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

Abstract

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

Which part of the blood in the knee joint is responsible for its detrimental effects? (An experimental study on the knee joint in rabbits)

“…also stated that reactive oxygen species in blood caused synovitis and cartilage damage by changing the integrity and activity of the cartilage in vitro 15 . New systemic or intra‐articular treatment methods are being developed to reduce the damage of blood in the joint 16 . In haematological diseases associated with excessive accumulation of iron and aluminium such as thalassemia, hemochromatosis, acute iron poisoning, chelators are used in the treatment to bind excess iron and aluminium 17,18 .…”

“…15 New systemic or intra-articular treatment methods are being developed to reduce the damage of blood in the joint. 16 In haematological diseases associated with excessive accumulation of iron and aluminium such as thalassemia, hemochromatosis, acute iron poisoning, chelators are used in the treatment to bind excess iron and aluminium. 17,18 Therefore, in case of joint bleeding, the efficacy of intra-articular and oral chelator use were investigated in several animal studies.…”

A single centre, open label, pilot study evaluating the effect of intra‐articular hyaluronic acid injection on pain and functionality when injected into the ankle (tibio‐talar and sub‐talar) joint in patients with haemophilic arthropathy

“…However, the body of existing data, taken together with our data, show that HA is a safe treatment that can be used effectively and safely for haemophilic arthropathy, a sentiment that was echoed in a recent narrative review. 25 Intuitively, it is reasonable to conceive as to why HA can improve pain in PWH and arthropathy, since HA serves to act as a 'replacement' synovial fluid, and a support medium for cartilage matrix 26 ' providing a viscous, shock absorbing material in a damaged joint that can reduce pain and perhaps ease stiffness. This may account for our participant's comments about 'easing of stiffness in the joint' .…”

Intra‐articular injections in people with haemophilia in the COVID‐19 era

“…The most common intra-articular injections performed on haemophilia patients are arthrocentesis, infiltration (with corticosteroids, local anaesthetics, hyaluronic acid or platelet-rich plasma-PRP) and synoviorthesis (chemical or radioactive). 3,4 All of these invasive procedures require a prolonged period of contact with the patient and a recovery period before discharge. Therefore, all these techniques must be performed with the same level of protection.…”