How do patients and professionals differentiate between intra‐articular joint bleeds and acute flare‐ups of arthropathy in patients with haemophilia?

Timmer, Merel A.; Pisters, Martijn F.; Kleijn, P. de; Veenhof, Cindy; Gorkom, Britta A P Laros-van; Kruip, Marieke J.H.A.; Bie, Rob A. de; Schutgens, Roger E. G.

doi:10.1111/hae.12858

Cited by 10 publications

(12 citation statements)

References 24 publications

(30 reference statements)

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“…A multidisciplinary approach is essential for joint health. In the ageing population that already has chronic arthropathy, it can be difficult to distinguish pain due to chronic arthropathy from the pain of acute bleeds, which may lead to over use of factor replacement (Timmer et al , , ). Point of care ultrasound can be used to help evaluate whether pain is secondary to an acute bleed.…”

Section: Musculoskeletal Issuesmentioning

confidence: 99%

Haemophilia and ageing

Shapiro

Makris

2018

Br J Haematol

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Summary Advances in the development of effective and safe treatments for haemophilia over the last 50 years have resulted in a significant increase in the life expectancy of persons with haemophilia (PWH). The management of this new cohort of middle‐aged and elderly PWH is challenging because of the opposing risks of haemophilia and age‐related cardiovascular disease and malignancy. Furthermore, this cohort of ageing PWH has the additional comorbidities of human immunodeficiency virus/hepatitis C and chronic haemophilic arthropathy. This article reviews the prevalence, underlying mechanisms and treatment strategies for managing these comorbidities. International collaboration is essential for registry data and further prospective trials to inform optimal evidence‐based management for this rare disorder in the future.

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Section: Musculoskeletal Issuesmentioning

confidence: 99%

Haemophilia and ageing

Shapiro

Makris

2018

Br J Haematol

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“…Acute clinical signs and symptoms of hemarthrosis include some or all of the following: ‘aura’, i.e., an unusual sensation of tingling inside a joint, pain, swelling, warmth of the skin over the joint, decreased range of motion or full loss of function [ 6 ]. One of the biggest issues for patients with hemophilia is the need for a better self-differentiation between acute hemarthrosis and chronic joint pain, and it is still a matter of debate whether or not they are able to distinguish the two conditions [ 16 , 17 ]. In fact, significant discrepancies have been reported by means of musculoskeletal ultrasound findings between patient and physician classification of pain as due to bleeding or non-bleeding [ 18 ].…”

Section: Management Of Acute Joint Bleedingmentioning

confidence: 99%

Current and Emerging Approaches for Pain Management in Hemophilic Arthropathy

et al. 2022

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Introduction: Hemophilia is an inherited bleeding hematological disorder characterized by the partial or complete deficiency of clotting factor VIII or IX. Hemophilic arthropathy is the consequence of repeated joint bleeding (hemarthrosis) and its management is based on the prevention of acute bleeding through the administration of the deficient clotting factor concentrate or non-factor therapies. In addition, the management of acute and chronic pain is pivotal in hemophilic arthropathy in order to restore function and allow rehabilitation of the joint. Methods:We conducted a qualitative review of the literature regarding current and emerging strategies for pain treatment in hemophilic arthropathy. This review considers systemic and local pharmacological and non-pharmacological interventions for acute and chronic pain management.Results: In hemophilic arthropathy, pain management is based on analgesics such as paracetamol, which represents the first choice for acute and chronic pain in adults and children, in association with opioids for adults. Non-steroidal anti-inflammatory drugs inhibit platelet function, so that the currently preferred drugs are short courses of cyclooxygenase 2 inhibitors. Local treatment with intra-articular injections of corticosteroids is an option for refractory cases and physiotherapy has an important role after hemarthrosis and for the long-term management of chronic pain for both pediatric and adult patients. Conclusions: The management of pain in hemophilia requires more standardization. Meanwhile, the safest drugs should be used at the lowest effective dosage and for periods as short as possible. For the non-pharmacological management of pain in these patients, a multidisciplinary team including hematologists, orthopedic surgeons, rheumatologists, and physiotherapists is warranted.

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“…The information modules consist of text blocks supported by short videos [1,6,[20][21][22][23][24]. For the physiotherapists, the following 5 information modules are available: (1) What is hemophilia?…”

Section: Self-management Information Modulesmentioning

confidence: 99%

A Blended Physiotherapy Intervention for Persons With Hemophilic Arthropathy: Development Study

Timmer¹,

Kloek²,

Kleijn³

et al. 2020

J Med Internet Res

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Background Joint bleeds are the hallmark of hemophilia, leading to a painful arthritic condition called as hemophilic arthropathy (HA). Exercise programs are frequently used to improve the physical functioning in persons with HA. As hemophilia is a rare disease, there are not many physiotherapists who are experienced in the field of hemophilia, and regular physiotherapy sessions with an experienced physiotherapist in the field of hemophilia are not feasible for persons with HA. Blended care is an innovative intervention that can support persons with HA at home to perform the advised physical activities and exercises and provide self-management information. Objective The aim of this study was to develop a blended physiotherapy intervention for persons with HA. Methods The blended physiotherapy intervention, namely, e-Exercise HA was developed by cocreation with physiotherapists, persons with HA, software developers, and researchers. The content of e-Exercise HA was compiled using the first 3 steps of the Center for eHealth Research roadmap model (ie, contextual inquiry, value specification, and design), including people with experience in the development of previous blended physiotherapy interventions, a literature search, and focus groups. Results A 12-week blended intervention was developed, integrating face-to-face physiotherapy sessions with a web-based app. The intervention consists of information modules for persons with HA and information modules for physiotherapists, a graded activity program using a self-chosen activity, and personalized video-supported exercises. The information modules consist of text blocks, videos, and reflective questions. The patients can receive pop-ups as reminders and give feedback on the performance of the prescribed activities. Conclusions In this study, we developed a blended physiotherapy intervention for persons with HA, which consists of information modules, a graded activity program, and personalized video-supported exercises.

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How do patients and professionals differentiate between intra‐articular joint bleeds and acute flare‐ups of arthropathy in patients with haemophilia?

Cited by 10 publications

References 24 publications

Haemophilia and ageing

Haemophilia and ageing

Current and Emerging Approaches for Pain Management in Hemophilic Arthropathy

A Blended Physiotherapy Intervention for Persons With Hemophilic Arthropathy: Development Study

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