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Lippi L, de Sire A, Turco A, Santi RM, Polverelli M, Ammendolia A, Follenzi A, Invernizzi M. Efficacy of rehabilitation interventions on functioning in patients with hemophilic arthropathy: A systematic review with meta-analysis. J Back Musculoskelet Rehabil 2024:BMR230320. [PMID: 38578880 DOI: 10.3233/bmr-230320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND Hemophilic arthropathy is a detrimental condition that crucially affects functional outcomes in hemophilic patients. In recent years, due to the advances in systemic therapies, growing attention has been raised in the rehabilitation field in order to improve functional outcomes of hemophilic patients. However, the optimal rehabilitation modalities in these patients are far from being fully characterized. OBJECTIVE The present study aimed to assess the effects of different rehabilitation interventions on physical functioning and health-related quality of life of hemophilic arthropathic patients. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Five databases were systematically searched for randomized controlled trials (RCTs) published until June 22nd, 2023. The selection criteria included adult patients with hemophilia A and B receiving rehabilitation interventions. The outcomes were muscle strength, physical function, pain intensity, physical performance, and health-related quality of life. RESULTS Out of 1,743 identified records, 17 studies were included in the qualitative synthesis. Rehabilitation interventions were categorized into exercise intervention, fascial therapy, and multimodal intervention. The findings suggested positive outcomes in terms of muscle modifications, range of motion improvements, joint health enhancements, pain intensity reduction, and quality of life improvements. More in detail, meta-analyses showed significant improvements in pain intensity [ES: -1.10 cm (-1.37, -0.82), p< 0.00001], joint health [ES: -1.10 (-1.38, -0.82), p< 0.00001], In accordance, exercise interventions showed significant benefits in terms of joint health [ES: -2.54 (-3.25, -1.83), p< 0.00001)] and quality of life [ES: 1.17 (0.48, 1.86), p< 0.0000)]. CONCLUSION Rehabilitation interventions have a positive impact on functional outcomes and health-related quality of life of hemophilic arthropathic patients. Further studies are needed to better elucidate the role of a comprehensive intervention combining different rehabilitation approaches to treat hemophilic arthropathy.
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Affiliation(s)
- Lorenzo Lippi
- Department of Scientific Research, Campus LUdeS Lugano (CH), Off-Campus Semmelweis, University of Budapest, Budapest, Hungary
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alessio Turco
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Roberto Mario Santi
- Hemorrhagic and Thrombotic Diseases Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marco Polverelli
- Rehabilitation Unit, Department of Rehabilitation, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Antonia Follenzi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Bordbar M, Beigipour R, Tahami M, Zekavat OR, Haghpanah S, Moshfeghinia R. Skeletal complications in patients with hemophilia: a single-center experience. J Orthop Surg Res 2023; 18:907. [PMID: 38017431 PMCID: PMC10685514 DOI: 10.1186/s13018-023-04409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/26/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Arthropathy is a common complication in patients with hemophilia. We examined the prevalence of this skeletal complication in patients with hemophilia who were registered at a Comprehensive Hemophilia Center in Shiraz, Southern Iran. MATERIALS AND METHODS In this cross-sectional study, an orthopedic specialist visited 448 patients and conducted screenings for skeletal complications. The assessment included evaluating the type of hemophilia, disease severity, treatment modality, the presence of inhibitors, and the identification of skeletal complications. RESULTS Ninety patients with hemophilia A, with a mean age (SD) of 31.6 (14.4) years, and 10 patients with hemophilia B, with a mean age of 30.5 (20.6) years, were assessed. The most frequently affected joints were the knee and ankle joints. In the univariate analysis, patients with severe disease were more likely to exhibit synovitis, a target joint, and bone disease compared to patients with non-severe disease. Additionally, a history of treated or active hepatitis and an annual bleeding rate showed significant associations with the target joint. In the multivariable logistic regression analysis, disease severity (OR 14.43, 95% CI 1.6-129.6) and a higher age at diagnosis (OR 1.06, 95% CI 1.00-1.13) increased the likelihood of developing osteoporosis. A history of hepatitis (OR 3.67, 95% CI 1.28-10.48) was identified as an independent risk factor for the target joint. CONCLUSION Skeletal complications are a common occurrence in hemophilia. Regular consultations with orthopedic specialists, focusing on bleeding control and hepatitis prevention, are essential for reducing the impact of this debilitating complication.
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Affiliation(s)
| | - Razieh Beigipour
- Pediatrics Department, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Tahami
- Bone and Joint Disease Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Reza Zekavat
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Moshfeghinia
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
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Alawad MJ, Abu-Tineh M, Alshurafa A, Al-Taie A, Yousaf A, Yassin MA. Glanzmann Thrombasthenia Associated with Siderotic Synovitis and Arthropathy: A Case Report. J Blood Med 2023; 14:563-567. [PMID: 37941894 PMCID: PMC10629506 DOI: 10.2147/jbm.s418937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/20/2023] [Indexed: 11/10/2023] Open
Abstract
Glanzmann thrombasthenia is a bleeding disorder with a low incidence. It typically manifests as superficial bleeding episodes, which tend to be mild. Deep organ involvement is not uncommon but remains rare due to the rarity of the disease itself and the unusual association between platelet disorders and deep organ implications. A 17-year-old boy with Glanzmann thrombasthenia since infancy developed ankle pain after a minor trauma. His initial workup was negative, but he continued to experience ankle pain. A magnetic resonance imaging (MRI) done after four weeks suggested siderotic synovitis. The patient was lost to follow-up after that and returned after two years with recurrent left ankle pain. Imaging and studies have shown evidence of chronic arthropathy. A specialized orthopedic team assessed the patient. The patient underwent intra-articular steroid injection for pain relief and was referred to continue physical therapy. In conclusion, hemarthrosis is more common in hemophilia than in platelet disorders and has potential morbidity and quality-of-life implications.
