Differentiating between signs of intra‐articular joint bleeding and chronic arthropathy in haemophilia: a narrative review of the literature

Timmer, Merel A.; Pisters, Martijn F.; Kleijn, P. de; Bie, Rob A. de; Fischer, Kathelijn; Schutgens, Roger E. G.

doi:10.1111/hae.12667

Cited by 44 publications

(50 citation statements)

References 32 publications

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“…In this regard, appropriate assessment with imaging tools plays a role, especially for detection of early joint changes, since clinical assessment may underestimate abnormalities. Recent studies have highlighted the importance of imaging techniques in the assessment of early arthropathy, revealing abnormalities in joints that are almost asymptomatic on physical examination . If we consider synovitis as a parameter indicating active disease due to either inappropriate treatment or to problems related to low therapeutic adherence (eg, missing appointments and/or non‐compliant patients), this was found in a considerable number of HB patients treated OD: severe (grade 2) synovitis was observed in 18% of cases and moderate to severe (grade 1 + grade 2) synovitis in up to 57%.…”

Section: Discussionmentioning

confidence: 99%

Joint status in Spanish haemophilia B patients assessed using the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD‐US) score

et al. 2018

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Aim The use of musculoskeletal ultrasound (MSK‐US) following protocols for haemophilic arthropathy and the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD‐US) score can help standardize monitoring in haemophilia. This study evaluated the joint status (elbows, knees and ankles) of patients with haemophilia B (HB) in Spain using MSK‐US and the HEAD‐US score. Methods Haemophilia B patients ≥14 years old were included in this observational, multicentre, cross‐sectional study, regardless of their clinical condition, HB severity and treatment received. Two blinded observers were involved in image acquisition and scoring in each centre. Results Eighty‐two patients from 12 centres were enrolled: 27% mild HB, 23% moderate, 50% severe HB. Mean age was 38.9 ± 16.4 years, 60% were treated on demand (OD) and 40% were on prophylaxis. HEAD‐US was zero in all joints in 28.6% OD patients and 36.4% on prophylaxis. Mean scores significantly worsened with HB severity, except for the left knee. Patients on primary and secondary prophylaxis had significantly better joint health vs OD patients in all joints, except the right ankle. Among OD patients, those with severe disease presented significantly worse scores in all HEAD‐US items related to permanent damage. Conclusion Joint status of HB patients in Spain is influenced by severity and treatment modality, related to the development of arthropathy, which appears prevalent in OD patients with severe HB. Routine assessment with an imaging tool such as ultrasound and HEAD‐US system may help to improve joint health by personalizing and adjusting treatment in this population.

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Section: Discussionmentioning

confidence: 99%

Joint status in Spanish haemophilia B patients assessed using the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD‐US) score

et al. 2018

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“…2 Moreover, in patients with severe haemophilia, <15% experience pain in only 1 or 2 regions, while more than 35% report pain in at least 5 regions. 4 This unconditional association (acute pain relates to bleeding, and chronic pain is due to joint arthropathy) used in scientific literature and in clinical settings is remarkable. Traditionally, a differentiation is made between pain resulting from an acute bleed (haemarthrosis) and chronic pain originating from joint damage (arthropathy).…”

Section: Introductionmentioning

confidence: 99%

“…Traditionally, a differentiation is made between pain resulting from an acute bleed (haemarthrosis) and chronic pain originating from joint damage (arthropathy). 1,4,7,8 A study comparing perceptions regarding the aetiology of pain in PwH with ultrasound evaluation confirmed that a diagnosis based on the sole perception of pain is unreliable in the majority of the cases: the aetiology of pain (bleeding versus joint inflammation or other regional pain syndrome) was correctly judged in only 30% of the cases, either by the physician or the patient! Firstly, the terms "acute" and "chronic" originally referred to a time frame and not to a specific underlying cause of pain.…”

