The Future of Osteoarthritis Management: Plasma Exchange as a New Generation Treatment

Osteoarthritis (OA), traditionally viewed as a mechanical wear-and-tear condition, is increasingly recognized as an inflammatory disorder with autoimmune features. Despite its high global prevalence, disease-modifying treatments remain limited. Therapeutic plasma exchange (TPE) offers a novel, mechanistically targeted approach by removing systemic inflammatory mediators, pathogenic autoantibodies, and degradative enzymes such as matrix metalloproteinases. By modulating cytokines like interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) and depleting cartilage-directed autoantibodies, TPE may disrupt the inflammatory and immune cascades driving joint degradation. This editorial explores TPE as a potential adjunct therapy in OA, particularly for patients with inflammatory or metabolic phenotypes. While complications such as hypotension, vascular access issues, and transient immunosuppression must be considered, the safety profile of TPE is well-established in other autoimmune conditions. Future clinical trials are urgently needed to validate efficacy, optimize protocols, and identify ideal patient subgroups. If successful, TPE could represent a paradigm shift from symptomatic relief toward disease modification in OA, with the potential to improve long-term outcomes and quality of life.