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Affiliation(s)
- Mouhammad J Alawad
- Department of Medical Education, Internal Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Abu-Tineh
- Department of Medical Oncology, Hematology and BMT Section, National Center for Hamad Medical Corporation, Doha, Qatar
| | - Awni Alshurafa
- Department of Medical Oncology, Hematology and BMT Section, National Center for Hamad Medical Corporation, Doha, Qatar
| | - Alaa Al-Taie
- Clinical Imaging Department, Hamad Medical Corporation, Doha, Qatar
| | - Anil Yousaf
- Department of Medical Oncology, Hematology and BMT Section, National Center for Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A Yassin
- Department of Medical Oncology, Hematology and BMT Section, National Center for Hamad Medical Corporation, Doha, Qatar
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Russell S, Whitehart S, Mason J, Window P. Does the method of telehealth delivery affect the physiotherapy management of adults with bleeding disorders? A comparison of audioconferencing and videoconferencing. Haemophilia 2023; 29:1589-1596. [PMID: 37729471 DOI: 10.1111/hae.14869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Abstract
AIM To determine whether the method of telehealth delivery (audioconferencing or videoconferencing) affects the physiotherapy management of adults with inherited bleeding disorders. METHODS A cross-sectional observational study was utilised involving 40 physiotherapy consultations (23 initial consultations and 17 follow-up consultations) of adults (>18) with a diagnosed bleeding disorder. Each consultation involved an initial audioconferencing component followed immediately by a separate videoconferencing component. Following each component, the physiotherapist utilised the clinical information gathered to formulate and record a management plan, and additionally recorded their confidence in this plan. Differences between the management plans and clinician confidence were recorded, including where applicable the visual information prompting a change in management plans. RESULTS Audioconferencing and videoconferencing management plans differed in 40% of all consultations, including 52.0% of initial consultations and 23.5% of follow-up consultations. Among consultations where management plans differed, this was prompted by visual information related to the anatomic location of symptoms (31.3%), the absence/presence of swelling (31.3%), joint range of movement (25.0%), and general appearance (12.5%). Median self-reported clinician confidence of management plans increased significantly from 70.0% following audioconferencing to 93.0% following videoconferencing. CONCLUSION When utilizing telehealth, the choice between audioconferencing or videoconferencing may affect physiotherapy management of adults with bleeding disorders, particularly with initial consultations. Videoconferencing potentially leads to more appropriate management plans, clinician confidence and utilization of healthcare resources. Further high-quality studies are required to confirm the findings of this study.
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Affiliation(s)
- Scott Russell
- Queensland Haemophilia Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Simon Whitehart
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jane Mason
- Queensland Haemophilia Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Peter Window
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Brisbane, Australia
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Yin DL, Lin JM, Li YH, Chen P, Zeng MD. Short-term outcome of total knee replacement in a patient with hemophilia: A case report and review of literature. World J Clin Cases 2023; 11:2788-2795. [PMID: 37214564 PMCID: PMC10198112 DOI: 10.12998/wjcc.v11.i12.2788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/15/2023] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Hemophilia A is a rare inherited bleeding disorder caused by mutations in the factor VIII gene. This clotting factor plays an intrinsic role in the blood coagulation pathway. Patients with hemophilia may develop orthopedic manifestations such as hemarthrosis, but multiple malunion of fractures over the knee is rare and difficult to treat.
CASE SUMMARY We report a patient with hemophilia A who developed severe knee osteoarthritis along with fracture malunion and nonunion. Total knee replacement was performed using a custom-made modular hinged knee prosthesis (cemented) equipped with extended distal and proximal stems. At 3 years’ follow-up, the patient exhibited excellent clinical function and remained satisfied with the surgical outcome. Surgical intervention was accompanied by rigorous coagulation factor replacement.
CONCLUSION This case highlights various unique scenarios specific to individuals with hemophilia and fracture deformity.
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Affiliation(s)
- De-Long Yin
- Department of Orthopedic, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Jia-Min Lin
- Department of Orthopedic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Yuan-Hui Li
- Department of Orthopedic, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
| | - Peng Chen
- Department of Orthopedic, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
- Department of Orthopedic, Yichang Chinese Medicine Hospital, Yichang 443003, Hubei Province, China
| | - Mian-Dong Zeng
- Department of Orthopedic, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong Province, China
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Mancuso ME, Holstein K, O'Donnell JS, Lobet S, Klamroth R. Synovitis and joint health in patients with haemophilia: Statements from a European e-Delphi consensus study. Haemophilia 2023; 29:619-628. [PMID: 36622258 DOI: 10.1111/hae.14734] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Synovitis, a common feature in haemophilia, is triggered by the presence of blood in joints, and represents the first step towards the development of chronic arthropathy. Synovitis may be detected early by means of ultrasound or magnetic resonance imaging scan; clinical joint scores are less sensitive in this setting. Regular long-term prophylaxis with clotting factor concentrates, as primary prophylaxis and tailored to individual needs, has high efficacy in preventing synovitis. In general, higher factor levels lower bleeding risk, but no direct correlation between factor levels and synovitis incidence has been demonstrated. AIM This study aimed to develop an expert consensus relating to the definition, pathophysiology, diagnosis, prevention, follow-up and treatment of synovitis, recognising its relevance for joint health and taking into account existing knowledge gaps. METHODS A Delphi consensus study was designed and performed. An expert group prepared 22 statements based on existing literature; a wider expert panel subsequently voted on these. RESULTS Retention of panellists was high. Four statements required amending and consensus on all statements was achieved after three rounds of voting. CONCLUSION This e-Delphi consensus study addressed the importance of synovitis in joint health of people with haemophilia and highlighted knowledge gaps in this field. Studies on the natural course of synovitis are lacking and the biological mechanisms underlying this process are not yet fully elucidated. While basic and clinical research proceeds in this field, expert consensus can help guide clinicians in their routine clinical practice, and Delphi methodology is often used to produce best-practice guidelines.
