Rheumatoid arthritis is a chronic inflammatory joint disease that often leads to degradation of the cartilage. Several inflammatory cells and microvascular factors are common in the disease process. There are certain growth factors that are increased in the inflamed joint of both rheumatoid arthritis and osteoarthritis.
Response to therapies differs in rheumatoid arthritis and osteoarthritis. Though nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids are used in both conditions, biological agents such as anti-tumor necrosis factor (anti-TNF) therapies more convincingly reduce inflammation in rhuematoid arthritis. Biologic disease-modifying antirheumatic drugs that target key immunological disease mechanisms are also use for the management of rheumatoid arthritis. However, clinical responses can be inconsistent.
There remains an ongoing search for treatments that target joint inflammation and prevent damage to healthy cartilage.
Platelet-rich plasma (PRP) and hyaluronic acid (HA) treatments are now being used more often with very good success. PRP is an autologous blood sample that has highly concentrated platelets containing very important growth factors and healing cells. PRP treatment has been shown to reduce inflammation and restore cartilage health due to its action on joint cell proliferation and differentiation and inhibition of inflammatory cells. Though PRP has shown good efficacy in osteoarthritis and other musculoskeletal conditions such as chronic tendinitis, there is limited research for the use of PRP in patients with rheumatoid arthritis.
The study below presented with clinical experience for the treatment of rheumatoid arthritis with PRP in patients who had inadequate response and persistent pain and inflammation with joint steroid injections. The presented case studies administered activated PRP with high concentrations of platelets of 4ml. It was administered to patients with persistent pain and inflammation in joints by injection.
Benefits of PRP for repair and regeneration of joint cartilage have been confirmed in many preclinical studies. In cell cultures of cartilage cells, PRP increases cellular and cartilage matrix proliferation and synthesis of bio-composition and collagen type II as well as downregulates cellular breakdown mediators directly and indirectly. Clinical benefits of PRP have been reported for many musculoskeletal conditions including tendinopathies, bone defects, and other joint defects. PRP has demonstrated beneficial effects in osteoarthritis by facilitating repair and elimination of inflammation. Monthly joint PRP injections decreased pain and swelling, in elderly patients with mild-to-moderate knee OA and associated bursitis. After 2 injections, there was a significant decrease in pain and reported improvements on functional capacity. There was a decrease in proinflammatory proteins and an increase in proteins which help combat the degenerative processes.
PRP is also a safe and useful therapy in patients with haemophilia who develop chronic joint inflammation. PRP was shown to significantly reduced the Haemophilia Joint Health Score (HJHS) and numbers of bleeding episodes haemophilia. All patients reported relief in pain. The below study report the use of PRP in rheumatoid arthritis patients who are not responding adequately to conventional therapy with one or more treatment options for rheumatoid arthritis.
Joint injection treatment with PRP (4 ml) resulted in improvement in pain at 4 and 8 weeks after injection. The effects were sustained for up to 1 year of follow-up. These clinical effects of PRP were independent of the duration of disease and past or ongoing treatment for rheumatoid arthritis. In addition, all patients showed a decrease in joint capsule growth and joint fluid. The clinical benefits of PRP in rheumatoid arthritis treatment can potentially be explained by anti-inflammatory effects. PRP suppresses pathways that caused breakdown at the same time as restoring cells which preserve and maintain joint health. PRP treatment has also significantly improved chronic low back pain. Pain relief with PRP is reported in patients with skeletal muscle injuries and strains. There is also evidence for reduction of inflammation and size of tissue scars with PRP in skeletal muscle injury.
No adverse reactions were reporter over the 5-12 months in the patients who received the treatment with PRP. PRP is a very safe treatment, with no serious adverse events reported for PRP in literature. Furthmore, there is no risk for immunogenic reactions, and no systemic effects have been reported.
Platelet activation results in growth-factor release. These growth factors accelerate healing and improve functional outcomes in joint and soft tissue injuries. This explains the acceleration of healing with PRP in joint conditions. In addition, PRP has a role in cartilage regeneration. Together, these growth factors can help to repair joint structure and restore function, at the same time as combating inflammation.
The findings on the below study suggest a beneficial role of PRP in patients with rheumatoid arthritis. Further studies should be conducted to understand the impact of PRP specifics. Ultimately, PRP may be a safe and useful therapy in patients with inflammatory joint conditions like rheumatoid arthritis. Also, PRP may evolve as a surgery-sparing option. PRP should be evaluated in more clinical trials for improvement in joint structure and composition and restoration of function and quality of life in patients. Treatment with NSAIDs and steroids may have efficacy for relief in joint pain and stiffness, but these are often short lived and do not influence disease progression. Disease modifying drugs gained importance for attenuation of disease progression though long-term remissions have not been adequately achieved in patients with rheumatoid arthritis.
Platelet Rich Plasma for Treatment of Rheumatoid Arthritis: Case Series and Review of Literature 2020.
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