Evaluation of the autologous conditioned serum in the treatment of osteoarthritis

Year 2019, , 94 - 98, 01.08.2019

Bekir Eray Kılınç , Yunus Öç

https://doi.org/10.25000/acem.569936

Cited By: 5

Abstract

Aim: The
present study was a retrospective study aiming to determine the effect of the autologous
conditioned serum (ACS) on osteoarthritis (OA); we made this analysis by
injecting it to a symmetrically involved knee.

Methods: The present
study comprised 33 patients (19 females, 14 males) with 66 knees and a mean age
of 57.6±8.21 (range: 41-70). The patients included in the study
had radiologically verified bilateral grade 2-3 OA of the knee according to
Kellgren-Lawrence classification. Secondary arthritis, inflammatory
joint diseases, clinically relevant hematologic or abnormal clinical chemistry
values, joint instability, intra-articular corticosteroid injection within the
previous 6 months, history of diabetes mellitus and body mass index greater
than 30 kg/m² were the exclusion criteria. Patients who had VAS
difference more than 2 points between their knees were excluded from the study.
ACS was injected twice a week for a total of 6
times in both knee joints for 3 weeks. The
patients were analyzed with the Visual Analog Scale (VAS) (no pain was
graded 0 and maximal pain was graded 10), the
Knee Injury and Osteoarthritis Score (KOOS) (scoring ranges between 0
and 100. 0 indicates abnormally high level of knee problems, while 100
indicates a healthy knee with no problems) and
the Knee Society Score (KSS) (Of the maximum 100 points, a possible 50
points are assigned to pain, 25 points to stability, and 25 points for range of
motion) before the administration of the first
injection and again 1 year after the last injection.

Results: The
pre-treatment and 1-year follow-up VAS values ​​of the patients were 7.36±0.93 (range: 5-9) and 3.27±1.23 (range: 1-6), respectively. ACS treatment showed a statistically
significant decrease in VAS score (p <0.01). Pre-treatment and 1-year
follow-up KOOS values ​​of the patients were 42.39±13.38 (range: 21-65) and 72.36±8.81 (range: 54-92), respectively. There was a
statistically significant increase in the KOOS values of the patients (p
<0.01). The pre-treatment and 1-year follow-up KSS values ​​of the patients
were 42.79±10.26 (range: 14-61) and 70.61±9.32
(range: 49-84), respectively. There was a
statistically significant increase in the KSS values of the patients (p
<0.01).

Conclusion: Intra-articular injection of ACS in patients with painful OA
leads to significant improvements in pain severity, KOOS, KSS and DCS scores. In
the light of these findings, ACS treatment may be considered as an effective
and safe alternative treatment method in osteoarthritis.

Keywords

Intra-articular injection, autologous conditioned serum, knee osteoarthritis

Osteoartrit tedavisinde otolog zenginleştirilmiş serumun değerlendirilmesi

Abstract

Amaç: Çalışmamızda
retrospektif olarak otolog zenginleştirilmiş serum (OZS) tedavisinin osteoartritteki
etkisinin bilateral diz enjeksiyonu ile değerlendirilmesi amaçlanmıştır.

Yöntemler:
Çalışmamıza yaş ortalaması 57.6 ± 8.21 yıl (41-70) olan 33
hasta (19 kadın, 14 erkek) 66 diz dahil edilmiştir. Çalışmamıza katılan
hastaların diz osteoartritleri Kellgren-Lawrence sınıflamasına göre bilateral
olarak evre 2-3 idi. Sekonder artrit, enflamatuar eklem hastalıkları, klinik
olarak ilgili hematolojik veya anormal klinik kimya değerleri, eklem
instabilitesi, son 6 ay içerisinde eklem içi kortikosteroid enjeksiyonu
uygulanan, diabetes mellitus öyküsü, 30 kg/m²'dan büyük vücut kitle indeksi mevcut olan hastalar
çalışmadan dışlandı. Her iki diz arasındaki VAS farklılığı 2 puandan fazla olan
hastalar çalışmadan çıkarıldı. Üç hafta boyunca haftada iki kez toplamda 6 kez her
iki diz eklem içine OZS enjekte edildi. Hastalar VAS ağrı skorlaması (hiç ağrı
olmaması 0 olarak ve maksimum ağrı 10 olarak derecelendirildi), Diz Yaralanması
ve Osteoartirit Skalası (DYOS) (puanlama 0 ile 100 arasında değişmektedir. 0
anormal derecede yüksek diz problemleri gösterirken, 100 problemsiz sağlıklı
bir diz göstermektedir) ve Diz Cemiyeti Skorlaması (DCS) (Maksimum 100 puan
olan skala ağrıya 50, stabiliteye 25 ve eklem hareket açıklığına 25 puan
atanır) skalaları ile ilk enjeksiyon öncesi ve son enjeksiyondan 1 yıl sonra
değerlendirildi.

