Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Research Article

Evaluating the Efficacy of Intra-articular Injections of Platelet Rich Plasma (PRP) in Rheumatoid Arthritis Patients and its Impact on Inflammatory Cytokines, Disease Activity and Quality of Life

Author(s): Dalia S. Saif*, Nagwa N. Hegazy and Enas S. Zahran

Volume 17, Issue 2, 2021

Published on: 13 November, 2020

Page: [232 - 241] Pages: 10

DOI: 10.2174/1573397116666201113090629

Price: $65

Open Access Journals Promotions 2
Abstract

Background: Among rheumatoid arthritis patients (RA), general disease activity is well regulated by disease-modifying anti-rheumatic medications (DMARDS), but sometimes local inflammation still persists among a few joints. Adjuvant modern molecular interventions as Platelet Rich Plasma (PRP) with a suggested down regulating effect on inflammatory mediators has a proven effect in the management of RA.

We aim to evaluate the therapeutic effect of intra-articular PRP versus steroid in RA patients and their impact on inflammatory cytokines IL1B, TNF α, local joint inflammation, disease activity and quality of life (QL).

Methods: Open-labeled parallel randomized control clinical trial was carried out on 60 RA patients randomly divided into 2 groups, Group 1: included 30 patients received 3 intra-articular injections of PRP at a monthly interval, Group 2: included 30 patients received single intra-articular injection of steroid. They were subjected to clinical, laboratory, serum IL1B and TNF α assessment at baseline and at 3, and 6 months post injection.

Results: Patients of both groups showed improvements in their scores of evaluating tools at 3months post injection and this improvement was persistent in the PRP group up to 6 months post injection while it was continued only for 3 months in the steroid group.

Conclusion: PRP is a safe, effective and useful therapy in treating RA patients who had an insufficient response and persistent pain and inflammation in just one or two joints through its down regulating effect on inflammatory cytokines IL1B, TNF α with subsequent improvement of local joint inflammation, disease activity and QL.

Keywords: PRP, VAS, HAQ, DAS 28, TNF α, IL1B.

