Abstract
Dear Editor,
Recently, have followed with great interest and explored an article entitled ‘Inadequate anticoagulation and hyperuricemia cause knee pain after platelet-rich plasma injection: A retrospective study. 1 This retrospective study have enrolled a total of 225 patients with osteoarthritis of the knee who have undergone treatment with platelet-rich plasma (PRP) injections. The objective is to explore and analyse the relationship between the choice of anticoagulant type and dose and the subsequent efficacy of the PRP during its preparation. In addition, the study want to analyse the relevant influencing factors. Ultimately, the authors have concluded that higher doses of anticoagulants and hyperuricaemia were detrimental to the patients’ prognosis. However, there are still aspects of this study that could be improved in order to provide a more rigorous and scientific reference for subsequent studies.
Firstly, patients with knee osteoarthritis often take various types of nonsteroidal anti-inflammatory drugs, psychotropic medications, or other physical therapy before and after treatment to reduce pain and anxiety symptoms. 2 The additional treatments may introduce bias into the study data, which could subsequently impact the assessment of pain, function, and related inflammatory markers in the blood and joint fluid.
Meanwhile, in a systematic review that included 80 RCTs, both prescription-grade chondroitin sulfate as well as vitamin D are also found to improve pain and function in patients with osteoarthritis of the knee. 3 It would have been beneficial for the authors to investigate and conduct subgroup analyses of the patients’ history of medication use during PRP treatment. This would have increased the accuracy of the experimental findings, thereby enhancing the persuasiveness of the study.
Furthermore, it is important to consider the potential variations in the composition of PRP itself among patients with osteoarthritis. In a prospective study, 4 differences in leukocyte concentration have been found to influence the composition of pain- and inflammation-related cytokines in PRP in patients with Kellgren-Lawrence grade 2 to 3 knee osteoarthritis (OA).Leukocyte-rich PRP (LR-PRP) generally expresses higher levels of IL-1Ra, IL-4, and IL-8, which are associated with higher anti-inflammatory effects, and the higher concentration of MMP-9 in LR-PRP suggests a more cartilage-invasive toxicity than that of Leukocyte-poor PRP (LP-PRP.) The injection of PRP through the joint cavity will likely have a direct impact on all types of inflammatory markers in the joint cavity, as well as subsequent changes in bone morphology. Therefore, failure to account for differences in leukocyte concentration will interfere with the accuracy of all subsequent assessments. At the same time, platelet and white blood cell data can be obtained at once from the routine blood test, which is easy to obtain.
Finally, we sincerely thank the authors of the article for their contribution. If the above factors are taken into account in subsequent studies, they may better inform subsequent clinical treatment and thus benefit patients.
