INTRODUCTION: Rheumatoid arthritis of the hand is debilitating and difficult to manage, with medical therapies having many side effects. Control of inflammation using autologous stromal vascular fraction (SVF) cells offers a possible alternative to drug therapy.
BACKGROUND: The autoimmune process of RA involves the production of inflammatory cytokines from Th1/Th17 cells. SVF contains adipose-derived stem cells (ADSCs). Via their release of paracrine factors, ADSCs reduce inflammation and enhance Treg cell function in collagen-induced arthritis. Specific inhibition of Th1/Th17 cells by ADSCs has been shown. Local infiltration of SVF is a rational strategy for treatment of the hand.
OBJECTIVE: Demonstrate safety and efficacy of autologous SVF in controlling symptoms of small joint RA of the hands.
PATIENTS AND METHODS: Five female patients with chronic RA of five+years duration and no steroid use were chosen.
MATERIALS AND METHODS: Lipoaspirate was processed to produce SVF with 238x10⁵ and 895x10⁵ viable cells. 1 cc of suspension was injected intra- and peri-articularly to all 15 joints with 10 cc to the dorsum. Serial measurements were performed in a 6 months follow-up: functional hand score (FHS: pain, stiffness and activities); visual analog score (VAS: pain intensity); and dynamometry (grip strength).
RESULTS: Percentage change from baseline at six months for FHS score and VAS score was 91.3% and 91% respectively showing almost complete remission of osteoarthritic pain. The average grip strength increased 59%.
DISCUSSION: Cell dose was not age-related but did vary with disease chronicity. The degree of improvement was not dose-related.
CONCLUSIONS: This first-in-man use of fresh, non-fractionated, non-expanded SVF shows that intra-articular injection is safe. Minimal dose/hand should exceed 3x10⁶ cells. Data are strongly suggestive of significant therapeutic effect for small joint arthritis.