Graphical Abstract
[1]
Lippross S, Moeller B, Haas H, et al. Intraarticular injection of platelet-rich plasma reduces inflammation in a pig model of rheumatoid arthritis of the knee joint. Arthritis Rheum 2011; 63(11): 3344-53.
[http://dx.doi.org/10.1002/art.30547] [PMID: 21769848]
[2]
Guo Q, Wang Y, Xu D, Nossent J, Pavlos NJ, Xu J. Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone Res 2018; 6: 15.
[http://dx.doi.org/10.1038/s41413-018-0016-9] [PMID: 29736302]
[3]
Brink M, Verheul MK, Rönnelid J, et al. Anti-carbamylated protein antibodies in the pre-symptomatic phase of rheumatoid arthritis, their relationship with multiple anti-citrulline peptide antibodies and association with radiological damage. Arthritis Res Ther 2015; 17(1): 25.
[http://dx.doi.org/10.1186/s13075-015-0536-2] [PMID: 25889922]
[4]
Kahlenberg JM, Fox DA. Advances in the medical treatment of rheumatoid arthritis. Hand Clin 2011; 27(1): 11-20.
[http://dx.doi.org/10.1016/j.hcl.2010.09.002] [PMID: 21176795]
[5]
Magyari L, Varszegi D, Kovesdi E, et al. Interleukins and interleukin receptors in rheumatoid arthritis: Research, diagnostics and clinical implications. World J Orthop 2014; 5(4): 516-36.
[http://dx.doi.org/10.5312/wjo.v5.i4.516] [PMID: 25232528]
[6]
Smolen JS, Breedveld FC, Burmester GR, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis 2016; 75(1): 3-15.
[http://dx.doi.org/10.1136/annrheumdis-2015-207524] [PMID: 25969430]
[7]
Brown AK, Conaghan PG, Karim Z, et al. An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 2008; 58(10): 2958-67.
[http://dx.doi.org/10.1002/art.23945] [PMID: 18821687]
[8]
Malmström V, Catrina AI, Klareskog L. The immunopathogenesis of seropositive rheumatoid arthritis: from triggering to targeting. Nat Rev Immunol 2017; 17(1): 60-75.
[http://dx.doi.org/10.1038/nri.2016.124] [PMID: 27916980]
[9]
Tong S, Zhang C, Liu J. Platelet-rich plasma exhibits beneficial effects for rheumatoid arthritis mice by suppressing inflammatory factors. Mol Med Rep 2017; 16(4): 4082-8.
[http://dx.doi.org/10.3892/mmr.2017.7091] [PMID: 28765945]
[10]
Dhillon RS, Schwarz EM, Maloney MD. Platelet-rich plasma therapy - future or trend? Arthritis Res Ther 2012; 14(4): 219.
[http://dx.doi.org/10.1186/ar3914] [PMID: 22894643]
[11]
Fullerton BD, Reeves KD. Ultrasonography in regenerative injection (prolotherapy) using dextrose, platelet-rich plasma, and other injectants. Phys Med Rehabil Clin N Am 2010; 21(3): 585-605.
[http://dx.doi.org/10.1016/j.pmr.2010.06.003] [PMID: 20797551]
[12]
Dohan Ehrenfest DM, Andia I, Zumstein MA, Zhang CQ, Pinto NR, Bielecki T. Classification of platelet concentrates (Platelet-Rich Plasma-PRP, Platelet-Rich Fibrin-PRF) for topical and infiltrative use in orthopedic and sports medicine: current consensus, clinical implications and perspectives. Muscles Ligaments Tendons J 2014; 4(1): 3-9.
[http://dx.doi.org/10.32098/mltj.01.2014.02] [PMID: 24932440]
[13]
Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med 2008; 1(3-4): 165-74.
[http://dx.doi.org/10.1007/s12178-008-9032-5] [PMID: 19468902]
[14]
Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010; 60(9): 2560-81.
[15]
Prevoo ML, van ’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995; 38(1): 44-8.
[http://dx.doi.org/10.1002/art.1780380107] [PMID: 7818570]
[16]
Glynn LG, Mustafa A, Casey M, et al. Platelet-rich plasma (PRP) therapy for knee arthritis: a feasibility study in primary care. Pilot Feasibility Stud 2018; 4: 93.
[http://dx.doi.org/10.1186/s40814-018-0288-2] [PMID: 29997901]
[17]
Huang PH, Wang CJ, Chou WY, Wang JW, Ko JY. Short-term clinical results of intra-articular PRP injections for early osteoarthritis of the knee. Int J Surg 2017; 42: 117-22.
[http://dx.doi.org/10.1016/j.ijsu.2017.04.067] [PMID: 28476542]
[18]
Kubota G, Kamoda H, Orita S, Inage K, Ito M, Yamashita M, et al. Efficacy of Platelet-Rich Plasma for Bone Fusion in Transforaminal Lumbar Interbody Fusion. Asian Spine J 2018; 12(1): 112-8.
[http://dx.doi.org/10.4184/asj.2018.12.1.112]
[19]
Kitamura Y, Suzuki M, Tsukioka T, et al. Spectrophotometric determination of platelet counts in platelet-rich plasma. Int J Implant Dent 2018; 4(1): 29.
[http://dx.doi.org/10.1186/s40729-018-0140-8] [PMID: 30276491]
[20]
Ben-Nafa W, Munro W. The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review. SICOT J 2018; 4: 11.
[http://dx.doi.org/10.1051/sicotj/2017062] [PMID: 29561260]
[21]
Paul-Dauphin A, Guillemin F, Virion JM, Briançon S. Bias and precision in visual analogue scales: a randomized controlled trial. Am J Epidemiol 1999; 150(10): 1117-27.
[http://dx.doi.org/10.1093/oxfordjournals.aje.a009937] [PMID: 10568628]
[22]
Haefeli M, Elfering A. Pain assessment. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2006; 15(1): 17-24.
[http://dx.doi.org/10.1007/s00586-005-1044-x]
[23]
