Shively Dana, Amin Neel
Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, USA.
Anesthesiology and Pain Management, University of Washington, Seattle, USA.
Cureus. 2021 Nov 16;13(11):e19629. doi: 10.7759/cureus.19629. eCollection 2021 Nov.
Rheumatoid Arthritis (RA) is a chronic disease characterized by severe inflammation that leads to degradation of articular cartilage and the formation of bony erosions. Currently, certain anesthesiologist-led pain management clinics have begun to take on a collaborative role in the treatment of patients with RA, as this progressive disease impairs work capacity due to chronic pain. We present three clinical cases in which platelet-rich plasma (PRP) was used for the treatment of RA in patients seeking a new therapy for pain control and improved range of motion, specifically in certain joints of the hand. The Patient Activity Scale II was employed as a standardized method to assess RA disease severity, recorded on the day of injection, at one month, at three months, and at six months. All of the included patients, ages 49, 60, and 63, had an established diagnosis of RA affecting the proximal interphalangeal and metacarpophalangeal joints of the hand. Over the course of six months, two out of three patients reported a 20% reduction in pain from the initial visit and a 30% improvement in overall well-being. The third patient noted a 50% decrease in pain from the initial visit and a 50% improvement in overall well-being. PRP treatment consistently resulted in functional improvement for each of the three patients treated, while also reducing long term pain and inflammation. Initial clinical and laboratory studies have shown that autologous plasma rich in platelets serves as a source of an abundance of growth factors once activated. The multitude of these growth factors injected into and around the diseased joints improves functionality in patients with RA indicating PRP may be a safe and beneficial therapy in patients with RA primarily affecting the joints of the hand.
类风湿性关节炎(RA)是一种慢性疾病,其特征是严重炎症,可导致关节软骨退化和骨侵蚀形成。目前,一些由麻醉医生主导的疼痛管理诊所已开始在RA患者的治疗中发挥协作作用,因为这种进展性疾病会因慢性疼痛而损害工作能力。我们介绍三例临床病例,其中富血小板血浆(PRP)被用于治疗寻求新的疼痛控制和改善活动范围(特别是手部某些关节)疗法的RA患者。采用患者活动量表II作为评估RA疾病严重程度的标准化方法,在注射当天、1个月、3个月和6个月时进行记录。所有纳入患者年龄分别为49岁、60岁和63岁,均已确诊RA,累及手部近端指间关节和掌指关节。在六个月的时间里,三名患者中有两名报告称,与初次就诊相比疼痛减轻了20%,总体健康状况改善了30%。第三名患者指出,与初次就诊相比疼痛减轻了50%,总体健康状况改善了50%。PRP治疗始终使三名接受治疗的患者的功能得到改善,同时还减轻了长期疼痛和炎症。初步临床和实验室研究表明,富含血小板的自体血浆一旦被激活,就可作为大量生长因子的来源。将这些大量生长因子注射到患病关节及其周围,可改善RA患者的功能,这表明PRP可能是主要影响手部关节的RA患者的一种安全有益的治疗方法。