Management of haemophilic arthropathy

Abstract

Despite the tremendous benefit offered by primary prophylaxis, recurrent joint bleeding with progression to chronic synovitis and haemophilic arthropathy is still a daily concern for the multidisciplinary health care teams managing patients with severe haemophilia or haemophilia complicated by inhibitor development. Advanced stages of arthropathy could be prevented by regular assessment of musculoskeletal status and thus early detection of symptoms, daily rehabilitation exercises at home, and implementation of appropriate physiotherapy and medical training. Patient's education and psychological counselling are crucial. New tools such as magnetic resonance imaging are promising for the monitoring of these patients and might promote early detection of arthropathy and thus appropriate preventive measures to avoid further joint deterioration can be implemented. Medical synovectomy such as radionucleide synoviorthesis is a simple and non-invasive procedure that often delays the need for surgery which despite considerable improvement in techniques and postoperative rehabilitation remains a high-risk strategy in patients with severe haemophilia, especially those with inhibitors. In these high risk patients, availability of specific clotting factors such as activated prothrombin complex concentrate (FEIBA, Baxter, Vienna, Austria) and more recently, recombinant factor VIIa (rFVIIa, NovoSeven, Bagsvaerd, Denmark) has allowed to perform effective and safe orthopaedic procedures. The on-going EUREKA study will undoubtedly provide additional information about the optimal use of rFVIIa in this context.

Multidiciplinary Treatment of a Haemophilic Person with Total Hip Replacement Surgery- A Case Report

“…Strength, flexibility, balance and proprioception are important factors in reducing the occurrence of injuries, and thus bleeds [18]. In all cases, the guiding principle of physiotherapy is that it should not induce pain [1]. Also, it's important first to relieve pain in arthropathic joints, and next to decrease the functional limitations [19].…”

“…After 10 days of applications, the pain in these joints disappeared. Bossard et al emphasized that the electrotherapy was not sufficiently evaluated, and that in practice, only two physical agents can be used: analgesic electrical currents (cutaneous stimulation below the pain threshold), effective for chronic pain, and excitatory motor currents, mostly useful immediately after surgery [1].…”

“…Regular assessment of musculoskeletal status allows for early detection of symptoms and consecutive implementation of appropriate physiotherapy and medical training could prevent advanced stages of arthropathy [1].…”

“…[1]. It leads to permanent deformities, limited range of motion, muscle wasting, misalignment, loss of mobility, and extremities of unequal lengths [2].…”

O efeito do exercício aeróbico aquático na hemartrose experimental induzida em ratos

“…Dentro do processo de reabilitação e prevenção da artropatia hemofílica, diferentes modalidades de exercícios têm sido recomendadas (Bossard et al, 2008;Blamey et al, 2010;Schafer et al, 2016) com os objetivos de manutenção da força muscular (Hilberg et al, 2001;Tiktinsky et al, 2002;Harris, Boggio et al, 2006;González et al, 2007), evitar retração de tecidos periarticulares e musculares Heijnen, Kleijn, 1999), melhora da propriocepção (Hilberg et al, 2001) e do equilíbrio (Gallach et al, 2008;Fearn et al; (Olofsson et al, 2015). Porém, em paciente com hemofilia A grave, apesar de ter sido reportado um aumento na concentração de FvW (Zourikian et al, 2016), nenhuma alteração na meia-vida do FVIII foi identificada (Olofsson et al, 2015;Zourikian et al, 2016).…”