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Affiliation(s)
- Maria Elisa Mancuso
- IRCCS Humanitas Research Hospital, Centre for Thrombosis and Haemorrhagic Diseases, Rozzano, Milan, Italy
| | - Katharina Holstein
- Department of Haematology and Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - James S O'Donnell
- National Coagulation Centre, St. James's Hospital, Dublin, Ireland.,Irish Centre for Vascular Biology, School of Pharmacy and Biomedical Sciences, RCSI, Dublin, Ireland
| | - Sébastien Lobet
- Hematology department, Saint-Luc University Clinics, Avenue Hippocrate 10, Brussels, Belgium.,Neuromusculoskeletal Lab (NMSK), Institute for Experimental and Clinical, Catholic University of Louvain, Avenue Hippocrate, Woluwe-Saint-Lambert, Belgium.,Physical Medicine and Rehabilitation Service, Saint-Luc University Clinics, Avenue Hippocrate 10, Brussels, Belgium
| | - Robert Klamroth
- Vivantes Hospital, Friedrichshain, Berlin, Germany.,Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
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- IRCCS Humanitas Research Hospital, Centre for Thrombosis and Haemorrhagic Diseases, Rozzano, Milan, Italy
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Elshennawy S, Zahreldin AA, Mortada H, Hozien M, Youssef ASA, Galal A, Shahien M, Elfeky A, Elaraby A, Hamed M. The Efficacy of Physical Therapy Modalities in Patients With Hemophilia: A Systematic Review of Randomized Controlled Trials With Meta-analysis. Arch Phys Med Rehabil 2023; 104:475-489. [PMID: 35868453 DOI: 10.1016/j.apmr.2022.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the efficacy of different physical therapy interventions that could validate decisions taken by health care providers in the field of rehabilitation of patients with hemophilia according to the International Classification of Functioning, Disability and Health (ICF), including body functions and structures, activity, and participation. DATA SOURCES Seven databases-PubMed, Cochrane Library, Scopus, Web of Science, Physiotherapy Evidence Database, Google Scholar, and Clinicaltrials.gov-were systematically searched for randomized controlled trials evaluating any physical therapy modality to manage hemophilia. STUDY SELECTION After abstract and full-text filtration, a methodological quality assessment was performed using the Physiotherapy Evidence Database scale for the studies that met the eligibility criteria. DATA EXTRACTION Relevant data were extracted from eligible studies and outcomes were categorized according to the ICF. DATA SYNTHESIS Using Review Manager and Microsoft Excel, a quantitative analysis using standardized mean differences with the 95% confidence interval was completed. Statistical heterogeneity between studies was explored using the I2 test. A fixed effect model was applied to all data analyses. If heterogeneity was statistically significant, the Der Simonian and Laird random effects models were used instead. RESULTS 35 randomized controlled trials with 1216 participants were included in this systematic review; 13 of them dealt with pediatric patients. Most of the studies were of good quality; 12 studies were of low quality. Meta-analysis showed a significant difference in favor of manual therapy, laser, and therapeutic exercises on selected outcomes of body function and structure, activity, and participation categories of the ICF model. CONCLUSION This systematic review recommends using manual therapy and therapeutic exercise modalities to improve join health status in combination with educational sessions to improve the quality of life of patients with hemophilic arthropathy. For pediatric patients with hemophilic arthropathy, using laser therapy is promising for improving functional capacity.
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Affiliation(s)
- Shorouk Elshennawy
- Faculty of Physical Therapy, Cairo University, Giza, Egypt; Faculty of Physical Therapy, Misr University for Science and Technology, Giza, Egypt
| | | | - Hossam Mortada
- Biomechanics Department, Faculty of Physical Therapy, Ahram Canadian University, Giza, Egypt
| | - Menna Hozien
- Department of Neurological Disorders and Surgery Faculty of Physical Therapy, Ahram Canadian University, Giza, Egypt
| | - Ahmed S A Youssef
- Faculty of Physical Therapy, Beni-Suef University, Beni-Suef, Egypt; Huazhong University of Science and Technology, Wuhan, China
| | - Amira Galal
- Faculty of Physical Therapy, Egyptian Chinese University, Cairo, Egypt
| | | | - Amr Elfeky
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Maged Hamed
- Faculty of Physical Therapy, Misr University for Science and Technology, Giza, Egypt.
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Boccalandro EA, Begnozzi V, Garofalo S, Pasca S, Peyvandi F. The evolution of physiotherapy in the multidisciplinary management of persons with haemophilia (PWH): A scoping review. Haemophilia 2023; 29:11-20. [PMID: 36167324 PMCID: PMC10086794 DOI: 10.1111/hae.14661] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Haemophilia is a rare congenital bleeding disorder, and the most common manifestation is spontaneous bleeding in muscles and joints. Despite the benefits linked to recent and dramatic pharmacological advances at least in high income setting, many patients still develop musculoskeletal dysfunctions during their lifetime, which must be managed by physiotherapists in the frame of a multidisciplinary team. The aim of the scoping review is to map the available evidence by providing an overview on the past and present physiotherapy scenario in persons with haemophilia (PWH). MATERIALS AND METHODS The review was conducted according to the guidelines of the PRISMA extension for scoping reviews. Scientific articles on physiotherapy and sport interventions for PWH published from 1960 up to September 2021 have been included. Search was conducted on the e-databases PubMed and PEDro without restrictions for the study design. RESULTS Sixty eight articles were included, 52 related to rehabilitation and preventive physiotherapy, 16 to sport. The results have been reported in chronological order and divided into two categories: (1) rehabilitation and preventive physiotherapy; (2) sport activities. CONCLUSIONS This is the first scoping review on physiotherapy in haemophilia, based on the existing evidence on this topic which allowed us to underline how the role of the physiotherapist changed over time. Historically this specialist did intervene only after an acute bleed or surgical operation, but now he has a pivotal role in the multidisciplinary team that acts to improve from birth the quality of life of the PWH. His activity is also closely intertwined with sport promotion and supervision.
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Affiliation(s)
- Elena A Boccalandro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Valentina Begnozzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Sofia Garofalo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Samantha Pasca
- Padua University Hospital, Biomedical Sciences Department (DSB), Padua, Italy.,Padua University Hospital, Medicine Department (DIMED), Padua, Italy
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy.,Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
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9
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Sidonio RF, Hoffman M, Kenet G, Dargaud Y. Thrombin generation and implications for hemophilia therapies: A narrative review. Res Pract Thromb Haemost 2022; 7:100018. [PMID: 36798897 PMCID: PMC9926221 DOI: 10.1016/j.rpth.2022.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 01/07/2023] Open
Abstract
Thrombin plays an essential role in achieving and maintaining effective hemostasis and stable clot formation. In people with hemophilia, deficiency of procoagulant factor (F)VIII or FIX results in insufficient thrombin generation, leading to reduced clot stability and various bleeding manifestations. A correlation has been found between the bleeding phenotype of people with hemophilia and the extent of thrombin generation, with individuals with increased thrombin generation being protected from bleeding and those with lower thrombin generation having increased bleeding tendency. The amount, location, and timing of thrombin generation have been found to affect the formation and stability of the resulting clot. The goal of all therapies for hemophilia is to enhance the generation of thrombin with the aim of restoring effective hemostasis and preventing or controlling bleeding; current treatment approaches rely on either replacing or mimicking the missing procoagulant (ie, FVIII or FIX) or rebalancing hemostasis through lowering natural anticoagulants, such as antithrombin. Global coagulation assays, such as the thrombin generation assay, may help guide the overall management of hemostasis by measuring and monitoring the hemostatic potential of patients and, thus, assessing the efficacy of treatment in people with hemophilia. Nevertheless, standardization of the thrombin generation assay is needed before it can be adopted in routine clinical practice.
