Efficacy of Intra Articular Botulinum Toxin Injection in Sickle Cell Patients’ Joints

Abstract

Background: Sickle cell disease patients have a tendency for vaso-occlusive attacks involving their bones. Osteonecrosis results in infarction of the articular surfaces and heads of long bones, leading to chronic joint pain, significant interference in functioning and quality of life. Intra-articular Botox injection is safe andreduces chronic pain while patients' mobility. Objective:The study aimed to evaluate the symptomatic change and its duration after intra-articular Botox injection, in sickle cell disease patients with chronic pain.Methods: Sickle cell disease patients with chronic joint pain observed at Salmaniya medical complex were included. Patients were injected with Botox intra-articularly and followed up for a year. Symptomatic parameters were assessed at every follow-up, raw data collected was entered into Microsoft Excel spreadsheet were the numerical variables analyzed and graphs were created.Results: Forty-eight sickle cell disease patients were included. Post the intra-articular injection at 3 months, the level of pain according to, Numerical rating scale (NRS) reduced by 44.6% (p-value <0.005) and 27.8% (p-value < 0.001) at 6 months and 9.54% (p-value <0.01) at 1 year, and significant improvement of other parameters. Conclusion:Intra-articular BoNT/ A injection provides an alternative treatment in sickle disease patients with good results in reduction of pain, improved physical function, mood, and sleep pattern lasting at least 6 months. Although a small scale study, the results suggest that BoNT/ A is an effective and safe treatment.