Chellamuthu Girinivasan, Muthu Sathish, Khanna Manish, Khanna Venus
Orthopaedic Research Group, Coimbatore, India.
Indian Stem Cell Study Group, Lucknow, India.
Rheumatol Int. 2021 Nov;41(11):1895-1903. doi: 10.1007/s00296-021-04849-9. Epub 2021 Apr 8.
The treatment of rheumatoid arthritis (RA) has been closely evolving with an understanding of disease pathogenesis with disease modifying anti-rheumatoid drugs (DMARDS) and Biologic DMARDS being the main stay. platelet rich plasma (PRP) has been the center of research in many specialties in the past decade. Its ability to stop and reverse inflammation have attracted researchers to try PRP in RA. A systematic review of studies on PRP in RA is lacking. The study protocol was prospectively registered in PROSPERO. Detailed search of Cochrane, Scopus, Medline, Embase, and Web of science databases were made to identify the relevant articles till Sep 2020 following Cochrane and PRISMA guidelines. Number of subjects, Animal model used, cell lines used for the study, method of induction of arthritis, PRP dose, concentration used, frequency of administration and clinical, histologic, and molecular changes from baseline following PRP use were extracted and analysed. Eight studies were included for the review. Four of these were in-vitro studies. Two were exclusive animal studies. One study analysed the effects of PRP in RA in both animal models (mice) and Hela cell lines. One study was a report of a series of patients of resistant RA treated with PRP. In the in vitro studies while platelets increase the migration and invasion of RA-FLS, they suppressed the inflammation on the whole. Available animal studies and the Human study have shown encouraging results. There has been no evidence of exacerbation of inflammation in these studies. The quantity and quality of literature on the effects of PRP in treating joint pathologies in RA is limited. Preclinical studies show decrease in disease activity with good safety profile. Invitro studies show suppression of inflammation. Thus, the available literature is encouraging towards the use of PRP in RA. Larger trials and molecular studies to understand the exact role of platelets in disease pathogenesis and treatment mechanisms are needed to decide the future course of PRP in RA.
类风湿关节炎（RA）的治疗一直随着对疾病发病机制的认识而不断发展，改善病情抗风湿药（DMARDs）和生物DMARDs是主要治疗手段。在过去十年中，富血小板血浆（PRP）一直是许多专业领域的研究核心。其阻止和逆转炎症的能力吸引了研究人员尝试将PRP用于RA治疗。目前缺乏对PRP治疗RA的研究进行系统评价。该研究方案已在国际前瞻性系统评价注册库（PROSPERO）中进行了前瞻性注册。按照Cochrane和PRISMA指南，对Cochrane、Scopus、Medline、Embase和科学网数据库进行了详细检索，以识别截至2020年9月的相关文章。提取并分析了研究对象数量、所用动物模型、用于研究的细胞系、关节炎诱导方法、PRP剂量、所用浓度、给药频率以及PRP使用后与基线相比的临床、组织学和分子变化。纳入八项研究进行综述。其中四项为体外研究。两项为单纯动物研究。一项研究分析了PRP在动物模型（小鼠）和人宫颈癌细胞系（Hela）中对RA的影响。一项研究是关于一系列接受PRP治疗的难治性RA患者的报告。在体外研究中，虽然血小板增加了类风湿关节炎成纤维样滑膜细胞（RA-FLS）的迁移和侵袭，但总体上它们抑制了炎症。现有的动物研究和人体研究均显示出令人鼓舞的结果。这些研究中没有炎症加重的证据。关于PRP治疗RA关节病变效果的文献数量和质量有限。临床前研究显示疾病活动度降低且安全性良好。体外研究显示炎症受到抑制。因此，现有文献对于在RA中使用PRP是令人鼓舞的。需要进行更大规模的试验和分子研究，以了解血小板在疾病发病机制和治疗机制中的确切作用，从而确定PRP在RA治疗中的未来发展方向。