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Affiliation(s)
- Robert F. Sidonio
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA,Department of Pediatrics, Emory University, Atlanta, Georgia, USA,Correspondence Robert F Sidonio, Aflac Cancer and Blood Disorders Center Children’s Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA 30322, USA. @nashgreenie
| | - Maureane Hoffman
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gili Kenet
- The Israeli National Hemophilia Center and Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel,The Amalia Biron Thrombosis Research Institute, Tel Aviv University, Tel Aviv, Israel
| | - Yesim Dargaud
- Unité d’Hémostase Clinique, Centre National de Reference de l'Hemophilie, Hôpital Cardiologique Louis Pradel, Université Lyon, Lyon, France
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10
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Chin B, Wee I, Syn NL, O'Neill GK, Yap ES, Koh PL. Surgery for chronic arthropathy in people with haemophilia. Cochrane Database Syst Rev 2022; 11:CD013634. [PMID: 36448638 PMCID: PMC9710191 DOI: 10.1002/14651858.cd013634.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Chronic arthropathy is a potentially debilitating complication for people with haemophilia - a genetic, X-linked, recessive bleeding disorder, characterised by the absence or deficiency of a clotting factor protein. Staging classifications, such as the Arnold-Hilgartner classification for haemophilic arthropathy of the knee, radiologically reflect the extent of knee joint destruction with underlying chronic synovitis. Management of this highly morbid disease process involves intensive prophylactic measures, and chemical or radioisotope synovectomy in its early stages. However, failure of non-surgical therapy in people with progression of chronic arthropathy often prompts surgical management, including synovectomy, joint debridement, arthrodesis, and arthroplasty, depending on the type of joint and extent of the damage. To date, management of people with mild to moderate chronic arthropathy from haemophilia remains controversial; there is no agreed standard treatment. Thus, the benefits and disadvantages of non-surgical and surgical management of mild to moderate chronic arthropathy in people with haemophilia needs to be systematically reviewed. OBJECTIVES: To assess the efficacy and safety of surgery for mild to moderate chronic arthropathy in people with haemophilia A or B. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, and two trial registers to August 2022. We also handsearched relevant journals and conference abstract books. SELECTION CRITERIA Randomized controlled trials (RCTs) and quasi-RCTs comparing surgery and non-surgical interventions, for any joint with chronic arthropathy, in people with haemophilia, who were at least 12 years old. DATA COLLECTION AND ANALYSIS The review authors did not identify any trials to include in this review. MAIN RESULTS The review authors did not identify any trials to include in this review. AUTHORS' CONCLUSIONS The review authors did not identify any trials to include in this review. Due to a lack of research in this particular area, we plan to update the literature search every two years, and will update review if any new evidence is reported. There is a need for a well-designed RCT that assesses the safety and efficacy of surgical versus non-surgical interventions for chronic arthropathy in people with haemophilia.
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Affiliation(s)
- Brian Chin
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Ian Wee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Nicholas Lx Syn
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Gavin K O'Neill
- Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Eng Soo Yap
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Pei Lin Koh
- Department of Paediatrics, National University Health System, Singapore, Singapore
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11
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Ray A, Colville JG, Hartley R, Rowbotham E. The musculoskeletal manifestations of haemophilia: a review of the imaging findings. Clin Radiol 2022; 77:730-737. [PMID: 35985846 DOI: 10.1016/j.crad.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/29/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
Haemophilia is a common hereditary cause of bleeding diathesis and the musculoskeletal system is frequently affected. Repeated episodes of haemarthrosis initiate a cascade towards haemophilic arthropathy, a disabling and deforming joint disease with both degenerative and inflammatory features, which include articular cartilage loss, bone erosions, and synovitis. Haemophilic pseudotumour and intra-muscular haematoma make up the remainder of the musculoskeletal manifestations of this systemic condition. Radiological assessment is vital in the assessment and follow-up of these haemophilic complications and MRI is the reference standard. This article summarises the radiological findings relevant to the diagnosis and monitoring of this complex patient group.
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Affiliation(s)
- A Ray
- Department of Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK.
| | - J G Colville
- Department of Radiology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| | - R Hartley
- Department of Radiology, The James Cook University Hospital, South Tees NHS Trust, Middlesbrough TS43BW, UK
| | - E Rowbotham
- Department of Radiology, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Chapel Town Road, Leeds LS7 4SA, UK
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12
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Gönen T, Yakut Y, Akbayram S. The effects of close kinetic chain exercises on proprioception and physical activity level in pediatric patients with hemophilia. Haemophilia 2022; 28:e189-e198. [PMID: 35921241 DOI: 10.1111/hae.14645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Knee joint proprioception is affected, and lower extremity functioning declines over time in patients with hemophilia A. AIM To investigate the effects of a structured exercise programme consisting of the close kinetic chain (CKC) exercises on proprioception and physical activity level in pediatric patients with hemophilia. METHODS A total of 21 patients with hemophilia A who had at least one target knee joint were randomized into three groups: Study Group (SG, n = 7), Conventional Treatment Group (CTG, n = 7) and Control Group (CG, n = 7). The SG received a structured, lower limb-specific exercise protocol consisting of CKC exercises 2 days a week for 12 weeks, in addition to prophylactic treatment. The CTG received exercise training as described in the published literature. The CG continued to receive prophylactic treatment during the study period. Proprioception was measured using a digital goniometer before and after treatment in open and closed kinetic chain positions (CKCPs). The Five Times Sit to Stand (STS), Timed Up and Go (TUG) and Functional Independence Score in Hemophilia were used for the assessment of physical activity level. RESULTS A significant pre/post-treatment difference was found among the groups in proprioception (p = .001) and physical activity level (TUG p = .008, STS p = .001, FISH p = .006). Improvements in proprioception and physical activity level were greater in the SG compared to the other two groups (p < .05). CONCLUSION Compared to conventional exercise, the structured exercise protocol consisting of CKC exercise training produced improvements in proprioception and physical activity in patients with hemophilia A.
