Background The investigations of the platelet-derived biologic agents in osteoarthritis treatment had shown promising but often controversial results.

Objectives To study the efficacy (in clinic & experiment) & safety (in clinic) of the platelet autologous plasma (PAP) in cartilage repair and treatment of early knee OA.

Methods The study was conducted at the Department of Family Medicine and Traumatology and Orthopedic Department and consisted of 2 parts: experimental (20 rabbits with the traumatic damage of the knee cartilages) and clinical (included 146 patients with diagnosed knee OA (radiological stage I-II). Rabbits were randomly divided in 4 groups: in 1st and 2nd grs. 10 animals received 3 intra-articular injections of PAP (on 5th,7th,14th day after knee trauma) as a control (gr.3 and 4) 10 rabbits received 3 intra-articular injections of 0,9% NaCl at the same days after trauma; histopathology was performed at 45th (1st and 3rd gr.) & at 90th day (2nd and 4th gr.) after trauma. 146 patients - 58 men (39.7%) & 88 women (60.3%), were divided into 2 grs. Gr.1 included 68 patients who consented to receive standard OA treatment and 3 weekly intra-articular injections of PAP (total 2 courses in 12 months) (plasma volume 12–15ml/course, total platelets number per injection 1260,24±22,1x10⁹); Gr.2 consisted of 78 patients with the same diagnosis who received only standard OA treatment (non-steroidal anti-inflammatory drugs, physiotherapy, exercises). Both groups were of comparable age, gender and initial WOMAC data (Gr.1 40,9±0,7 Gr.2 39,7±0,9, p>0,05). WOMAC scale parameters were analyzed before treatment and after 3 weeks; 6 & 12 months after course of treatment in both groups.

Results In animals histopathology has found better repair, ↓ inflammation, better structure of the knee cartilage after PAP injections comparing with the control groups animals; in addition in 3rd group of rabbits ↓ signs of early posttraumatic osteoarthritis were found (comparing to 4th gr.).

Clinical study demonstrated better changes in pain, stiffness and function in 3 weeks after treatment in patients of Gr.1 comparing to Gr.2 (WOMAC had decreased by 35.8% in Gr.2 and by 74.1% in Gr.1), p<0,05.

After 6 months of follow-up (before 2 course of PAP treatment), the mean number of OA exacerbations was (0,7±0,02) in Gr.1 & (1,6±0,04) in Gr.2 (p<0,05) and general WOMAC index in Gr.1 was significantly lower than in Gr.2 (accordingly (22,8±0,3) and (36,5±0,8); p<0,05).

In the next 6 months again patients in Gr.1 had less exacerbations (0,51±0,03) then patients in Gr.2 (1,4±0,03),p<0,05; & better WOMAC performance (Gr.1-(17,5±0,6 & Gr.2–37,1±0,5 accordingly,p<0,05).

1. Histopathology of the knee cartilage has shown promising results concerning possibility of cartilage repair after trauma and prophylaxis of the early posttraumatic OA after PAP injections in animal model.

2. Repeating intra-artricular injections of PAP, added to the standard care in knee OA improves functional activity, reduces pain and number of OA exacerbations in 12 months of follow up.

3. The further studies (both experimental and clinical) are needed to obtain more accurate information and determine the most effective methods of PAP use in OA patients.

References

1. Autologous platelet-rich plasma (PRP) in osteoarthritis treatment [sat0462]. L. Smolina, L. Khimion, EULAR-2016. London, GB, (Suppl2): 838.

References

Disclosure of Interest None declared