Faculty of Continuing Education, Rīga Stradiņš University, Riga, Latvia.
"ORTO klinika" Ltd., Riga, Latvia.
J Orthop Surg Res. 2020 Jul 10;15(1):257. doi: 10.1186/s13018-020-01753-z.
Osteoarthritis is the most prevalent type of arthritis, which significantly impacts the patient's mobility and quality of life. Pharmacological treatments for osteoarthritis, such as corticosteroids, produce an immediate reduction of the patient's pain as well as an improvement in the patient's mobility and quality of life, but with a limited long-term efficacy. In this context, platelet-rich plasma (PRP) infiltrations represent a therapeutic tool due to its trophic properties and its ability to control inflammatory processes, especially in musculoskeletal applications. The aim of this study is to evaluate and compare the clinical benefits of PRP when injected intra-articularly vs a commonly used corticosteroid (CS, triamcinolone acetonide, Kenalog®) in patients affected by mild to moderate symptomatic knee osteoarthritis.
Forty patients affected by symptomatic radiologically confirmed knee osteoarthritis (Kellgren-Lawrence grades II-III) were enrolled in this randomized study. Patients randomized in the PRP group (n = 20) received an intra-articular injection of PRP (8 mL) while patients randomized in the CS group (n = 20) received an intra-articular injection of triamcinolone acetonide (1 mL of 40 mg/mL) plus lidocaine (5 mL of 2%). The pain and function of the target knee were evaluated by the VAS, IKDC, and KSS scales at the baseline (V1), 1 week (V2), 5 weeks (V3), 15 weeks (V4), 30 weeks (V5), and 1 year (V6) after treatment.
No serious adverse effects were observed during the follow-up period. A mild synovitis was registered in 15 patients (75%) in the PRP group within the first week after treatment which resolved spontaneously. Both treatments were effective in relieving pain and improving the knee function in the very short-term follow-up visit (1 week). A high improvement of the subjective scores was observed for both groups up to 5 weeks, with no significative differences between the groups for the VAS, IKDC, or KSS. After 15 weeks of follow-up, the PRP group showed significative improvements in all scores when compared to the CS group. Overall, the patients who received PRP treatment had better outcomes in a longer follow-up visit (up to 1 year) than those who received CS.
A single PRP or CS intra-articular injection is safe and improves the short-term scores of pain and the knee function in patients affected by mild to moderate symptomatic knee OA (with no significant differences between the groups). PRP demonstrated a statistically significant improvement over CS in a 1-year follow-up. This study was registered at ISRCTN with the ID ISRCTN46024618.
骨关节炎是最常见的关节炎类型，它会显著影响患者的活动能力和生活质量。治疗骨关节炎的药物，如皮质类固醇，能立即减轻患者的疼痛，改善患者的活动能力和生活质量，但长期疗效有限。在这种情况下，富血小板血浆（PRP）渗透治疗因其营养特性和控制炎症过程的能力而成为一种治疗工具，尤其是在肌肉骨骼应用中。本研究旨在评估和比较 PRP 与常用皮质类固醇（曲安奈德，得宝松）关节内注射治疗轻中度症状性膝骨关节炎患者的临床疗效。
本随机研究纳入了 40 例症状性放射学确诊的膝骨关节炎（Kellgren-Lawrence 分级 II-III）患者。将患者随机分为 PRP 组（n=20）和 CS 组（n=20）。PRP 组患者接受关节内注射 PRP（8 mL），CS 组患者接受关节内注射曲安奈德（1 mL 40 mg/mL）加利多卡因（5 mL 2%）。在基线（V1）、1 周（V2）、5 周（V3）、15 周（V4）、30 周（V5）和 1 年（V6）时，采用 VAS、IKDC 和 KSS 量表评估目标膝关节的疼痛和功能。
在随访期间未观察到严重不良事件。PRP 组有 15 例（75%）患者在治疗后第 1 周出现轻度滑膜炎，自行消退。两种治疗方法在短期随访（1 周）时均能有效缓解疼痛，改善膝关节功能。两组患者的主观评分在 5 周内均有较高的改善，两组间 VAS、IKDC 或 KSS 评分无显著差异。15 周随访后，与 CS 组相比，PRP 组所有评分均有显著改善。总的来说，接受 PRP 治疗的患者在较长的随访期（长达 1 年）内的疗效优于接受 CS 治疗的患者。
单次 PRP 或 CS 关节内注射是安全的，能改善轻中度症状性膝骨关节炎患者的短期疼痛评分和膝关节功能（两组间无显著差异）。PRP 在 1 年随访时的效果明显优于 CS。本研究在 ISRCTN 注册，编号为 ISRCTN46024618。