Bulgular: Hastaların
tedavi öncesi ve 1. yıl takip VAS değerleri sırası ile 7.36±0.93 (aralık: 5-9) ve 3.27±1.23 (aralık:
1-6) idi. OZS tedavisi VAS skorunda
istatistiksel olarak anlamlı düşme göstermiştir (p<0.01). Hastaların tedavi
öncesi ve 1. yıl takip DYOS toplam değerleri sırası ile 42.39±13.38 (aralık:
21-65) ve 72.36±8.81 (aralık: 54-92) idi. Hastaların
DYOS total skorunda istatistiksel olarak anlamlı yükselme saptanmıştır
(p<0.01). Hastaların tedavi öncesi ve 1. yıl takip DCS değerleri sırası ile 42.79±10.26
(aralık: 14-61) ve 70.61±9.32 (aralık: 49-84) idi. Hastaların DCS değerlerinde istatistiksel olarak anlamlı yükselme saptanmıştır
(p<0.01).

Sonuç:
Ağrılı diz osteoartriti olan hastalarda inra-artiküler OZS kullanımı ağrı
şiddeti, DYS, DYOS ve DCS skorları açısından anlamlı iyileşmelere yol
açmaktadır. Bu bulgular ışığında, OZS tedavisi osteoartritte etkili ve güvenli
bir alternatif bir tedavi yöntemi olarak değerlendirilebilir.

Keywords

intra-artiküler enjeksiyon, otolog zenginleştirilmiş serum, diz osteoartriti, diz osteoartriti

