COMPARISON OF CONVENTIONAL DISEASE MODIFYING ANTI-RHEUMATIC DRUGS WITH AND WITHOUT INTRA-ARTICULAR PLATELET RICH PLASMA INJECTION IN THE ALTERATION OF DISEASE PROGRESSION OF EARLY RHEUMATOID ARTHRITIS: A RANDOMIZED CONTROLLED TRIAL

Background and Objectives:Rheumatoid arthritis (RA) is a symmetric inflammatory polyarticular arthritis, where autoimmune response causes chronic inflammation and destruction of joints leading to deformities and affecting the activities of daily living. ACR recommends early diagnosis and aggressive treatment of RA with combination disease modifying anti-rheumatic drugs (DMARDs). Although it attenuates disease progression, long-term remissions have not been adequately achieved. Injection of platelet rich plasma(PRP) decrease joint inflammation by modulating synovial cell proliferation, differentiation and inhibition of catabolic pathways. Aim:to compare conventional DMARDs with and without intra-articular platelet rich plasma injection in wrist joint in the alteration of disease progression of early rheumatoid arthritis. Methods:A randomized controlled trial, done among newly diagnosed patients of Rheumatoid Arthritis affecting wrist joint, in Department of PMR, RIMS. Data collected in pretested structured proforma and analysis for Pain, Disease activity, USG grading and hand function done using Chi-square test, students t-test, repeated measure ANOVA test. Results:There is significant improvement in VAS, DAS28, Cochin scale and USG Grade in study group at the end of 8 weeks, however at 20 weeks it is found to be comparable and p-value is not significant. Conclusion:Addition of Intra articular PRP in wrist along with DMARDs has early and better improvement in pain and delay disease progression. Intra-articular PRP injection under USG guidance helps in reduction of synovial inflammation and pain, improvement in function and a safe treatment modality. Early treatment and reduction of disease activity by intervention in targeted joint may delay joint deformity and disability.