Rheum in Review: Platelet-rich Plasma, Fall Prevention, Disability in RA, and More

Here are the top stories covered by DocWire News this week in the Rheumatology section. In this edition, read the latest research on platelet-rich plasma in rheumatology, how functional disability status differs based on rheumatoid arthritis status, a new strategy to minimize fall risk in older adults, and whether lower pressure tourniquet is effective in total knee arthroplasty.

A few recent studies have evaluated the efficacy of platelet-rich plasma (PRP) in musculoskeletal disease and rheumatic diseases such as osteoarthritis (OA). PRP treatment is performed by taking a patient’s own platelets from their blood. The platelets undergo centrifugation to increase their concentration, and the platelets are then mixed with the blood again. A systematic review recently published in Sports Health: A Multidisciplinary Approach evaluated 78 randomized controlled trials with a total of 5,308 patients; the trials compared platelet-rich therapy to a control in patients with musculoskeletal bone, cartilage, or soft tissue injuries. PRP was associated with reduced pain at three months (standardized mean difference [SMD], –0.34; 95% CI, –0.48 to –0.20) and one year (SMD, –0.60; 95% CI, –0.81 to –0.39). Low-to-moderate quality evidence supported the use of PRP in lateral epicondylitis (SMD, –0.69; 95% CI, –1.15 to –0.23) and knee OA (SMD, –0.91; 95% CI, –1.41 to –0.41) at one year. A study featured in the Journal of Back and Musculoskeletal Rehabilitation also supported the use of PRP in OA, associating its use with reduced visual analog scale scores and McMaster University Osteoarthritis Index pain sub-scores.

Rheumatoid arthritis (RA) patients are significantly more likely to have functional disability compared to patients without RA, and activities of daily living (ADL) may be impacted even before an RA diagnosis is received. Patients self-reported ADL they were able to perform without assistance during routine Mayo Clinic visits, including feeding oneself, dressing, using the toilet, bathing, walking, and housekeeping. Final analysis included 586 RA patients and 531 controls; each group filled out 4,301 and 3,145 questionnaires, respectively, for a total of 7,446 total completed questionnaires. RA patients were significantly more likely to report difficulty with at least one ADL than non-RA patients at the RA incidence/index date (26% vs. 11%, respectively; P < 0.001). They also had higher rates of difficulty with two or more ADL (13% vs. 5%, respectively; P < 0.001). RA patients reported ADL difficulties up to two years before they received their RA diagnosis. Women had higher functional disability rates than men in both the RA (P < 0.001) and non-RA (P = 0.04) cohorts.

Total knee arthroplasty (TKA) patients may have similar blood loss outcomes with lower tourniquet pressure compared to conventional tourniquet pressure, a recent study found. Lower tourniquet pressure was defined as systolic blood pressure (SBP) + 120 mmHg, and conventional was SBP + 150 mmHg. A total of 160 patients undergoing TKA for advanced knee OA were randomized to receive conventional tourniquet pressure (n = 80) or lower tourniquet pressure (n = 80). Median age was similar in the conventional (71 years) and lower pressure (71.8 years) groups, and both cohorts were mostly female (91% and 85%, respectively). The conventional group had a 100% bloodless surgical field rate, and the lower pressure group had a 99% rate. In the one case where bloodless surgical field was not achieved, the patient received a 30 mmHg increase in tourniquet pressure. Intraoperative blood oozing occurred in the conventional (n = 1) and lower pressure (n = 2).

Fall-related deaths in older Americans are increasing. A recent study evaluated the efficacy of an in-home exercise program to help prevent future falls in patients with a history of falling. Patients aged ≥ 70 years who had sustained a fall within the last year received either usual care in conjunction with an in-home strength and balance retraining exercise program with a physical therapist (intervention group, n = 173) or usual care alone, which was fall prevention care with a geriatrician (usual care group, n = 172). Patients self-reported their number of falls during the intervention period. Out of 345 total patients (mean age, 81.6 years; 67% female), 296 (86%) finished the trial. There were a total of 236 falls involving 172 intervention group patients, and 366 falls in 172 usual care patients. The absolute fall incidence difference was 0.74 (95% CI, 0.04-1.78; P = 0.006) falls per person-year; the incident rate ratio was 0.64 (95% CI, 0.46-0.90; P = 0.009).