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Affiliation(s)
- Tuğba Gönen
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Yavuz Yakut
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Sinan Akbayram
- Faculty of Medicine, Department of Pediatric Hematology-Oncology, Gaziantep University, Gaziantep, Turkey
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13
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Callaghan MU, Asikanius E, Lehle M, Oldenburg J, Mahlangu J, Uguen M, Chebon S, Kruse-Jarres R, Jiménez-Yuste V, Shima M, Trask P, Kempton CL, Kessler CM, Levy GG, Peyvandi F. Untreated bleeds in people with hemophilia A in a noninterventional study and intrapatient comparison after initiating emicizumab in HAVEN 1-3. Res Pract Thromb Haemost 2022; 6:e12782. [PMID: 36171959 PMCID: PMC9468791 DOI: 10.1002/rth2.12782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 12/31/2022] Open
Abstract
Background Bleeding in people with hemophilia A can be life threatening, and intra‐articular bleeds can result in joint damage. Most clinical studies focus on treated bleeds, while bleeds not treated with coagulation factor(s) (untreated bleeds) are underreported. Objectives We assessed the incidence of untreated bleeds during a noninterventional study (NIS) wherein people with hemophilia A, with or without factor VIII (FVIII) inhibitors, were managed according to standard practice. Patients/Methods Using the Bleed and Medication Questionnaire, we prospectively collected data from three cohorts: Cohort A, adults/adolescents (age ≥12 years) with FVIII inhibitors; Cohort B, children (aged <12 years) with FVIII inhibitors; Cohort C, adults/adolescents without FVIII inhibitors. Untreated bleeds were analyzed for site, frequency, and etiology of bleeding and compared with those during emicizumab prophylaxis in the same individuals after transferring to a Phase III HAVEN trial. Results In the 221 participants enrolled in the NIS (Cohort A, n = 103; Cohort B, n = 24; Cohort C, n = 94), the incidence of untreated bleeds was approximately 40% of all bleeds in people with FVIII inhibitors and 26.2% in adolescents/adults without inhibitors. Approximately 70% of treated bleeds and approximately 54% of untreated bleeds in adults/adolescents were in joints. Untreated joint bleeds were less common (7.1%) in children. Overall, intra‐individual comparisons showed reduced treated/untreated bleeds following transition from standard to emicizumab prophylaxis. Conclusion A significant proportion of bleeding events are untreated in people with hemophilia A. There is a need to further understand why bleeds remain untreated and to capture such events in clinical studies.
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Affiliation(s)
- Michael U Callaghan
- Department of Pediatrics Central Michigan University Detroit Michigan USA.,Agios Pharmaceuticals Cambridge Massachusetts USA
| | - Elina Asikanius
- Product Development, F. Hoffmann-La Roche Ltd Basel Switzerland.,The Finnish Medicines Agency Helsinki Finland
| | - Michaela Lehle
- Product Development, F. Hoffmann-La Roche Ltd Basel Switzerland
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine University of Bonn Bonn Germany
| | - Johnny Mahlangu
- Haemophilia Comprehensive Care Centre, Faculty of Health Sciences University of the Witwatersrand and NHLS Johannesburg South Africa
| | - Marianne Uguen
- PDB Biostatistics, F. Hoffmann-La Roche Ltd Basel Switzerland
| | - Sammy Chebon
- PDB Biostatistics, F. Hoffmann-La Roche Ltd Basel Switzerland
| | - Rebecca Kruse-Jarres
- University of Washington and Washington Center For Bleeding Disorders Seattle Washington USA
| | | | - Midori Shima
- Department of Pediatrics Nara Medical University Kashihara Japan
| | - Peter Trask
- Patient Centered Outcomes Research, Genentech, Inc. South San Francisco California USA
| | - Christine L Kempton
- Department of Hematology and Medical Oncology and Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory Emory University School of Medicine Atlanta Georgia USA
| | - Craig M Kessler
- The Division of Coagulation Georgetown University Hospital Washington District of Columbia USA
| | - Gallia G Levy
- Product Development, Genentech, Inc. South San Francisco California USA.,Spark Therapeutics, Inc. Philadelphia Pennsylvania USA
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center Milan Italy.,Department of Pathophysiology and Transplantation Università degli Studi di Milano Milan Italy
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14
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Cuesta-Barriuso R, Pérez-Llanes R, Donoso-Úbeda E, Ucero-Lozano R. LongHest project: A prospective, observational study of extended half-life treatment in the musculoskeletal health of patients with severe haemophilia A. Haemophilia 2022; 28:857-864. [PMID: 35561281 PMCID: PMC9541876 DOI: 10.1111/hae.14592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/21/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
Abstract
Background Prophylactic treatment is the gold standard in the treatment of patients with haemophilia. Prophylaxis with extended half‐life (EHL) treatment has shown long‐term safety and efficacy in patients with haemophilia. Aim To evaluate the efficacy of prophylaxis with EHL treatment in the frequency of haemarthrosis and musculoskeletal health in adult patients with severe haemophilia A. Methods Prospective cohort study. Forty‐six patients with severe haemophilia A were recruited. The frequency of haemarthrosis (self‐reports), joint condition (Haemophilia Joint Health Score), pain intensity (visual analogue scale), range of motion (goniometry), and strength (dynamometry) and muscle activation (surface electromyography) were evaluated. Three assessments were carried out: at baseline (T0), at 6 months (T1) and at 12 months following treatment (T2). Results There were significant changes in the within‐subject effect in the frequency of haemarthrosis in elbow (F(1.05;96.20) = 3.95; P < .001) and knee (F(1.73;157.99) = 9.96; P < .001). Significant within‐subject effect in elbow pain intensity (F(2;182) = 63.51; P < .001) was found. The mean values of the frequency haemarthrosis in elbow (from .66±1.01 to .04±.20) and knees (from .55±.68 to .33±.53) decrease after the period study. The intensity of elbow pain and (from 3.08±1.69 to 2.67±1.73), decrease after the 12‐month follow‐up period. Conclusions Prophylaxis with extended half‐life treatment reduces the frequency of haemarthrosis in elbow and knee in adult patients with haemophilia. EHL treatment reduces the intensity of elbow pain in patients with haemophilic arthropathy.
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Affiliation(s)
- Rubén Cuesta-Barriuso
- Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine, University of Oviedo, Oviedo, Spain.,Royal Victoria Eugenia Foundation, Madrid, Spain
| | - Raúl Pérez-Llanes
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
| | - Elena Donoso-Úbeda
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
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15
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Zwagemaker A, Kloosterman FR, Hemke R, Gouw SC, Coppens M, Romano LGR, Kruip MJHA, Cnossen MH, Leebeek FWG, Hutten BA, Maas M, Fijnvandraat K. Joint status of patients with nonsevere hemophilia A. J Thromb Haemost 2022; 20:1126-1137. [PMID: 35171522 PMCID: PMC9314729 DOI: 10.1111/jth.15676] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/01/2022] [Accepted: 02/11/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Joint bleeding in hemophilia may eventually lead to joint damage. In nonsevere hemophilia, joint bleeds occur infrequently. Currently, knowledge on the joint status of patients with nonsevere hemophilia using objective imaging is limited. OBJECTIVE To investigate the joint status in patients with nonsevere hemophilia A. METHODS This cross-sectional study included patients with nonsevere hemophilia A aged 24-55 years. Joint status was assessed by magnetic resonance imaging (MRI) of the elbows, knees, and ankles and International Prophylaxis Study Group (IPSG) scores were calculated. Lifetime joint bleeding history was collected from medical files. The contribution of factors to joint outcome was explored using multivariable linear regression analysis. RESULTS In total, 51 patients were included, of whom 19 (37%) had moderate and 32 (63%) had mild hemophilia. Patients had a median age of 43 years (interquartile range [IQR] 32-50), a median factor VIII activity of 10 IU/dl (IQR 4-16) and a median annual joint bleeding rate (AJBR) of 0.0 (IQR 0.0-0.2). Soft-tissue changes (IPSG subscore > 0) in the elbows, knees, and ankles were present in 19%, 71%, and 71% of patients, respectively. Osteochondral changes (IPSG subscore > 0) in the elbows, knees, and ankles were present in 0%, 20%, and 35% of patients, respectively. In 14% of bleed-free joints, hemosiderin depositions were observed. Age and AJBRs were most strongly associated with the IPSG score. CONCLUSION This study demonstrates that a substantial proportion of adults with nonsevere hemophilia has joint changes on MRI despite low joint bleeding rates.
