Platelet-rich Plasma and Synovial Cytokines in Knee Osteoarthritis
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      A prospective study was performed on 90 patients were included and categorized into mild (30
      cases, moderate (30 cases) and severe (30 cases) knee OA. Three intra-articular (I.A)
      injections of PRP, 2 weeks a part, were received. Pain score and MRI Osteoarthritis Knee
      Score (MOAKS) were assessed. Serial synovial fluid cytokines assays in the form of Tumor
      necrosis factor-α (TNF-α) and Macrophage migration inhibitory factor (MIF), were performed
      using commercially available ELISA assay kits. The assays were performed pre-injection (S1),
      two weeks from the 1st I.A injection and two weeks from the 2nd I.A injection (S3) for all
      included patients.
    

Detailed description: 
      Background: Osteoarthritis (OA) is a multifactorial disease that commonly affects the knee.
      Tumor necrosis factor-α (TNF-α) is able to regulate inflammation in OA. Macrophage migration
      inhibitory factor (MIF) may be involved in the pathophysiology of arthritis. Platelet-rich
      plasma (PRP) may reduce pain associated with OA. The current study aimed to assess the
      possible therapeutic effects of PRP in patients with knee OA of various severities.

      Methods: A prospective study was performed on 90 patients were included and categorized into
      mild (30 cases, moderate (30 cases) and severe (30 cases) knee OA. Three intra-articular
      (I.A) injections of PRP, 2 weeks a part, were received. Pain score and MRI Osteoarthritis
      Knee Score (MOAKS) were assessed. Serial synovial fluid cytokines assays in the form of Tumor
      necrosis factor-α (TNF-α) and Macrophage migration inhibitory factor (MIF), were performed
      using commercially available ELISA assay kits. The assays were performed pre-injection (S1),
      two weeks from the 1st I.A injection and two weeks from the 2nd I.A injection (S3) for all
      included patients.

      PRP preparation: The PRP needed for IA injection has been prepared under complete aseptic
      conditions. In order to avoid the effect of food intake on purified PRP, on the day of
      injection the patients were instructed to fast for 4 hours before blood collection.
      Approximately 20 mL of venous blood were drawn from the antecubital vein using an aseptic
      technique in an effort to avoid irritation and trauma to the platelets. Anti-coagulated blood
      was obtained in ten extraction tubes (2 mL each), containing sodium citrate. The tubes were
      then centrifuged at 2100 rpm at room temperature for 8 minutes to separate the blood in each
      tube into the citrated plasma, the buffy coat and the residual red blood cells ( RBCs) .
      Using a pipette, the PRP situated just above the selectively precipitated RBCs but not
      including the buffy coat was carefully aspirated from each tube. In each affected joint,
      10-mL PRP samples (from the collected venous blood) were used for IA injection . For each
      intra-articular injection new fresh PRP samples were made from the patients.
    

Intervention name(s): Intra-articular injection of platelet-rich plasma
Intervention type(s): Drug
Intervention description(s): The patient was put in 20 degree flexion in supine position with the knee. Under aseptic conditions, a 21-gage needle was used to inject 5 mL of PRP into the suprapatellar knee joint pouch, using a superolateral method. Local anesthetics were not used. Patients were instructed after the injection to refrain from physical exercise for at least 24 hours but no restriction was specified regarding activities of daily living. Three IA-PRP injections were administered at 2-week intervals. The same physician who was engaged in selecting and testing participants did the injections
Other intervention name(s): PRP injection
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A prospective study was performed on 90 patients were included and categorized into mild (30 cases, moderate (30 cases) and severe (30 cases) knee OA. Three intra-articular (I.A) injections of PRP, 2 weeks a part, were received. Pain score and MRI Osteoarthritis Knee Score (MOAKS) were assessed. Serial synovial fluid cytokines assays in the form of Tumor necrosis factor-α (TNF-α) and Macrophage migration inhibitory factor (MIF), were performed using commercially available ELISA assay kits. The assays were performed pre-injection (S1), two weeks from the 1st I.A injection and two weeks from the 2nd I.A injection (S3) for all included patients.
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Platelet rich plasma; Knee osteoarthritis; MRI Osteoarthritis Knee Score; pain score; synovial fluid; tumor necrosis factor-α; macrophage migration inhibitory factor