Association Between Visual Analogue Scale (VAS) and Inflammatory Markers (ESR & CRP) in Patients with Knee Osteoarthritis Before and After Injection with Platelets –Rich Plasma(PRP)

Abstract

Osteoarthritis (OA) are defined as a progressive architecture destruction of the joints compared to slow healing of these joints which leads to reduce protection against degeneration and the movement of the joint is associated with roughness and accompanied by pain. Often this disease affect the knee joint, it may affect any other joints in the body. It is considered the most common disease among people over age 60. The aim of this study is to evaluate the efficacy of platelets-rich plasma injection in treatment of knee osteoarthritis and estimation of the biological and immunological markers associated with the treatment. This study involved 50 patients suffering from inflammation of the knee joint, most of these patients attended Al-Shaheed Firooz hospital in wasit Governorate and private Clinics of Orthopedic and Rheumatology in the district during the period from April 2015 until October 2015. Diagnosis of OA was done according to kellgren and Lawrance system.The age range of patients was 35 - 65 years; 31 females and 19 males. All patient groups were injected in the knee joint by a specialist physician with two injections (Two week apart) during one month with platelets-rich plasma (PRP) after its preparation from the same patient's blood in a sterile condition. This was done after the signing of the patient or one of his relatives on the written consent to conduct the injection process after explaining and clarifying the principle of injection and the purpose.The level of pain to patients group was measured by Visual Analogue Scale (VAS). The enzyme linked immunnosorbant assay (ELISA) was applied to estimate the concentration of C.Reactive protein in serum of patients group as well as healthy control the rate of Erythrocyte Sedimentation Rate (ESR) was also estimated .All these tests were done to all patients groups before and after injections with PRP. Statistical analysis showed no significant differences between males and females ages (54.5±1.2 males, 53.2±2.1 females).The study showed significant decrease in the mean of the Visual Analogue Scale (VAS) of patients before and after injections with (PRP) 5.98 ± 0.129,8.46 ± 0.104, respectively, with highly significant differences (P=000.0) , also the study showed that there was a differences with no significant differences in VAS between age groups (30ʹs, 40ʹs, 50ʹs , 60ʹs) before and after injections with PRP (7.5,8.0 ,8.38 ,9.05), (5.0,5.55,5.69,6.7) respectively.The study also revealed a difference in the mean for inflammatory marker C. reactive protein concentration before and after injections with PRP (7.156± 0.328 µg/ml, 5.384± 0.196) respectively, with highly significant differences (P=0.000).The study also revealed a difference in the mean of ESR before and after injections with PRP (35.66± 0.879 mm/1hr, 23.7±0.856) (respectively), with highly significant differences (P=0.000). Positive correlation were obtained between VAS score and CRP as well as ESR after treatment.

Keywords: Osteoarthritis, PRP, VAS score, ESR, CRP