Efficacy and safety of point‐of‐care ultrasound‐guided intra‐articular corticosteroid joint injections in patients with haemophilic arthropathy

Martin, Emily J.; Cooke, Esther J; Ceponis, A; Barnes, R. F. W.; Moran, Colleen; Holle, S.; Hughes, Tudor; Moore, Randy; Drygalski, Annette von

doi:10.1111/hae.13057

Cited by 22 publications

(30 citation statements)

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“…In this regard, regular prophylactic therapy should be the most effective treatment for synovial hyperplasia in patients aged ≤10 years, but insufficient for older patients, who may benefit from extra-local therapies, such as radiosynovectomy 19 and intra-articular drug injection. [20][21][22][23][24] Unlike synovial hypertrophy, the osteochondral subscores increased with age in the knee, elbow and overall joints mainly before 30 years of age, then elevated slightly or remained stable. Although not distinct, a similar tendency of ankle osteochondral progression could be concluded.…”

Section: Discussionmentioning

confidence: 99%

“…tissue and osteochondral alterations in HA [15][16][17][18]. In this regard, regular prophylactic therapy should be the most effective treatment for synovial hyperplasia in patients aged ≤10 years, but insufficient for older patients, who may benefit from extra-local therapies, such as radiosynovectomy19 and intra-articular drug injection [20][21][22][23][24]. Synovial hyperplasia is thought to be a reversible pathological process caused by joint bleeding, 1 but repeated haemarthroses or occult subclinical bleeding tend to cause chronic synovitis, which is harder to eliminate.…”

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confidence: 99%

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Age‐related severity and distribution of haemophilic arthropathy of the knee, ankle and elbow among Chinese patients with haemophilia

et al. 2019

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Introduction and aims Age‐related severity and distribution of haemophilic arthropathy (HA) among Chinese patients with haemophilia using the Haemophilia Early Detection with Ultrasound (HEAD‐US) system have not been extensively studied. Methods In our study, 89 patients with moderate and severe haemophilia were recruited. A total of 534 joints (knees, ankles and elbows on both sides included) were evaluated using musculoskeletal ultrasound (MSKUS) and scored using the HEAD‐US system. Results Prevalence and average number of HA were 39.1% and 0.7, 90.6% and 3.2, 94.1% and 4.5, and 100% and 4.3 for ages ≤10, 11‐20, 21‐30 and 31‐40 years, respectively. Prevalence and mean number of knee, ankle and elbow arthropathies also increased with age, although joint damages progressed in unparallel patterns. A significant difference in synovium subscores was observed between patients aged <10 and >10 years. An increasing tendency was observed in cartilage and subchondral bone subscores along with age before 30 years. No significant difference in mean joint scores was found between patients receiving on‐demand therapy and those receiving on‐demand to low‐dose prophylactic therapy. Conclusions Haemophilic arthropathy developed in early childhood and progressed mainly before 30 years of age among Chinese patients with haemophilia, although in different ways among the knee, ankle and elbow.

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Age‐related severity and distribution of haemophilic arthropathy of the knee, ankle and elbow among Chinese patients with haemophilia

et al. 2019

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“…The duration of pain relief had a median of 8 weeks.The study demonstrated that ultrasound-guided corticosteroid injections for painful haemophilic joints are safe and clinically effective 2. This treatment was prescribed because the lack of sensitivity to substitutive therapy with the deficient coagulation factor during 2 months.…”

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Haemophilic arthropathy: A narrative review on the use of intra‐articular drugs for arthritis

et al. 2019

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Introduction: Intra-articular injections of various drugs are commonly used in patients with degenerative osteoarthritis and also in haemophilic patients. Haemophilic arthropathy is a particular type of secondary osteoarthritis (OA), but the degeneration of strong synovial, cartilaginous and subchondral constituents is provoked by the direct action of iron and blood in the joint.Aim of the study: The aim of this study is to review the literature regarding the use of various intra-articular drugs in joints affected by haemophilic arthropathy. Methods: We reviewed the data from the literature; the search was performed on three medical electronic databases (PubMed, Cochrane Library and Scopus Web of Science) by three authors (B. E., A. M. and V. N.) from 3 December 2018 till 15 December 2018. The search string was as follows: (hyaluronic acid OR viscosupplementation OR platelet-rich plasma OR corticosteroid OR mesenchymal stem cells) AND (haemophilia OR haemophilic arthropathy OR haemophilic arthritis).Results: Once the research was performed, a total of 300 articles were identified. 47 selected articles were analysed by the reviewers, and the eligibility of the study inclusion was assessed independently. Twelve papers were included based on clear fulfilment of the inclusion criteria. Thirty-five articles were excluded for the following reasons: no full text or accessible data for 14 of them, 15 involved surgery or rehabilitation therapy as the primary topic and 6 were systematic reviews (the main topics were beyond the haemophilic arthropathy). Conclusion:Although the degree of scientific evidence of the publications on intraarticular injections of various drugs (hyaluronic acid, corticosteriods, PRP and MSCs) in haemophilia is very low, it seems that intra-articular injections of hyaluronic acid can relieve joint pain for months and can be repeated every 6-12 months, which is why they can be recommended. Corticosteroid injections seem to relieve joint pain for a few weeks, but their routine use is not recommended in haemophilia. The efficacy of PRP and MSCs in haemophilic arthropathy is pending confirmation, which is why they are not currently recommended. K E Y W O R D Sarthritis, arthropathy, drugs, haemophilia

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“…These data strengthen the hypothesis that vascular remodelling and angiogenesis contribute significantly to bleed propagation and development of HA, which may partly explain why haemostatic factor replacement alone may not be sufficient [19]. Another application of POC-MSKUS is US-guided joint aspiration and intra-articular corticosteroid injection to alleviate chronic joint pain in PwH with advanced arthropathy as reported by von Drygalski et al, where median pain score decreased from 7 to 1 out of 10 (P < 0.001) with a median duration of pain relief of 8 weeks [20]. More recently, joint lavage followed by injections of triamcinolone and Hylan G-F 20 (viscosupplement) was shown to improve balance, function and bleeding events in severe HA patients [21].…”

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A new wave in the evaluation of haemophilic arthropathy

Bakeer

2017

Haemophilia

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Efficacy and safety of point‐of‐care ultrasound‐guided intra‐articular corticosteroid joint injections in patients with haemophilic arthropathy

Abstract: Point-of-care ultrasound enabled intra-articular corticosteroid injections that provided highly effective, safe, and relatively long-lasting pain relief in haemophilic arthropathy. This approach should be used to improve pain management in haemophilic arthropathy.

Cited by 22 publications

References 54 publications

Age‐related severity and distribution of haemophilic arthropathy of the knee, ankle and elbow among Chinese patients with haemophilia

Age‐related severity and distribution of haemophilic arthropathy of the knee, ankle and elbow among Chinese patients with haemophilia

Haemophilic arthropathy: A narrative review on the use of intra‐articular drugs for arthritis

A new wave in the evaluation of haemophilic arthropathy

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