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Affiliation(s)
- Anne‐Fleur Zwagemaker
- Pediatric HematologyAmsterdam UMCUniversity of AmsterdamEmma Children’s HospitalAmsterdamThe Netherlands
| | - Fabienne R. Kloosterman
- Pediatric HematologyAmsterdam UMCUniversity of AmsterdamEmma Children’s HospitalAmsterdamThe Netherlands
| | - Robert Hemke
- Department of Radiology and Nuclear MedicineAmsterdam University Medical CentersUniversity of AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Samantha C. Gouw
- Pediatric HematologyAmsterdam UMCUniversity of AmsterdamEmma Children’s HospitalAmsterdamThe Netherlands
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Michiel Coppens
- Department of Vascular MedicineAmsterdam University Medical CentersAmsterdamthe Netherlands
| | - Lorenzo G. R. Romano
- Department of HematologyErasmus MCErasmus University Medical CenterRotterdamThe Netherlands
| | - Marieke J. H. A. Kruip
- Department of HematologyErasmus MCErasmus University Medical CenterRotterdamThe Netherlands
| | - Marjon H. Cnossen
- Department of Pediatric HematologyErasmus MC Sophia Children’s HospitalErasmus University Medical CenterRotterdamThe Netherlands
| | - Frank W. G. Leebeek
- Department of HematologyErasmus MCErasmus University Medical CenterRotterdamThe Netherlands
| | - Barbara A. Hutten
- Department of Epidemiology and Data ScienceAmsterdam Cardiovascular SciencesAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear MedicineAmsterdam University Medical CentersUniversity of AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Karin Fijnvandraat
- Pediatric HematologyAmsterdam UMCUniversity of AmsterdamEmma Children’s HospitalAmsterdamThe Netherlands
- Department of Molecular Cellular HemostasisSanquin Research and Landsteiner LaboratoryAmsterdamThe Netherlands
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16
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Chimeno-Hernández A, Querol-Giner F, Pérez-Alenda S, Núñez-Cortés R, Cruz-Montecinos C, Carrasco JJ, Aguilar-Rodríguez M. Effectiveness of physical exercise on postural balance in patients with haemophilia: A systematic review. Haemophilia 2022; 28:409-421. [PMID: 35363925 PMCID: PMC9325530 DOI: 10.1111/hae.14556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/13/2022] [Accepted: 03/14/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Balance training is important to improve balance and to decrease the risk of falls in patients with haemophilia (PWH). AIM To analyse the current knowledge about the effectiveness of physical exercise on postural balance in PWH. METHODS A systematic search for clinical trials, published before November 2021, was conducted using the following electronic databases: PubMed/MEDLINE, Web of Science, Embase, Wiley Online Library and the Cochrane Central Register of Controlled Trials (CENTRAL). Two independent reviewers extracted the data and assessed the risk of bias. The certainty of the evidence was analyzed using GRADE. RESULTS A total of ten studies involving 304 patients were included. The studies performed strength and balance exercises, and some included flexibility, mobilization, and/or aerobic exercises in their training programs. Postural balance was evaluated using a force platform and the one leg stand test was the most frequently used. Only five exercise programs achieved a significant increase in balance (pre-post) with a strength, postural balance, flexibility, and aerobic intervention. In general, the quality rate of the risk of bias was fair but the overall quality of the evidence across the studies was very low. CONCLUSION Five studies showed that there is a positive change in balance after the intervention. However, there is currently an unclear demonstration of evidence for the use of physical exercises to improve postural balance in people with haemophilia. Further studies with a higher methodological quality are needed.
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Affiliation(s)
- Ana Chimeno-Hernández
- Physiotherapy in Motion. Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Felipe Querol-Giner
- Physiotherapy in Motion. Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion. Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rodrigo Núñez-Cortés
- Physiotherapy in Motion. Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Physiotherapy in Motion. Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Division of Research, Devolvement and Innovation in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | - Juan J Carrasco
- Physiotherapy in Motion. Multispecialty Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Valencia, Spain.,Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
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17
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Long-term efficacy and safety of subcutaneous concizumab prophylaxis in hemophilia A and hemophilia A/B with inhibitors. Blood Adv 2022; 6:3422-3432. [PMID: 35290453 PMCID: PMC9198939 DOI: 10.1182/bloodadvances.2021006403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/28/2022] [Indexed: 11/20/2022] Open
Abstract
Despite current treatments, there remains an unmet need for patients with hemophilia. The main parts of two phase 2 trials established clinical proof-of-concept for once-daily, subcutaneous concizumab prophylaxis in patients with hemophilia A/B with inhibitors (HAwI/HBwI; explorer4) and severe hemophilia A without inhibitors (HA; explorer5,). Here, we present results from extension parts of these trials, included to evaluate longer-term safety and efficacy. Both trials included main (≥24 weeks) and extension parts (52-102 weeks), with patients receiving 0.15 mg/kg concizumab with potential dose escalation to 0.20 or 0.25 mg/kg if they experienced ≥3 treated spontaneous bleeds within 12 weeks. Endpoints included annualized bleeding rate (ABR), adverse events (AEs), and anti-drug antibody (ADA) occurrence. Thromboembolic events were AEs of special interest. Thirty-six patients with HA, 15 with HAwI and 10 with HBwI were exposed to concizumab. Estimated ABRs during the main+extension parts at last dose level were 4.8 (95% confidence interval [CI]: 3.2-7.2) and 6.4 (95% CI: 4.1-9.9) in explorer4 and explorer5, respectively (spontaneous ABRs were 1.8 [95% CI: 1.2-2.6] and 2.1 [95% CI: 1.3-3.3]). Most AEs were mild, with no deaths, events leading to withdrawal or thromboembolic events. ADAs developed in 25% of patients and were low titer and transient with no observed clinical effect in most cases. Results of the main+extension parts of these trials were consistent with the main parts. Ongoing phase 3 trials will further evaluate concizumab as a once-daily, subcutaneous treatment across hemophilia subtypes. Trials registered at www.clinicaltrials.gov (NCT03196284; NCT03196297).
