Pilot Synovial Fluid Molecular/Stem Cell Response to PRP in Knee Osteoarthritis: Clinical & Imaging Outcome Correlation

This is an interventional basic science trial for Knee Osteoarthritis focused on measuring Knee Osteoarthritis, Platelet Rich Plasma, Mechanism of Action, Stem Cells, Synovial Fluid Read More

Inclusion Criteria:

1. Early/Mild to Moderate Stage knee osteoarthritis (KOA), as determined by Kellgren-Lawrence Grade 2 to 3 on PA standing radiograph within the past three months;

   • A prospective subject who has a diagnosis of non-end stage KOA (i.e., a potential study candidate) and expresses interest in participating but has no XRAY within the specified time-period will be sent for a fresh XRAY. This XRAY will be read by a radiologist & be paid for by the study.
2. >=40 years of age;

3. Average 100-point VAS score of >50, on average, within the past 3 months*, with KOA felt to be the primary contributor to pain.

   • Alternate 10-point scales with pain scores averaging >5 may be considered if the prospective subject also completes a VAS with score >50 at screening.
4. Exam consistent with KOA being primary etiology of pain;
5. No signs of inflammatory arthropathy in medical record, history or physical examination;
6. A >3 millimeter intra-articular (IA) effusion present on ultrasound evaluation.
7. [If a chronic liver or renal disease patient, evidence of stable disease over/within the past six months, else exclusion.]
8. Veteran receiving care at McGuire VAMC.

Exclusion Criteria:

1. Morbid obesity (BMI >40);
2. Poorly controlled diabetes (hemoglobin A1C > 7.5 or fasting blood glucose of >200) in last 6 months;
3. Ipsilateral knee surgery, trauma within last 6 months, or corticosteroid injection within 3 months.
4. 4. History of inflammatory arthropathy (RA, SLE or crystalline arthritis of the knee)**;
5. Any rheumatoid arthritis or gout diagnosis is exclusionary.
6. Current infection of the affected joint or any other uncontrolled or untreated active infection.

7. Moderate to severe anemia (hemoglobin < 11 g/dl) or thrombocytopenia (platelet count < 100,000); Hemoglobin >17 g/dl or <11 g/dl and/or platelet counts >500,000 or <100,000 platelets/μl.

   • [CBC obtained within 6 months will be required, even if obtained at initial screening visit.]

8. Individuals on dialysis, with liver failure, or uncontrolled renal or liver disease are excluded.

   • In those with chronic renal or liver disease, documentation of stable disease within the most recent 6 months will be required.

9. Individuals on a therapeutic anticoagulant (e.g., Warfarin, Dabigatran, Enoxaparin) and those with a history of coagulopathy are excluded.

   • Per standard clinical practice, subjects on anti-platelet therapy are not excluded.

10. Pregnancy or breast-feeding;

    • Female subjects of child-bearing potential must have a negative pregnancy screen prior to enrollment.
    • Female subjects of child-bearing potential must confirm they are not actively breast-feeding prior to enrollment.
11. Current illicit drug abuse / active alcohol abuse (i.e, Current substance abuse);
12. Uncontrolled psychiatric disorder;
13. Lack of transportation (i.e., to get to/from appointments at VAMC) and/or willingness to attend study appointments (screening/consent, Intervention, Day10-follow-up, Month-6 follow-up, and then visits over-the-phone / in-person / or via Telehealth for Month-3 and Month-12;
14. Advanced or currently active cancer.
15. Blood disorders (such as Sickle Cell Anemia, TTP, others)
16. Vulnerable populations: Individuals incapable of making informed decisions will not be enrolled, nor will those under some form of incarceration.