References

• 1. Gupta S, Hawker GA, Laporte A, Croxford R, Coyte PC. The economic burden of disabling hip and knee osteoarthritis (OA) from the perspective of individuals living with this condition. Rheumatology (Oxford). 2005;44:1531-7.
• 2. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60:91-7.
• 3. Michael JW, Schlüter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee. Dtsch Arztebl Int. 2010;107:152–62.
• 4. Baltzer A, Moser C, Jansen S, Krauspe R. Autologous conditioned serum (Orthokine) is an effective treatment for knee osteoarthritis. Osteoarthritis Cartilage. 2009;17:152-60.
• 5. Frisbie DD, Ghivizzani SC, Robbins PD, Evans CH, McIlwraith CW. Treatment of experimental equine osteoarthritis by in vivo delivery of the equine interleukin-1 receptor antagonist gene. Gene Ther. 2002;9:12-20.
• 6. Fotouhi A, Maleki A, Dolati S, Aghebati-Maleki A, Aghebati-Maleki L. Platelet rich plasma, stromal vascular fraction and autologous conditioned serum in treatment of knee osteoarthritis. Biomed Pharmacother. 2018;104:652-60.
• 7. Fernandes J, Tardif G, Martel-Pelletier J, Lascau-Coman V, Dupuis M, Moldovan F. et al. In vivo transfer of interleukin-1 receptor antagonist gene in osteoarthritic rabbit knee joints: prevention of osteoarthritis progression. Am J Pathol. 1999;154:1159-69.
• 8. de Ascurra JL, Ehrle A, Einspanier R, Lischer C. Influence of Incubation Time and Incubation Tube on the Cytokine and Growth Factor Concentrations of Autologous Conditioned Serum in Horses. J Equine Vet Sci. 2019;75:30-4.
• 9. Linardi RL, Dodson ME, Moss KL, King WJ, Ortved KF. The effect of autologous protein solution on the inflammatory cascade in stimulated equine chondrocytes. Front Vet Sci. 2019;6:64.
• 10. Rutgers M, Saris DBF, Dhert WJA, Creemers LB. Cytokine profile of autologous conditioned serum for treatment of osteoarthritis, in vitro effects on cartilage metabolism and intra-articular levels after injection. Arthritis Res Ther. 2010;12:R114.
• 11. Chevalier X, Giraudeau B, Conrozier T, Marliere J, Kiefer P, Goupille P. Safety study of intraarticular injection of interleukin 1 receptor antagonist in patients with painful knee osteoarthritis: a multicenter study. J Rheumatol. 2005;32:1317-23.
• 12. Burmester GR, Grifka J. Revision of the recommendations of the Commission on the Pharmacotherapy of the German Society for Rheumatology. Z Rheumatol. 2007;66:83-4.
• 13. Frisbie D, Kawcak C, Werpy N, Park RD, McIlwraith CW. Clinical, biochemical, and histologic effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis. Am J Vet Res. 2007;68:290-6.
• 14. Yang K, Raijmakers NJ, van Arkel ER, Caron JJ, Rijk PC, Willems WJ, et al. Autologous interleukin-1 receptor antagonist improves function and symptoms in osteoarthritis when compared to placebo in a prospective randomized controlled trial. Osteoarthritis Cartilage. 2008;16:498-505.
• 15. Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis. 1957;16:494-501.
• 16. Roos EM, Roos PH, Lohmander LS, Ekdahl C, Beynnon BD. Knee injury and Osteoarthritis Outcome Score (KOOS): Development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;78:88-96.
• 17. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–4
• 18. Freyd M. The graphic rating scale. J Educ Psychol. 1923;14:83-102.
• 19. Goldring MB. Osteoarthritis and cartilage: the role of cytokines. Curr Rheumatol Rep. 2000;2:459-65.
• 20. Goldring SR, Goldring MB. The role of cytokines in cartilage matrix degeneration in osteoarthritis. Clin Orthop Relat Res. 2004;427:27-36.
• 21. Fernandes JC, Martel-Pelletier J, Pelletier JP. The role of cytokines in osteoarthritis pathophysiology. Biorheology. 2002;39:237-46.
• 22. Arend WP, Malyak M, Guthridge CJ, Gabay C. Interleukin-1 receptor antagonist: role in biology. Annu Rev Immunol. 1998;16:27-55.
• 23. Dinarello CA. Interleukin-1 and interleukin-1 antagonism. Blood. 1991;77:1627-52.
• 24. Dinarello CA. The role of the interleukin-1-receptor antagonist in blocking inflammation mediated by interleukin-1. N Engl J Med. 2000;343:732-4.
• 25. Zarringam D, Bekkers J E, Saris DB. Long-term effect of injection treatment for osteoarthritis in the knee by orthokin autologous conditioned serum. Cartilage. 2018;9:140-5.
• 26. Arend WP, Leung DY. IgG induction of IL-1 receptor antagonist production by human monocytes. Immunol Rev.1994;139:71-8.
• 27. Frisbie DD, Kawcak CE, Werpy NM, Park RD, McIIwraith CW. Clinical, biochemical, and histologic effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis. Am J Vet Res. 2007;68:290-6.
• 28. Wright-Carpenter T, Opolon P, Appell HJ, Meijer H, Wehling P, Mir LM. Treatment of muscle injuries by local administration of autologous conditioned serum: animal experiments using a muscle contusion model. Int J Sports Med. 2004;25:582-7.
• 29. Yang KG, Raijmakers NJ, Van Arkel ER, Caron JJ, Rijk PC, Willems WJ, et al. Autologous interleukin-1 receptor antagonist improves function and symptoms in osteoarthritis when compared to placebo in a prospective randomized controlled trial. Osteoarthritis Cartilage. 2008;16:498-505.
• 30. Damjanov N, Barac B, Colic J, Stevanovic V, Zekovic A, Tulic G. The efficacy and safety of autologous conditioned serum (ACS) injections compared with betamethasone and placebo injections in the treatment of chronic shoulder joint pain due to supraspinatus tendinopathy: a prospective, randomized, double-blind, controlled study. Med Ultrason. 2018;20:335-41.
• 31. von Wehren L, Pokorny K, Blanke F, Sailer J, Majewski M. Injection with autologous conditioned serum has better clinical results than eccentric training for chronic Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2019; Mar 21. doi: 10.1007/s00167-019-05465-8.
• 32. Tassara M, De Ponti A, Barzizza L, Zambelli M, Parisi C, Milani R, et al. Autologous conditioned serum (ACS) for intra-articular treatment in Osteoarthritis: Retrospective report of 28 cases. Transfus Apher Sci. 2018;57:573-7.
• 33. Barreto A, Braun R. A new treatment for knee osteoarthritis: Clinical evidence for the efficacy of Arthrokinex™ autologous conditioned serum. J Orthop. 2016;14:4-9.