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18
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Parhampour B, Alizadeh V, Torkaman G, Ravanbod R, Bagheri R, Vasaghi-Gharamaleki B, Dadgoo M, Mohsenipour SM, Sadat ZA. Muscle thickness and pennation angle in overweight persons with moderate haemophilia A after resistance and combined training: A randomized controlled trial. Haemophilia 2022; 28:505-514. [PMID: 35263502 DOI: 10.1111/hae.14539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Muscular atrophy and overweightness develop arthropathy in persons with haemophilia (PWH), and exercise increases their muscle strength and decreases their body weight. Musculoskeletal ultrasonography may be a non-invasive, safe, valid, and reliable tool to investigate muscle thickness (MT) and pennation angle (PA) after exercise training. OBJECTIVES The present study was conducted to evaluate the effects of 6 weeks of resistance training (RT) and combined resistance and aerobic training (CT) on MT and PA in overweight persons with moderate haemophilia A. MATERIALS AND METHODS Forty-two persons with moderate haemophilia A with a mean age of 35-55 years and a BMI of 25-30 kg/m2 were randomly assigned to three groups of 14, namely RT, CT, and control. The RT group performed 40 minutes of RT, and the CT group performed 20 min of RT and 20 min of aerobic training. The PA and MT of the biceps brachii (BB), triceps brachii (TB), vastus medialis (VM), vastus lateralis (VL), and medial gastrocnemius (MG) were measured before and after the intervention using B-mode ultrasonography. RESULTS Significant increases were observed in the MT of VM, VL, MG, BB, and TB and PA of VM, VL, and MG in the RT and CT groups compared to the control group (p < .001). No significant differences were observed between the intervention groups. CONCLUSION Both RT and CT were effective in enhancing MT and PA in overweight persons with moderate haemophilia A.
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Affiliation(s)
- Behrouz Parhampour
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Alizadeh
- Department of Radiology, Faculty of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Giti Torkaman
- Department of Physical Therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Roya Ravanbod
- Department of Physical Therapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Rasoul Bagheri
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Semnan University of Medical Sciences, Tehran, Iran
| | - Behnoosh Vasaghi-Gharamaleki
- Rehabilitation Research Center, Department of Rehabilitation Basic Sciences, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Dadgoo
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mehdi Mohsenipour
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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19
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The Application of Focused Medium-Energy Extracorporeal Shockwave Therapy in Hemophilic A Arthropathy. Healthcare (Basel) 2022; 10:healthcare10020352. [PMID: 35206968 PMCID: PMC8871785 DOI: 10.3390/healthcare10020352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Hemophilic arthropathy causes the damage of synovium, cartilage, and subchondral bone. The present study evaluated the safety and the effect of extracorporeal shockwave therapy (ESWT), a safe treatment widely used in musculoskeletal conditions in patients with hemophilic arthropathy. Between 1 August 2019 and 31 July 2020, seven hemophilia A patients were enrolled and treated with medium-energy ESWT on the knee joint in the first two months after prophylactic coagulation factor administration. At the beginning of the study and at 1-, 2-, 3-, and 6-month follow-ups, the Hemophilia Joint Health Score (HJHS), visual analog scale score (VAS), and Hemophilia Early Arthropathy Detection with Ultrasound score (HEAD-US) were evaluated for therapeutic effectiveness and safety, while serum bone morphogenetic protein 2 (BMP-2) and von Willebrand factor (vWF) levels were analyzed for assessing chondroprotection and bone healing. Magnetic resonance imaging (MRI) of the knee was performed at the beginning of the study and the 6-month follow-ups. As a result, a non-significant decrease in VAS scores (p = 0.151) but not HJHS after treatment was noticed. At the 3-month follow-up, there was a non-significant increase in BMP2 levels (p = 0.171) but not vWF. Ultrasonography showed no disease activity score elevation in five patients and no further disease damage in all patients. Repeated MRI examinations in three patients showed no structural progression during the 6-month follow-up. As to adverse events, redness, local heat, and mild swelling were noted in five patients without breakthrough bleeding. We concluded that medium-energy ESWT might be safe for hemophilic arthropathy once prophylactic coagulation factors are administered.
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20
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Hodroj MH, El Hasbani G, Al-Shamsi HO, Samaha H, Musallam KM, Taher AT. Clinical burden of hemophilia in older adults: Beyond bleeding risk. Blood Rev 2021; 53:100912. [PMID: 34887154 DOI: 10.1016/j.blre.2021.100912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 01/18/2023]
Abstract
The prospect of hemophilia patients has dramatically improved in the last few decades with the introduction of various interventions that can effectively treat or prevent their bleeding risk. The life expectancy of patients can now reach that of the healthy population, but this has paved the way for several previously unrecognized morbidities to manifest in older adults with hemophilia. Such clinical complications are attributed to suboptimal management or poor access to effective therapy during childhood as well as chronicity and prolonged exposure to the underlying pathophysiology of the disease and its treatment. Complications common in the aging population are also becoming increasingly relevant in this vulnerable patient subgroup. In this review, we highlight peculiarities of such morbidities including chronic viral infections and liver disease, debilitating joint impairment and bone disease, cardiovascular and chronic kidney disease, and cancers. We also reflect on topics of special interest in adulthood such as sexuality.
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Affiliation(s)
| | | | - Humaid O Al-Shamsi
- Burjeel Medical City, Abu Dhabi, United Arab Emirates; Emirates Oncology Society, Dubai, United Arab Emirates; University of Sharjah, Sharjah, United Arab Emirates
| | - Hanady Samaha
- Saint George Hospital University Medical Center, Beirut, Lebanon
| | | | - Ali T Taher
- American University of Beirut Medical Center, Beirut, Lebanon.
