OBJECTIVE: Rheumatoid arthritis of the hand constitutes a debilitating aspect of this chronic autoimmune disease. Conventional management with medication is difficult with many side effects. The anti-inflammatory properties of autologous stromal vascular fraction (SVF) cells present an attractive alternative to drug therapy. In a previous small safety and efficacy study we documented therapeutic effect of SVF cells administered intra-articularly and periarticularly for rheumatoid arthritis of the hand in 5 patients. Six-month results reported showed a strong reduction in joint paint, improved function and increased grip strength. These finding were consistent with known anti-inflammatory properties of SVF cells in soft tissues affected by burns, ischemia, and fibrosis. This follow-up study of the previous series is intended to ascertain the longevity of results achieved by SVF treatment in RA of the hand at 12 and 24 months.
PATIENTS AND METHODS: 5 female patients with RA greater than 5 years duration were chosen for treatment and long-term follow-up. Lipoaspirate was used to process and generate SVF cells as previously described. Each joint was injected with a total of 1 cc distributed intra-articularly and around the joint capsule. Serial measurements were taken at 6 months, 12 months, and 24 months post-implantation using a functional hand score (FHS: pain, stiffness and activities); Visual Analog Score (VAS: pain intensity) and dynamometry (grip strength).
RESULTS: Percentage changes at six months for FHS and VAS remained essentially unchanged from 6 months to 12 months to 24 months, showing durability of the response. Average grip strength was preserved at 12 and 24 months as well, with a slight decline relative to the 6-month values.
CONCLUSIONS: Engraftment of SVF cells to a niche in the highly vascularized synovium with survival of cells may possibly explain the longevity of the results. Despite systemic disease affecting other joints SVF at the treatment sites appears to play a localized and long-term protective function.