Pain control and functional improvement in patients treated by autologous conditioned serum after failure of platelet rich plasma treatments in knee osteoarthritis

Abstract

Objective To assess the efficacy of autologous conditioned serum (ACS) for the treatment of patients with knee osteoarthritis after failure of medical treatments and platelet rich plasma (PRP) injections. Background Knee osteoarthritis is the most common form of arthritis. Prior to prosthetic surgery these patients might benefit from medical treatments, physiotherapy, and in case of their ineffectiveness, from autologous blood component injections. Methodology We have treated 30 patients with Kellgren‐Lawrence I‐III knee osteoarthritis with ACS after failure of standard medical treatments/physiotherapy and platelet rich plasma (PRP) injections for a full cycle, within the previous year from enrollment. Results: ACS administration was performed in all patients with mild side effects and produced prompt (1 month) improvements of VAS and Lequesne scales in 67% of patients and this result persisted at 6 and 12 months. No relationship between the rate of response and Kellgren‐Lawrence scale at enrollment was observed whilst responders had a significantly higher amount of interleukin‐1 receptor antagonist (IL1‐RA) in ACS as compared to nonresponders. Conclusion The present study confirms the efficacy of ACS in pain control and functional recovery of patients with knee osteoarthritis resistant to medical and PRP treatment. These results were obtained in a well‐defined cohort of resistant patients and seem to be related with IL1‐RA content in injected ACS.

Comparisons of Cytokines, Growth Factors and Clinical Efficacy between Platelet-Rich Plasma and Autologous Conditioned Serum for Knee Osteoarthritis Management

“…While the data of contents indicated that PRP had lower levels of IL-1Ra and may limit its ability for pain relief, it further highlights the role of IL-1Ra in the treatment of knee OA. Leone et al [ 47 ] reported that ACS treatment responders had significantly higher levels of IL-1Ra levels than non-responders, with average concentrations of 930 and 200 pg/mL, respectively. This result is consistent with the present one, while the mean IL-1Ra concentration of PRP and ACS 3 h were 157.9 and 902.9 pg/mL, respectively.…”

“…This result is consistent with the present one, while the mean IL-1Ra concentration of PRP and ACS 3 h were 157.9 and 902.9 pg/mL, respectively. It is interesting to note that Leone et al demonstrated that in patients with knee OA who had failed to prior PRP treatment, the response rate of ACS was 67% [ 47 ]. This is consistent with the results of the present study that ACS has a better efficacy on pain relief compared to PRP.…”

Platelet Rich Plasma Versus Autologous Conditioned Serum in Osteoarthritis of the Knee: Clinical Results of a Five-Year Retrospective Study

“…Treatment with ACS is becoming important in terms of reducing drug side effects and costs. It has been reported in studies that ACS therapy is successful in the treatment of knee OA [ 7 , 8 , 17 - 19 ].…”

Pathogenic Mechanisms and Therapeutic Approaches in Obesity-Related Knee Osteoarthritis

“…Other studies, however, showed higher pain reduction and functional improvement with ACS compared to PRP, likely due to the higher IL-1Ra levels, decrease in IL-1β and improved synovial fluid viscosity [145,146]. Furthermore, it has been found that 67% of subjects with painful knee OA who had failed previous standard therapy, including physiotherapy and PRP, had a reduction of pain assessed on VAS one month after administration of ACS and this result persisted at 6 and 12 months of follow-up [147]. A notable finding from this study was that responders had significantly higher levels of IL-1Ra in their ACS compared to non-responders, underscoring the potential benefits of intra-articular IL-1β blockade in knee OA [147].…”

“…Furthermore, it has been found that 67% of subjects with painful knee OA who had failed previous standard therapy, including physiotherapy and PRP, had a reduction of pain assessed on VAS one month after administration of ACS and this result persisted at 6 and 12 months of follow-up [147]. A notable finding from this study was that responders had significantly higher levels of IL-1Ra in their ACS compared to non-responders, underscoring the potential benefits of intra-articular IL-1β blockade in knee OA [147]. These reports suggest that anti-cytokine therapy could have potential benefits in obesity-related knee OA considering their role in maintaining the low-grade inflammatory state characteristic of obesity, however they are yet to be studied in such conditions.…”