treatment works.”

The study represents the first attempt to understand how PRP works, said Bert Mandelbaum, MD, professor of Orthopaedics and senior author of the study.

“While this study is small and did not include a ‘placebo’ group that did not receive PRP, it is a first step toward identifying the active ingredients in the therapy so that we can design a complementary arthritis treatment based around them,” Mandelbaum said. “We are excited to continue this work.”  

Additional Cedars-Sinai authors include Lea Zila; Juliane D. Glaeser; Julia Sheyn; Giselle Kaneda; Jacob T. Wechsler; Parnika Karthik; Victoria Yu; Jasmine Galloway; Sarah Parker; Aleksandr Stotland; Catherine Bresee; Khosrowdad Salehi; Pablo Avalos, MD; Clive Svendsen, PhD; and Wafa Tawackoli, PhD.

The other author is Begonya Comin-Anduix.

Funding: This study was internally funded by Regenerative Orthobiologics Center and Precision Health Initiative.

Study Finds Hospital Addiction Consultation Service May Improve Outcomes at Low Cost

Helping hospitalized patients begin treatment for opioid use disorder may improve outcomes at a reasonable financial cost, according to a study co-led by investigators at Cedars-Sinai Health Sciences University.

The analysis, published in JAMA Network Open, suggests that the hospital-based addiction consultation service known as START (Substance Use Treatment and Recovery Team) is cost-effective and clinically effective, based on findings from a prior randomized trial.

Investigators used a computer-based model to analyze the clinical trial data and evaluate healthcare costs and patient outcomes over one year. Compared with patients who received standard or usual care, those who received START were more likely to begin treatment for opioid use disorder and connect with follow-up care after discharge. Compared with usual care, START use cost an additional $162 per patient and approximately $15,750 per additional year lived in good health—well below commonly accepted thresholds for cost-effectiveness.

“Hospitalization is a critical opportunity to begin treatment for opioid use disorder, yet most patients are discharged without it,” said Teryl Nuckols, MD, MSHS, director of the Division of Internal Medicine at Cedars-Sinai and the study’s senior author. “While new care models can be costly to implement, our findings suggest START delivers meaningful health benefits for a relatively modest additional investment—providing strong value for patients and health systems alike.”

The authors said additional research is needed to better understand how hospitals can overcome barriers to implementing START and similar addiction consultation services. This information can inform hospital leaders and healthcare policymakers who are making decisions about the role of addiction consultation services in the care of hospitalized patients with opioid use disorder.

Additional Cedars-Sinai authors include Itai Danovitch, MD.

Additional authors include Adeyemi Okunogbe, MBChB, PhD; Alexandra Peltz, MHS; and Allison J. Ober, PhD.

Funding/Support: This study was supported by grant U01TR002756-01A1 from the National Center for Advancing Translational Sciences and the National Institute on Drug Abuse.

Conflict of Interest Disclosures: Dr. Danovitch reported having equity from Bexson Biomedical and Workit Health outside the submitted work. Dr. Nuckols reported receiving grant 5 U01 FD005938-04 from U.S. Food and Drug Administration outside the submitted work. No other disclosures were reported.

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