Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease whose hallmark feature is a persistent symmetric polyarthritis (synovitis) that affects the hands and feet (see the image below).
Any joint lined by a synovial membrane may be involved, however, and extra-articular involvement of organs such as the skin, heart, lungs, and eyes can be significant. RA is theorized to develop when a genetically susceptible individual experiences an external trigger (eg, cigarette smoking, infection, or trauma) that triggers an autoimmune reaction. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.
Extra-articular involvement of organs such as the skin, heart, lungs, and eyes can be significant.
The inflammation associated with rheumatoid arthritis is what can damage other parts of the body as well. While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities.
Optimal care of patients with RA requires an integrated approach that includes nonpharmacologic therapies and pharmacologic agents such as nonbiologic and biologic disease-modifying antirheumatic drugs (DMARDs), nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, and corticosteroids.
Early therapy with DMARDs has become the standard of care; it not only can more efficiently retard disease progression than later treatment but also may induce more remissions. Many of the newer DMARD therapies, however, are immunosuppressive in nature, leading to a higher risk for infections.
New perspective to treat Rheumatoid Arthritis
Autologous platelet-rich plasma (PRP) injection is a safe biological method used to treat various musculoskeletal diseases. By downregulation of inflammatory cytokines and stimulation of synovial fibroblasts, PRP injection is a promising adjunctive treatment for patients with chronic autoimmune inflammatory diseases such as rheumatoid arthritis. A major problem in comparing the results of clinical trials in this area is the considerable variability in the cytokine content of PRP.
Platelets have immunomodulatory properties. In RA, their number and activation correlates with the disease activity. The proinflammatory products released in RA and the products of articular cartilage degradation lead to recruitment and dysregulated activation of platelets. There also exists a crosstalk between the immune cells and platelets by which platelets modulate both innate and adaptive immunity.
What are the results of this therapy?
Animal studies on pigs, rats , and mice have shown excellent results in preclinical studies, improving clinical and histological inflammation.
William Murell and his colleagues performed a clinical study in four patients with rheumatoid arthritis who had inadequate response and persistent pain and inflammation with intra-articular steroids.
Irrespective of past and ongoing treatments and duration of disease, all patients showed improvement in the visual analog scale and disease activity score of 28 joints at 4 and 8 weeks after injection.
There was an improvement in joint inflammation on ultrasound imaging in some patients. These effects were sustained for up to 1 year. No adverse effects were reported in any patient.
In this study the researchers used a 2-4ml of PRP in a very small sample, larger clinical studies are needed to establish the adequate dose to treat this chronic inflammation disease.
Humeira Badsha , Ghita Harifi , William D Murrell (January 31, 2022). Platelet Rich Plasma for Treatment of Rheumatoid Arthritis: Case Series and Review of Literature. National Library of Medicine. Retrieved from : https://pubmed.ncbi.nlm.nih.gov/32082684/
Photo by Towfiqu barbhuiya on Unsplash