Pain and structural alterations in knee joints in patients with haemophilia

Krüger, Steffen; Hoffmeister, Meike; Hilberg, Thomas

doi:10.1111/hae.13472

Cited by 19 publications

(33 citation statements)

References 35 publications

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“…Haemophilic patients suffer from emoarthropathies that lead them to have an increased sensitivity to pain. The somatosensory profile of these patients is impaired [21,22]. A later study by Roussel in 2018 still focused on pain, this study did not focus on joint bleeding as a cause of pain.…”

Section: Discussionmentioning

confidence: 99%

Oral and Psychological Alterations in Haemophiliac Patients

et al. 2019

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Haemophiliacs are hereditary coagulopathies whose basic anomaly consists of the quantitative or qualitative alteration of one or more plasma proteins in the coagulation system. The objective of this review is to analyse all risk factors, predispositions and alterations to the oral-maxillofacial district in patients with haemophilia. The broader assessment also includes the psychological aspects that could affect the treatment and maintenance of oral conditions. The study takes into consideration all the works in the literature in the last 10 years. Works that present oral, dental and psychological changes in haemophilia patients have been combined. A total of 16 studies were analysed carefully evaluating and explaining all the alterations and risk factors that this disease provides. The aim of the review is to report all the anomalies reported in the literature for these patients, and to direct and update the clinician in the treatment of haemophilia patients.

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Section: Discussionmentioning

confidence: 99%

Oral and Psychological Alterations in Haemophiliac Patients

et al. 2019

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“…These instances of bleeding may lead to haemophilic arthropathy based on changes in joint function and structure caused by inflammatory processes of synovia as well as destruction of the cartilage tissue . The course of this process is associated with pain in PwH . While an acute bleeding episode results in acute pain, the individual's pain status can shift towards being recognized as a chronic pain condition, induced by haemophilic arthropathy .…”

Section: Introductionmentioning

confidence: 99%

“…2,3 The course of this process is associated with pain in PwH. 4 While an acute bleeding episode results in acute pain, the individual's pain status can shift towards being recognized as a chronic pain condition, induced by haemophilic arthropathy. 5 Recent studies pointed out that more than 85% of patients suffered from pain over a period of the last six months, and up to 89% reported that pain during the last 4 weeks interfered with activities in daily life.…”

Section: Introductionmentioning

confidence: 99%

Understanding the pain profile in patients with haemophilia: Impaired descending pain inhibition as measured by conditioned pain modulation

Krüger

Hilberg

2020

Haemophilia

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Introduction Haemophilic arthropathy is associated with pain that often becomes chronic, likely caused by peripheral and central mechanisms. In the field of haemophilia, to our knowledge, the role of the descending pain pathway, which can also be involved in these pain processes, has not been examined to date. Aim In light of the dearth of existing literature, we sought to evaluate the function of endogenous descending pain modulation in patients with haemophilia. Methods Thirty adult patients with moderate to severe haemophilia A or B (median [interquartile range] age 51.0 [42.0‐54.0]) and 23 healthy adult controls (age 46.5 [36.8‐54.3]) underwent conditioned pain modulation (CPM) in order to examine the function of endogenous pain modulation. The CPM response was determined by scoring a test stimulus (heat) alone as well as under the influence of a conditioning stimulus (cold) on the basis of a numeric rating scale (NRS) (0 = ‘no pain’ to 100 = ‘worst possible pain’). Results Patients with haemophilia demonstrated a statistically significant reduced CPM response when compared with the age‐matched healthy controls (median (interquartile range) NRS score: patients: −10 (−17.5‐[−7.5]) vs controls: −20 (−30.0‐[−13.75]); P = .002). The determined difference in the CPM response between both cohorts showed a medium effect size of r = .433. Conclusion The results of this study indicate that an impaired degree of endogenous pain modulation could be present in patients with haemophilia. Therefore, the function of the descending pain pathway should be considered regarding an individual and comprehensive pain management.

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“…Sensitivity to pain in the knee joint in patients with haemophilia is accompanied by the presence of osteophytes and is linked to synovial hypertrophy. However, in the absence of structural changes there is an increased sensitivity to pain in the knee joints as a diffuse sign of peripheral or central sensitization 36 . Our study reports high values in the mean difference in perceived pain between the various evaluations in those patients who received manual therapy.…”

Section: Discussionmentioning

confidence: 47%

“…However, in the absence of structural changes there is an increased sensitivity to pain in the knee joints as a diffuse sign of peripheral or central sensitization. 36 Our study reports high values in the mean difference in perceived pain between the various evaluations in those patients who received manual therapy. This significant change points towards the suitability of this technique for the treatment of pain in patients with haemophilic knee arthropathy.…”

Section: Discussionmentioning

confidence: 55%

The effectiveness of manual therapy in addition to passive stretching exercises in the treatment of patients with haemophilic knee arthropathy: A randomized, single‐blind clinical trial

2020

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Background Haemophilic arthropathy is characterized by joint restrictions. One of the most affected joints in haemophilia patients is the knee. Aim This study evaluates the effectiveness of manual therapy and passive muscle stretching exercises for reducing the frequency of hemarthrosis and pain and improving joint health and range of motion in patients with haemophilic knee arthropathy. Methods Twenty eight patients with haemophilic knee arthropathy were randomized to an experimental group or to a control group (without intervention). Manual therapy sessions included joint traction and gliding manoeuvers, in addition to passive muscle stretching. The intervention included one 60‐minute with two weekly sessions over a 12‐week period. We evaluated the frequency of knee hemarthrosis (self‐reporting), joint health (Hemophilia Joint Health Score), range of motion (goniometry) and perceived knee pain (visual analogue scale). A baseline evaluation was performed at the end of the intervention and after a 12‐week follow‐up period. Results The frequency of hemarthrosis dropped significantly in the experimental group compared to the control group (F = 11.43; P < .001). Compared to the control group, the experimental group had consistently better results in the variables for joint health (F = 13.80; P < .001), range of motion in knee flexion (F = 24.29; P < .001) and loss of extension (F = 8.90; P < .001), and perceived pain (F = 49.73; P < .001). Conclusions Manual therapy using joint traction and gliding manoeuvers, in addition to passive muscle stretching, reduces the frequency of hemarthrosis in patients with haemophilia. Manual therapy with passive muscle stretching exercises improves joint health, range of motion and perceived joint pain.

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Pain and structural alterations in knee joints in patients with haemophilia

Cited by 19 publications

References 35 publications

Oral and Psychological Alterations in Haemophiliac Patients

Oral and Psychological Alterations in Haemophiliac Patients

Understanding the pain profile in patients with haemophilia: Impaired descending pain inhibition as measured by conditioned pain modulation

The effectiveness of manual therapy in addition to passive stretching exercises in the treatment of patients with haemophilic knee arthropathy: A randomized, single‐blind clinical trial

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