Comparing the Effectiveness of Intra-articular Platelet-Rich Plasma and Corticosteroid Injection under Ultrasound Guidance on Pain Control of Knee Osteoarthritis

Background: Knee osteoarthritis is one of the most prevalent and disabling diseases worldwide, which decreases patients' quality of life (QoL). However, pharmacological and non-pharmacological treatments, apart from complications, could not desirably control the disease. Objectives: The current study aimed at evaluating the effect of two methods of intra-articular injection of Platelet-Rich Plasma (PRP) and corticosteroid on pain control of knee osteoarthritis. Methods: A randomized clinical trial was performed on 67- patients with grades II-III of knee osteoarthritis (OA) referring to pain clinic of a referral, university-affiliated hospital, Rasht, Iran, from April 2016 to June 2017. Patients were randomly divided into two groups: Triamcinolone (T) (n=34) and PRP (P) (n=33) by quadruple block. In the group T, 40 mg Triamcinolone and in the group P, PRP was injected intra-articularly, under ultrasound- guidance, once a month, for three consecutive months. Patients' pain intensity was evaluated based on the Visual Analog Scale (VAS), and their outcome was determined based on the Knee injury and Osteoarthritis Outcome Score (KOOS) monthly for three consecutive months, as well as six months after the treatment. Results: There were no significant differences between the groups regarding demographic characteristics. VAS assessments indicated lower pain scores in the group P than group T; the difference between the groups was statistically significant two, three, and six months after the injections. In the group P, the mean initial VAS was 7.36 +/- 0.92 compared with 7.12 +/- 1.29 in the group T(P = 0.385). After six months, the scores dropped to 3.45 +/- 0.86 and 4.81 +/- 1.4, respectively (P = 0.00 01). Examination of the KOOS parameters showed a significant association between treatment outcomes in the group P than the group T. Therefore, test showed a significant difference between the groups regarding relief of pain, improvement of symptoms and activities of daily living (ADL) two, three, and six months after treatment; there was also a significant difference between the groups in terms of the quality of life (QoL) and doing sport activities three and six months after the treatment (P < 0.05). Based on the repeated measures analysis, a significant inter- and intra-group differences in the mean score of KOOS parameters was observed between the intervals (P = 0.0 001). Conclusions: The current study results showed that three intra-articular injections of Triamcinolone and PRP can reduce pain and improve articular function in patients with grades II-III knee osteoarthritis. However, pain relief and improvement in the outcomes were more effective and more prolonged secondary to PRP injections than corticosteroids