Duffy CM, Feldman BM. Assessment Of Health Status, Function, And Quality Of Life Outcomes. Textbook of Pediatric Rheumatology. (6th ed.). Philadelphia: W.B. Saunders 2011; pp. 157-67..
[http://dx.doi.org/10.1016/B978-1-4160-6581-4.10008-1]
[24]
Mortada MA, Abdelwhab SM, Elgawish MH. Intra-articular methotrexate versus corticosteroid injections in medium-sized joints of rheumatoid arthritis patients-an intervention study. Clin Rheumatol 2018; 37(2): 331-7.
[http://dx.doi.org/10.1007/s10067-017-3843-y] [PMID: 28963634]
[25]
Field A. Discovering statistics using SPSS. (3rd [25] ed.), Thousand Oaks, California: SAGE Publications Inc. 2009..
[26]
Badsha H, Harifi G, Murrell WD. Platelet rich plasma for treatment of rheumatoid arthritis: Case series and review of literature. Case Rep Rheumatol 2020; 2020: 8761485.
[http://dx.doi.org/10.1155/2020/8761485] [PMID: 32082684]
[27]
Descalzi F, Ulivi V, Cancedda R, et al. Platelet-rich plasma exerts antinociceptive activity by a peripheral endocannabinoid-related mechanism. Tissue Eng Part A 2013; 19(19-20): 2120-9.
[http://dx.doi.org/10.1089/ten.tea.2012.0557] [PMID: 23578218]
[28]
Andia I, Maffulli N. Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nat Rev Rheumatol 2013; 9(12): 721-30.
[http://dx.doi.org/10.1038/nrrheum.2013.141] [PMID: 24080861]
[29]
Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD. Efficacy of intra-articular platelet-rich plasma injections in knee osteoarthritis: a systematic review. Arthroscopy 2016; 32(3): 495-505.
[http://dx.doi.org/10.1016/j.arthro.2015.08.005] [PMID: 26432430]
[30]
Ogino Y, Ayukawa Y, Kukita T, Koyano K. The contribution of platelet-derived growth factor, transforming growth factor-β1, and insulin-like growth factor-I in platelet-rich plasma to the proliferation of osteoblast-like cells. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 101(6): 724-9.
[http://dx.doi.org/10.1016/j.tripleo.2005.08.016] [PMID: 16731390]
[31]
Huang G, Hua S, Yang T, Ma J, Yu W, Chen X. Platelet-rich plasma shows beneficial effects for patients with knee osteoarthritis by suppressing inflammatory factors. Exp Ther Med 2018; 15(3): 3096-102.
[http://dx.doi.org/10.3892/etm.2018.5794] [PMID: 29599843]
[32]
Tohidnezhad M, Bayer A, Rasuo B, et al. Platelet-Released Growth Factors Modulate the Secretion of Cytokines in Synoviocytes under Inflammatory Joint Disease. Mediators Inflamm 2017; 2017: 1046438.
[http://dx.doi.org/10.1155/2017/1046438] [PMID: 29348703]
[33]
Montaseri A, Busch F, Mobasheri A, et al. IGF-1 and PDGF-bb suppress IL-1β-induced cartilage degradation through down-regulation of NF-κB signaling: involvement of Src/PI-3K/AKT pathway. PLoS One 2011; 6(12): e28663.
[http://dx.doi.org/10.1371/journal.pone.0028663] [PMID: 22194879]
[34]
Hashemi M, Hoseini Khameneh SM, Dadkhah P, Mohajerani SA. Effect of Intraarticular injection of ozone on inflammatory cytokines in knee osteoarthritis. 2017; 2(2): 6.
[35]
Mariani E, Canella V, Cattini L, et al. Leukocyte-Rich Platelet-Rich Plasma Injections Do Not Up-Modulate Intra-Articular Pro-Inflammatory Cytokines in the Osteoarthritic Knee. PLoS One 2016; 11(6): e0156137.
[http://dx.doi.org/10.1371/journal.pone.0156137] [PMID: 27258008]
[36]
Ismaiel A. Comparison between the effect of intra-articular injections of platelet-rich plasma and corticosteroids in advanced knee osteoarthritis. Journal of Medicine in Scientific Research 2018; 1(4): 278-84.
[http://dx.doi.org/10.4103/JMISR.JMISR_66_18]
[37]
Gobbi A, Karnatzikos G, Mahajan V, Malchira S. Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis. Sport Health A Multidiscip Approach 2012; 4: 162-72.
[38]
Joshi Jubert N, Rodríguez L, Reverté-Vinaixa MM, Navarro A. Platelet-rich plasma injections for advanced knee osteoarthritis: a prospective, randomized, double-blinded clinical trial. Orthop J Sports Med 2017; 5(2): 2325967116689386.
[http://dx.doi.org/10.1177/2325967116689386] [PMID: 28255569]
[39]
Raeissadat SA, Rayegani SM, Hassanabadi H, et al. Knee osteoarthritis injection choices: platelet- rich plasma (prp) versus hyaluronic acid (a one-year randomized clinical trial). Clin Med Insights Arthritis Musculoskelet Disord 2015; 8: 1-8.
[40]
Kanchanatawan W, Arirachakaran A, Chaijenkij K, et al. Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 2016; 24(5): 1665-77.
[http://dx.doi.org/10.1007/s00167-015-3784-4] [PMID: 26387122]
[41]
Singh S, Kumar Sh. A Comparative study of intra-articular injection of steroid versus prolotherapy for pain relief in patients of osteoarthritis knee. Indian journal of pain 2019; 33: 25-30.
[42]
Saif DS, Serag DM, El Tabl MA. Comparative study between platelet-rich plasma injection and steroid injection in mild–moderate shoulder osteoarthritis and their relation to quality of life. 2019; 46(1): 55-61.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy