Pain status of patients with severe haemophilic arthropathy

Abstract

Patients with severe haemophilia A growing up before the establishment of prophylactic treatment frequently developed significant haemarthropathies. The goal of the following study was to clarify the role of haemarthropathic pain for haemophilic patients. Furthermore, we aimed to determine to what degree daily activities are influenced by the impairment and which therapeutic modalities are used in pain management. Using a questionnaire we consulted 71 haemophiliacs concerning their complaints and how they were treated in 1999 (average age 43 years; range 21-63 years). The pain in the large joints and spine and the effect of specific treatment was estimated by a visual analogue scale. On average, there were four joints with major pain and 0.5 with minor pain. The most frequent sources of pain were the ankle joints (45%), followed by the knee (39%), spine (14%) and elbow (7%). Fifty percent of all patients complained of pain throughout the day if no treatment was applied. In 29% of patients, pain persisted after application of factor VIII (FVIII), while 12% claimed that pain still remained after use of FVIII and pain killers. Restriction in activities of daily life was reported by 89% of the group and 85% reported on an impact of pain on their mood. Patients primarily used FVIII to decrease pain, followed in frequency by use of anti-inflammatory drugs, orthopaedic footwear, liniments and bandages. Haemophilic patients with haemarthropathy are chronic pain patients. By means of the questionnaire, it is possible to reveal the 'silent' sufferers. Sufficient pain treatment is essential so as to increase the patient's quality of life and avoid inadvertent abnormal postures possibly resulting in increased loading of joints and subsequent bleeding episodes.

Haemophilic arthropathy of the ankle treated by total ankle replacement: a case series

“…The degenerative changes that occur in the joints of these patients are usually progressive and result from recurrent bleeding in 'target' joints. The ankle, one such 'target' joint, is one of the most frequent sources of pain in haemophilic patients [2]. The current standard treatment for patients with advanced, painful arthropathy is ankle fusion [1,3,4].…”

Nacionalna priporočila za obravnavo bolnikov s hemofilijo

“…Pogostejša uporaba zdravil za lajšanje bolečine lahko zmanjša funkcijske omejitve, ki jih povzroča kronična sklepna bolečina (301)(302)(303). Zdravila ne smejo vplivati na strjevanje krvi.…”

Rationale for individualizing haemophilia care

“…There appears to be no difference between patients with acute or chronic pain in the use of over-the-counter medication for pain relief, including nonsteroidal anti-inflammatory drugs and paracetamol (acetaminophen), which is also used extensively [56]. For severe haemophilic arthropathy, 55% of patients used replacement factor for pain relief [57]. The large range of treatment options available, and the decision on which to utilize, will be largely based on individual patient needs and characteristics.…”