Questions to ask about a sore joint

Sources

1. The 2019 ACR/Arthritis Foundation guideline makes STRONG recommendations for exercise, weight loss in people with overweight or obesity, self-efficacy and self-management programmes, tai chi, cane use, hand orthoses for first-CMC joint OA, tibiofemoral bracing, topical NSAIDs for the knee, oral NSAIDs and intra-articular glucocorticoid injections for the knee; acupuncture, thermal modalities, radiofrequency ablation, acetaminophen, duloxetine and tramadol are only conditional.

   Kolasinski SL, et al. — 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.. Arthritis Rheumatol, 2020. DOI: 10.1002/art.41142.

2. FDA states verbatim that stem cell products, stromal vascular fraction (adipose-derived), umbilical cord blood, Wharton's jelly, amniotic fluid and exosome products have NOT been approved 'for the treatment of any orthopedic condition, such as osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain, or shoulder pain.' The only FDA-approved stem cell products in the United States are blood-forming (hematopoietic progenitor) cells derived from umbilical cord blood, approved only for disorders of blood production, and there are currently NO FDA-approved exosome products.

   U.S. Food and Drug Administration — Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. FDA (Center for Biologics Evaluation and Research), 2020.

3. A prospective cross-sectional study contacted 273 of 317 US direct-to-consumer stem-cell centres posing as a 57-year-old man with knee osteoarthritis. The mean advertised price of a unilateral same-day stem-cell knee injection was $5,156 (SD $2,446; 95% CI $4,550-5,762, n=65), and the mean claimed clinical efficacy was 82% (SD 9.6%, n=36) - a figure the authors describe as a gap between the published literature and marketing claims.

   Piuzzi NS, et al. — The Stem-Cell Market for the Treatment of Knee Osteoarthritis: A Patient Perspective.. J Knee Surg, 2018. DOI: 10.1055/s-0037-1604443.

4. CMS covers autologous platelet-rich plasma ONLY for patients with chronic non-healing diabetic, pressure and/or venous wounds, and only when the patient is enrolled in an approved clinical research study under the coverage-with-evidence-development National Coverage Determination. There is no national Medicare coverage for PRP in osteoarthritis of any joint.

   Centers for Medicare & Medicaid Services — Autologous Platelet-rich Plasma (Coverage with Evidence Development). CMS Coverage with Evidence Development, 2014.

5. A systematic review and meta-analysis of 25 randomized trials (1,048 participants) found mesenchymal stromal cell therapy for knee OA lowered 12-month pain VAS by 1.91 points versus viscosupplementation and by only 0.99 points versus placebo - and rated the certainty of evidence VERY UNCERTAIN by GRADE for both comparisons. Excluding high-risk-of-bias studies left a similar effect at moderate certainty versus viscosupplementation.

   Tabet CG, et al. — Advanced therapy with mesenchymal stromal cells for knee osteoarthritis: Systematic review and meta-analysis of randomized controlled trials.. J Orthop Translat, 2024. DOI: 10.1016/j.jot.2024.07.012.

6. A triple-blind randomized within-patient trial injected placental mesenchymal stromal cell-derived extracellular vesicles into one knee and saline into the other in 29 patients with bilateral grade 2-3 knee OA. NO statistically significant difference was detected between the treated and control knees on VAS, WOMAC or Lequesne scores at 2 or 6 months.

   Bolandnazar NS, et al. — Safety and efficacy of placental mesenchymal stromal cells-derived extracellular vesicles in knee osteoarthritis: a randomized, triple-blind, placebo-controlled clinical trial.. BMC Musculoskelet Disord, 2024. DOI: 10.1186/s12891-024-07979-w.

7. The 2010 ACR/EULAR classification criteria define 'definite rheumatoid arthritis' by confirmed synovitis in at least one joint, absence of a better alternative diagnosis, and a total score of 6 or more out of 10 across four domains: number and site of involved joints (0-5), serology (0-3), acute-phase response (0-1) and symptom duration (0-1). This is the formal boundary between inflammatory arthritis and degenerative joint disease.

   Aletaha D, et al. — 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.. Arthritis Rheum, 2010. DOI: 10.1002/art.27584.

8. The 2025 EULAR update recommends methotrexate, ideally combined with short-term glucocorticoids, as initial therapy for rheumatoid arthritis, within a treat-to-target strategy across conventional synthetic, biological and targeted synthetic DMARDs - a disease-modifying drug pathway that has no counterpart in osteoarthritis and which belongs to rheumatology.

   Smolen JS, et al. — EULAR recommendations for the management of rheumatoid arthritis with synthetic and biologic disease-modifying antirheumatic drugs: 2025 update.. Ann Rheum Dis, 2026. DOI: 10.1016/j.ard.2026.01.023.