A Gout Flare Caused by the Administration of Platelet Rich Plasma: A Clinical Case

Abstract

The therapy with Platelet Rich Plasma (PRP) administered in degenerated or injured musculoskeletal tissues is a new and promising regenerative treatment option. Traditionally, it is considered that as PRP represents an autologous (to the patient) blood product, the potential for serious side effects is neglectable. Consequently, it is important that any significant negative consequences are well described. We present a fifty-five years old male patient, complaining of pain and stiffness in his right ankle joint due to multiple traumas during his earlier sport career. He had no any contraindications and PRP was injected intraarticularly under ultrasound guidance. On the next day, the patient developed an intensive pain and swelling in the regions of the right ankle and the dorsum of the right foot. The acute phase reactants were elevated and there was no leukocytosis. On ultrasound examination, there was an effusion in the tibiotalar and talonavicular joints. Arthrocentesis was performed and the microscopic examination revealed the typical needle shaped monosodium urate crystals inside the joint fluid and no bacteria. Consequently, the diagnosis of acute gouty flare was made (the patient has a history of gout, but did not have any flares in the past two years). As PRP concentrate contains naturally many proinflammatory molecules, we speculate that some of them may activate the macrophages that residue normally in the synovium and the capsule of the injected joint. The activated macrophages further may react to the MSU crystals deposited there, leading to the development of a gouty flare. In conclusion, the possibility of a flare should be explained to gouty patients, candidate for PRP treatment.