Andia Isabel, Atilano Leire, Maffulli Nicola
Regenerative Therapies, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Plaza Cruces 12, Barakaldo, Bizkaia, 48903, Spain.
Regenerative Therapies, Biocruces Bizkaia Health Research Institute, Interventionist Radiology Unit, Department of Radiology, Cruces University Hospital, Barakaldo, Bizkaia, 48903, Spain.
Ther Adv Musculoskelet Dis. 2021 Mar 29;13:1759720X211004336. doi: 10.1177/1759720X211004336. eCollection 2021.
Intra-articular injections of platelet-rich plasma (PRP) and other novel blood-derived products developed specifically for osteoarthritis (OA) can provide pain relief and potential benefits in disease progression. Meta-analyses show the clinical superiority of PRP compared with other intra-articular injections, but results are modest and the effect sizes are small. PRP injections in knee OA are performed indiscriminately, but the clinical response varies enormously between patients because of an array of mixed OA phenotypes. Subgroup analyses are scarce; some studies stratify patients according to radiographic severity and found better results in early OA, without consensus for more advanced stages of the condition. Parallel identification of soluble and imaging biomarkers is essential to personalise and leverage PRP therapies. The inflammatory phenotype is most interesting from the PRP perspective because PRPs modulate inflammation by releasing a large pool of chemokines and cytokines, which interact with synovial fibroblasts and macrophages; in addition, they can modulate the innate immune response. No soluble biomarkers have been discovered that have implications for OA research and PRP interventions. Clinical examination of patients based on their inflammatory phenotype and imaging identification of pain sources and structural alterations could help discern who will respond to PRP. Synovial inflammation and bone marrow lesions are sources of pain, and intra-articular injections of PRP combined with subchondral bone injection can enhance clinical outcomes. Further refining ultrasound phenotypes may aid in personalising PRP therapies. Intra-articular delivery combined with injections in altered ligamentous structures, medial and coronal ligaments or premeniscal pes anserinus showed positive clinical outcomes. Although the evidence supporting these approaches are weak, they merit further consideration to refine PRP protocols and target the right OA phenotypes.
关节内注射富含血小板血浆（PRP）以及专门为骨关节炎（OA）研发的其他新型血液衍生产品，可缓解疼痛并对疾病进展产生潜在益处。荟萃分析表明，与其他关节内注射相比，PRP具有临床优势，但结果并不显著，效应量较小。膝关节OA的PRP注射应用广泛，但由于OA表型各异，患者的临床反应差异极大。亚组分析较少；一些研究根据影像学严重程度对患者进行分层，发现早期OA的效果更好，但对于病情更严重阶段尚无共识。同时识别可溶性和影像学生物标志物对于个性化和优化PRP治疗至关重要。从PRP的角度来看，炎症表型最为有趣，因为PRP通过释放大量趋化因子和细胞因子来调节炎症，这些因子与滑膜成纤维细胞和巨噬细胞相互作用；此外，它们还可以调节先天免疫反应。尚未发现对OA研究和PRP干预有意义的可溶性生物标志物。根据患者的炎症表型进行临床检查以及通过影像学识别疼痛来源和结构改变，有助于判断谁会对PRP产生反应。滑膜炎症和骨髓损伤是疼痛来源，关节内注射PRP联合软骨下骨注射可改善临床疗效。进一步完善超声表型可能有助于PRP治疗的个性化。关节内注射联合在改变的韧带结构、内侧和冠状韧带或半月板前鹅足处注射，显示出积极的临床效果。尽管支持这些方法的证据不足，但它们值得进一步考虑，以完善PRP方案并针对正确的OA表型。
