Viscosupplementation in symptomatic haemophilic arthropathy of the knee and ankle: Experience with a high molecular weight hyaluronic acid

Carulli, Christian; Rizzo, Anna Rosa; Innocenti, Massimo; Civinini, Roberto; Castaman, Giancarlo

doi:10.1111/hae.13979

Cited by 12 publications

(14 citation statements)

References 9 publications

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“…Since viscosupplementation in patients with chronic synovitis could be advised to reduce pain or improve joint function, but not to treat chronic inflammation of the synovium 73 , 74 no agreement was reached on its use as a therapeutic option in PwH with chronic synovitis. Statement 35: Radiosynoviorthesis is the first therapeutic option when medical therapy optimization fails (NO agreement/disagreement) …”

Section: Resultsmentioning

confidence: 99%

“…Since viscosupplementation in patients with chronic synovitis could be advised to reduce pain or improve joint function, but not to treat chronic inflammation of the synovium 73,74 no agreement was reached on its use as a therapeutic option in PwH with chronic synovitis. In case of unresolved chronic synovitis, a non-surgical synovectomy as a first-line treatment option is recommended 17 More in detail, the procedure can be performed in different ways: intra-articular injection (synoviorthesis) of chemicals or radioisotopes, arthroscopic synovectomy; or open surgical synovectomy.…”

Section: Role Of Orthopaedic Surgery (Table Iv)mentioning

confidence: 99%

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Diagnosis and treatment of chronic synovitis in patients with haemophilia: consensus statements from the Italian Association of Haemophilia Centres

et al. 2021

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Although synovitis is recognized as a marker of joint disease activity, its periodic assessment is not included in routine clinical surveillance of patients with haemophilia (PwH). In order to evaluate the current knowledge and to identify controversial issues, a preliminary literature search by the Musculoskeletal Committee of the Italian Association of Haemophilia Centres (AICE) has been conducted. Statements have been established and sent to the Italian AICE members to collect their level of agreement or disagreement by a Delphi process. Thirty-seven consensus recommendations have been drafted. We found a general agreement on the indication to consider the presence of synovitis as a marker of joint disease activity in PwH. Accordingly, there was agreement on the indication to search for synovitis both in patients reporting joint pain and in asymptomatic ones, recognizing ultrasound as the most practical imaging technique to perform periodic joint screening. Interestingly, after detection of synovitis, there was agreement on the indication to modify the therapeutic approach, suggesting prophylaxis in patients treated on demand and tailoring treatment in patients already under prophylaxis. Whereas the need of an early consultation with a physiotherapist is recommended for PwH affected by chronic synovitis, the exact timing for an orthopaedic surgeon consultation is currently unknown.

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Section: Resultsmentioning

confidence: 99%

“…Since viscosupplementation in patients with chronic synovitis could be advised to reduce pain or improve joint function, but not to treat chronic inflammation of the synovium 73,74 no agreement was reached on its use as a therapeutic option in PwH with chronic synovitis. In case of unresolved chronic synovitis, a non-surgical synovectomy as a first-line treatment option is recommended 17 More in detail, the procedure can be performed in different ways: intra-articular injection (synoviorthesis) of chemicals or radioisotopes, arthroscopic synovectomy; or open surgical synovectomy.…”

Section: Role Of Orthopaedic Surgery (Table Iv)mentioning

confidence: 99%

Diagnosis and treatment of chronic synovitis in patients with haemophilia: consensus statements from the Italian Association of Haemophilia Centres

et al. 2021

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“…The intra-articular administration of hyaluronic acid is a conservative treatment shown to be effective in osteoarthritis owing to its capability to provide joint lubrication, shock absorbance, and anti-inflammatory analgesic and chondroprotective effects [43]. However, evidence on its long-term efficacy in pain reduction and prevention of arthropathy progression is still limited [36,[44][45][46][47]. The injection of intra-articular platelet-rich plasma (PRP) has been proposed as an alternative to hyaluronic acid.…”

Section: Local Treatmentsmentioning

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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“…12 Despite these findings, small studies have been conducted in haemophilic arthropathy reporting positive outcomes, particularly for the knee joint. [13][14][15][16] There is limited evidence around the use of HA in ankle arthropathy. The aim of this study was to determine whether two intra articular injections of Ostenil Plus 6 months apart reduced pain in patients with haemophilic ankle arthropathy.…”

Section: Introductionmentioning

confidence: 99%

“…The evidence in this setting is varied 11 and in the UK, the National Institute for Clinical Excellence (NICE) do not recommend HA as treatment, primarily due to lack of high quality, double‐blinded studies rather than proven lack of efficacy 12 . Despite these findings, small studies have been conducted in haemophilic arthropathy reporting positive outcomes, particularly for the knee joint 13–16 . There is limited evidence around the use of HA in ankle arthropathy.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Aims Ankle arthropathy commonly affects persons with haemophilia (PWH). Joint damage causes loss of movement, pain and reduced function. Current treatments are limited. Viscosupplementation has been used to treat other patient groups with joint damage. Viscosupplements serve to augment or act as a substitute for synovial fluid and may ameliorate the effects of cartilage loss by cushioning joints and reducing pain. This study evaluated intra‐articular Ostenil Plus™ (HA) for ankle arthropathy in PWH. Reduction in pain was the primary outcome. Methods A single centre open label pilot study. PWH and significant ankle arthropathy, according to MRI scores, were recruited. Participants received intra‐articular HA injections at baseline and 6 months. Follow up assessments were completed three‐monthly for 1 year. Pain was assessed by the Visual Analogue Scale (VAS). Participant perceptions of overall changes to pain, function and quality of life were sought. Results Twenty‐four participants were recruited, three withdrew. Twenty‐six joints were injected. Twenty participants had severe haemophilia. Mean age 35 years. Participants reported significant reduction in pain over the study. VAS baseline: 5.62; 6 month 3.92; 12‐month 3.42, P < .0001. Joint function improved together with ankle HJHS. No change was seen for EQ‐5D‐5L. Sixteen participants reported reductions in ankle pain and stiffness and greater confidence in undertaking physical activities. No significant adverse reactions were reported. Conclusion Ostenil Plus™ treatment improves pain, function and patient perception of functional ability in PWH and ankle arthropathy. This study supports the use of HA as a safe treatment in PWH.

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Viscosupplementation in symptomatic haemophilic arthropathy of the knee and ankle: Experience with a high molecular weight hyaluronic acid

Cited by 12 publications

References 9 publications

Diagnosis and treatment of chronic synovitis in patients with haemophilia: consensus statements from the Italian Association of Haemophilia Centres

Diagnosis and treatment of chronic synovitis in patients with haemophilia: consensus statements from the Italian Association of Haemophilia Centres

Current and Emerging Approaches for Pain Management in Hemophilic Arthropathy

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

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