Osteoarthritis (OA) is a degenerative joint disease characterized by articular cartilage degradation which can affect many joints in the body, but is particularly common in weight-bearing joints such as the knee and hip. The loss of cartilage can lead to joint space narrowing (JSN), pain, and loss of function and ultimately leads to the need for total joint replacement. There are a number of risk factors associated with OA, including genetic predisposition, obesity, age, and previous joint trauma. With obesity set to rise in future years,(Salihu et al., 2009) combined with OA being a frequent condition among the elderly and an ageing population (Mabey,Honsawek 2015), the prevalence of OA is expected to increase. An effective and reliable method for diagnosis and prognosis is needed, with increased demands on health services

Background: Osteoarthritis (OA) is a multifactorial disease that commonly affects the knee. Tumor necrosis factor-α (TNF-α) is able to regulate inflammation in OA. Macrophage migration inhibitory factor (MIF) may be involved in the pathophysiology of arthritis. Platelet-rich plasma (PRP) may reduce pain associated with OA. The current study aimed to assess the possible therapeutic effects of PRP in patients with knee OA of various severities. Methods: A prospective study was performed on 90 patients were included and categorized into mild (30 cases, moderate (30 cases) and severe (30 cases) knee OA. Three intra-articular (I.A) injections of PRP, 2 weeks a part, were received. Pain score and MRI Osteoarthritis Knee Score (MOAKS) were assessed. Serial synovial fluid cytokines assays in the form of Tumor necrosis factor-α (TNF-α) and Macrophage migration inhibitory factor (MIF), were performed using commercially available ELISA assay kits. The assays were performed pre-injection (S1), two weeks from the 1st I.A injection and two weeks from the 2nd I.A injection (S3) for all included patients. Results: The mean values of pain score and synovial TNF-α and MIF levels were significantly higher levels (S1, pre-injection) among severe OA when compared with both mild and moderate cases, p˂0.05 for all. There were significantly lower pain score and synovial TNF-α and MIF levels at S3 in mild, moderate and severe knee OA when compared with S1 values, p˂0.05 for all. There was significant improvement in synovitis in both mild and moderate cases (p˂0.05 for both). Conclusion: I.A injection of PRP significantly reduces the synovial fluid TNF-α and MIF levels with great therapeutic effects on both synovitis via reducing inflammatory cytokines, and bone marrow lesions mainly for mild knee OA and to a lesser extent for moderate cases.

Osteoarthritis (OA) is a multifactorial disease that commonly affects the knee. Tumor Necrosis Factor-α (TNF-α) regulates inflammation during OA. Macrophage Migration Inhibitory Factor (MIF) may be involved in the pathophysiology of arthritis. Platelet-Rich Plasma (PRP) may reduce pain associated with OA. The present study assessed the possible therapeutic effects of PRP in patients with OA of the knee with varying severities. A prospective study was performed in 90 patients diagnosed with mild (30 cases), moderate (30 cases) and severe (30 cases) knee OA. Three Intra-Articular (IA) injections of PRP were administrated, 2 weeks a part, were received. Pain score and MRI Osteoarthritis Knee Score (MOAKS) were assessed. Serial synovial fluid cytokine assays to measure Tumor Necrosis Factor-α (TNF-α) and macrophage Migration Inhibitory Factor (MIF) were performed using commercially available ELISA kits. The assays were performed pre-injection (S1), 2 weeks after the first IA injection (S2) and 2 weeks after the second IA injection (S3) for all patients. The mean values of pain score and synovial TNF-α and MIF levels were significantly higher (S1, pre-injection) among severe OA than among those with either mild or moderate cases, p˂0.05 for all. Pain score and synovial TNF-α and MIF levels at S3 were significantly lower in those with mild, moderate and severe OA than the corresponding S1 values, (p˂0.05 for all). There was significant improvement in synovitis in both mild and moderate cases, (p˂0.05 for both). The IA injection of PRP reduces synovial fluid TNF-α and MIF levels significantly and exhibit significant therapeutic effects on synovitis by reducing inflammatory cytokine levels and bone marrow lesions primarily for mild knee OA and to a lesser extent for moderate cases.