“Platelet-rich plasma holds promise in management of rheumatoid arthritis”—systematic review

Abstract
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 infammation
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 efects 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 infammation on the whole. Available animal studies and the Human study
have shown encouraging results. There has been no evidence of exacerbation of infammation in these studies. The quantity
and quality of literature on the efects of PRP in treating joint pathologies in RA is limited. Preclinical studies show decrease
in disease activity with good safety profle. Invitro studies show suppression of infammation. 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.