Section: Introductionmentioning

confidence: 99%

Gaining insight into the complexity of pain in patients with haemophilia: State‐of‐the‐art review on pain processing

Roussel

2018

Haemophilia

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Despite the high prevalence of recurrent, constant and/or widespread pain in patients with haemophilia (PwH), there is an immense lack of studies examining the (patho)physiology of pain in this population. This contrasts to the bulk of literature in other pain conditions, such as osteoarthritis, low back pain or rheumatoid arthritis. Understanding the complexity of pain allows to better assess and manage pain. In PwH, the first priority is always to exclude bleeding as a cause of pain. An important next step in pain assessment is the evaluation of the predominant pain mechanism (ie nociceptive, neuropathic pain or altered central pain processing) as the treatment approach will be very different according to the underlying pain mechanism. Pain assessment should include both physiological and psychological components. This review summarizes the evidence regarding nociceptive, neuropathic and altered central pain processing in PwH and serves as a research agenda to prioritize pain research in PwH.

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“…Avoiding injection within four weeks of pending surgery recommended owing to HPA axis suppression ) Severe clotting abnormalities/bleeding disorders/ uncontrolled coagulopathy † Increased risk of bleeding complications with invasive procedure. Differentiating between haemarthorosis, haemophilic arthropathy and OA can be complex due to overlapping clinical signs (Roosendaal et al, 1999;Timmer et al, 2015). Specialist management suggested (Srivastava et al, 2013) Live vaccines.…”

Section: Pending Joint Surgerymentioning

confidence: 99%

Therapeutic Review of Methylprednisolone Acetate Intra‐Articular Injection in the Management of Osteoarthritis of the Knee – Part 2: Clinical and Procedural Considerations

McCrum

2016

Musculoskeletal Care

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The use of an intra-articular methylprednisolone acetate (MPA) injection has been shown to have benefits for symptoms of knee osteoarthritis (OA). However, considerations beyond drug efficacy can influence the appropriateness, clinical effectiveness and potential harm of an injection. A review of research evidence and published literature on clinical and procedural factors influencing the effectiveness and safety of a knee injection has been undertaken. Factors include dose, frequency, contraindications, precautions, drug interactions, side-effects, and procedural and patient-related considerations. An evaluation of evidence indicated that a 40 mg dose provides clinical benefit. No strong predictors of response were evident, with the exception of pain severity. Additional benefit for outcomes from higher doses, local anaesthetic, ultrasound guidance or particular anatomical approaches is yet to be demonstrated. Evidence for dose- and duration-related detrimental effects suggests judicious use and frequency. The evaluation showed that there are a number of contraindications and precautions arising from the drug pharmacology, concurrent medications, comorbidities and adverse events which need consideration and monitoring. There was limited safety evidence concerning anticoagulation. The review found that specialist guidance and limited evidence suggests that injection safety concerning warfarin may be enhanced by ensuring that the international normalized ratio level is within therapeutic range. However, the risk-benefit evaluation concerning non vitamin K antagonist oral anticoagulants remains challenging. Although there is published guidance, a lack of clinical studies, safety evidence and reversibility advocates caution. Overall, the review indicates that injection decisions and procedures need an individualized approach and supporting evidence is limited in many areas. Evaluation and discussion of benefits and risks, peri-procedural and post-injection management, and tailoring to the context and individuals' preferences are important in optimizing the benefits and safety of a knee injection.

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Differentiating between signs of intra‐articular joint bleeding and chronic arthropathy in haemophilia: a narrative review of the literature

Cited by 44 publications

References 32 publications

Joint status in Spanish haemophilia B patients assessed using the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD‐US) score

Joint status in Spanish haemophilia B patients assessed using the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD‐US) score

Gaining insight into the complexity of pain in patients with haemophilia: State‐of‐the‐art review on pain processing

Therapeutic Review of Methylprednisolone Acetate Intra‐Articular Injection in the Management of Osteoarthritis of the Knee – Part 2: Clinical and Procedural Considerations

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