Treatment of knee psoriatic arthritis using combination of extracellular vesicles enhanced platelet rich plasma with Mobithron Advance : A case studyDr Sivamuralitharan Muniandy

Treatment of knee psoriatic arthritis using combination of extracellular vesicles enhanced platelet rich plasma with Mobithron Advance : A case study

Background

1.     Patient with psoriasis may present with osteoarthritis because of knee inflammation and most common treatment for psoriasis is steroid

2.     Platelet Rich Plasma (PRP) used in early form of knee osteoarthritis but the result will be affected by long term steroid usage which are commonly used to treat psoriasis

3.     We aim to see changes in terms of reduction of pain and radiological evidence by using intra articular knee injection combining PRP and extracellular vesicles.

4.     We aim to show that combination of PRP with exosome can still produce regenerative changes at knee joint in patients who are using low dose DMARD

5.     Mobithron Advance is a combination of hyaluronic acid matrix, undenatured type 11 collagen Boswellia serrata gum extract

Methods:

·       Patient is a 59 years old female who had long-standing bilateral knee pain and skin rashes. The skin rashes were suggestive of guttate psoriasis. She was treated with Momethasone cream, prednisolone tablet 10mg daily and NSAIDS for painkiller.

·       We gradually reduced her steroid and introduced tablet sulfasalazine 500mg daily. We also started Mobithron Advance.

·       After 2 months, she was given intra articular injection of PRP and 25 billion particles of extracellular particles for each knee.

·       She was reviewed after 2 months using standing knee xray and symptoms assessment

Results:

Initial Xray- Reduced Knee joint space bilaterally with osteophytes. Kellgren Lawrence grade 4

Xray (after 2 months)- Marked increase in joint space. Kellgren Larence grade 2

Initial pain score – 7/10. Pain score after 2 months – 2/10

Conclusion:

1.     Combination of PRP with extracellular vesicles Mobithron Advance able to regenerate knee cartilage tissue even when given with low dose DMARD

2.     DMARD dose can be optimize after adequate improvement seen to prevent further inflammation.