Platelet Rich Plasma for Treatment of Rheumatoid Arthritis: Case Series and Review of Literature

Abstract

Platelet-rich plasma (PRP) is an autologous blood product with platelets above circulating levels and releases several growth factors after activation. PRP may help to decrease joint inflammation by modulating synovial cell proliferation and differentiation and inhibition of catabolic pathways in various articular conditions. Though PRP has shown good efficacy in osteoarthritis and other musculoskeletal conditions such as synovitis, epicondylitis, skeletal muscle injuries, and tendinopathy, there is limited experience for the use of PRP in patients with rheumatoid arthritis. Precise mechanisms of action of PRP are not known. We present clinical experience for treatment with PRP (2–4 ml) in four patients with rheumatoid arthritis who had inadequate response and persistent pain and inflammation with intra-articular steroids. Irrespective of past and ongoing treatments and duration of disease, all patients showed improvement in the visual analog scale and disease activity score of 28 joints at 4 and 8 weeks after injection. There was an improvement in joint inflammation on ultrasound imaging in some patients. These effects were sustained for up to 1 year. No adverse effects were reported in any patient. PRP may be a safe and useful therapy in patients with rheumatoid arthritis who fail to respond to one or more established treatment options.

PRP in acromio-clavicular joint arthritis – A prospective analysis

“…Starting with tendinopathies it has been tried in managing wound complications and as a means of postponing surgery in degenerative conditions like osteoarthritis of knee. [13][14][15] PRP is a cocktail with supraphysiological levels of platelets. 16 These when activated release a high concentration of various growth factors including but not limited to basic fibroblast growth factor, transforming growth factor, vascular endothelial growth factor, plateletderived growth factor, and epidermal growth factor among others.…”

Moving toward targeting the right phenotype with the right platelet-rich plasma (PRP) formulation for knee osteoarthritis

“…Badsha et al recently revealed proof of concept of the immunomodulatory effects of PRP in four RA patients 54 ; ultrasound evidenced clinical improvement and amelioration of joint inflammation. A placebo-controlled trial in OA patients revealed a reduction in plasma concentrations of inflammatory and proangiogenic factors (investigative biomarkers) compared with controls.…”

Cell Therapy: Types, Regulation, and Clinical Benefits

“…Albeit to a less documented extent than BM-MSCs, ADSCs have also shown a promising potential as a cell therapy for the treatment of immune system disorders, such as GVHD, Crohn's disease, psoriasis, and SS ( 282 – 285 ). Other cell-based therapies with less reported benefits in immune diseases include PRP, which has been shown to reduce pain and inflammation with ultrasound imaging evidence in patients with RA ( 286 ), and Tregs, which have been shown to reduce the incidence of acute GVHD ( 287 ). DCs are another type of immunotherapies exploited in the treatment of patients with immune system disorders.…”