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21
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Lin CY, Hosseini F, Squire S, Jackson S, Sun HL. Trends of outcomes and healthcare utilization following orthopaedic procedures in adults with haemophilia: A 3-decade retrospective review. Haemophilia 2021; 28:151-157. [PMID: 34730853 DOI: 10.1111/hae.14451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/14/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Haemophilic arthropathy is a serious complication of haemophilia often requiring surgical intervention. It is unclear whether advances in comprehensive care are associated with a reduction in orthopaedic interventions and peri-procedural resource utilization. AIM To determine temporal patterns of orthopaedic interventions in persons with haemophilia (PWH), and evaluate changes in healthcare utilization and outcomes. METHODS In this Canadian multicentre retrospective cohort study, adult PWH from Northern Alberta and British Columbia who underwent orthopaedic procedures (1990-2018) were included. Temporal changes in the type of procedures, length of stay (LOS), factor utilization and outcomes were examined. RESULTS Sixty-five patients (78% haemophilia A) underwent 102 surgeries at a median age of 46.3. Of the 46 severe PWH, 28 (61%) were on prophylaxis at time of surgery. The proportion of total knee arthroplasties (TKA) declined over time (56% 1990-1999, 51% 2000-2009, 27% 2010-2018), with a concomitant rise in ankle arthrodesis (0% 1990-1999, 18% 2000-2009, 27% 2010-2018). Over time, PWH underwent orthopaedic procedures at an older age (P = .02). There was a significant reduction in perioperative factor VIII utilization (P = .003) and median LOS (P < .0001). Major bleeds, prosthetic joint infections and thrombosis were not observed in the last decade. CONCLUSION In the last three decades, there was a decline in the proportion of TKA, likely reflecting the impact of widespread use of tertiary prophylaxis. However, ankle arthrodesis rates increased, suggesting that higher trough levels may be required to prevent ankle arthropathy. We observed a significant reduction in LOS and factor utilization, reflecting improvements in perioperative management.
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Affiliation(s)
- Chu Yang Lin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Farshad Hosseini
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Shannon Jackson
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Haowei Linda Sun
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Canada
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Paredes AC, Costa P, Roque S, Fernandes S, Lopes M, Carvalho M, Mateus A, Almeida A, Pinto PR. Effectiveness of hypnosis for pain and health-related quality-of-life among people with hemophilia: Three-month outcomes of a randomized controlled pilot trial. Complement Ther Clin Pract 2021; 45:101486. [PMID: 34601386 DOI: 10.1016/j.ctcp.2021.101486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 09/07/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE Pain is a common condition among people with hemophilia (PWH), negatively impacting quality of life. However, effective treatment remains a challenge. This two-arm, parallel randomized controlled pilot trial aimed to examine the three-month effects of hypnosis intervention on clinical and psychosocial variables, and on the inflammatory profile of PWH. MATERIALS AND METHODS The study was conducted between January and October 2018, in a Reference Center for Congenital Coagulopathies. Adult (age ≥18) patients were randomized to experimental group (EG) or control group (CG). The EG received four weekly hypnosis sessions plus treatment-as-usual, and the CG maintained treatment-as-usual only. Outcomes were evaluated at one week and three months post-intervention and included pain, joint status, health-related quality of life (HRQoL), emotional state and inflammatory profile (leukocytes, C-reactive protein, cytokines). The randomization sequence was computer-generated, and allocation was concealed until enrolment. The outcome assessor was blind to allocation, but blinding of the participants was not possible due to the differences in procedure. RESULTS Twenty patients were randomized to EG (n = 10; 8 analyzed) or CG (n = 10; 10 analyzed). Two-way mixed ANOVA showed significant time × group interactions on pain interference with normal work and with relations with other people, and on perception of health status. The EG significantly improved in pain interference with normal work and perception of health status. There was no report of harm. CONCLUSION Hypnosis may be a promising intervention to manage hemophilia-related pain and promote HRQoL, with benefits lasting up to three months.
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Affiliation(s)
- Ana Cristina Paredes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS / 3B's - PT Government Associate Laboratory, Braga / Guimarães, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS / 3B's - PT Government Associate Laboratory, Braga / Guimarães, Portugal; Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Susana Roque
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS / 3B's - PT Government Associate Laboratory, Braga / Guimarães, Portugal
| | - Susana Fernandes
- Congenital Coagulopathies Reference Centre, Department of Transfusion Medicine and Blood Bank, São João University Hospital Centre, Porto, Portugal
| | - Manuela Lopes
- Congenital Coagulopathies Reference Centre, Department of Transfusion Medicine and Blood Bank, São João University Hospital Centre, Porto, Portugal
| | - Manuela Carvalho
- Congenital Coagulopathies Reference Centre, Department of Transfusion Medicine and Blood Bank, São João University Hospital Centre, Porto, Portugal
| | - António Mateus
- Orthopedics and Trauma Department, São João University Hospital Centre, Porto, Portugal
| | - Armando Almeida
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS / 3B's - PT Government Associate Laboratory, Braga / Guimarães, Portugal
| | - Patrícia R Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS / 3B's - PT Government Associate Laboratory, Braga / Guimarães, Portugal.
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Paredes AC, Teixeira P, Almeida A, Pinto PR. Prevalence and Interference of Chronic Pain Among People With Hemophilia: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2021; 22:1134-1145. [PMID: 33945849 DOI: 10.1016/j.jpain.2021.03.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
Chronic pain is a common condition among people with hemophilia (PWH), associated with joint deterioration due to repeated joint bleeds. This systematic review and meta-analysis aimed to determine the prevalence of chronic pain due to haemophilia and to analyze its interference in the lives of patients. A systematic search was performed in May and June 2019 and updated in February 2021, using PubMed, EMBASE, Web of Science and SciElo. The search included terms related to hemophilia, pain, pain prevalence and pain interference. Studies were included if they reported data referring to hemophilia-related chronic pain among adult males (age ≥18). From 3,258 identified studies, 11 met the inclusion criteria. Three studies used a proposed definition for hemophilia-related chronic pain and 8 used direct questions developed by the authors. For the global samples, prevalence ranged from 17% to 84%. The random-effects meta-analysis including all studies demonstrated a pooled prevalence of chronic pain of 46% (95% Confidence Interval, CI = 34%-58%). Subgroup analysis of samples including all disease severities or including only severe patients revealed a pooled prevalence of 48% (95% CI = 29%-67%) and 53% (95% CI = 38%-69%), respectively. High heterogeneity between studies was observed in all models. Information concerning chronic pain interference was retrieved from 1 study, reporting a mean interference of 3.7 (0-10 numerical rating scale from the Brief Pain Inventory). This systematic review revealed a wide prevalence range of hemophilia-related chronic pain across studies, varying methodologies and sample characteristics. Research in the hemophilia field should clearly distinguish between acute and chronic pain and provide complete characterization of study samples. PERSPECTIVE: Pain is a central issue in the lives of people with hemophilia, posing a significant challenge for healthcare providers. A clear picture of chronic pain due to hemophilia is precluded by high heterogeneity among studies and various definitions used to investigate its prevalence.
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Affiliation(s)
- Ana Cristina Paredes
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Pedro Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Armando Almeida
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Patrícia Ribeiro Pinto
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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24
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Haemophilic Pelvic Pseudotumour: A New Surgical Option. Healthcare (Basel) 2021; 9:healthcare9101269. [PMID: 34682949 PMCID: PMC8536013 DOI: 10.3390/healthcare9101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Haemophilia is an inherited coagulopathy caused by the absence or dysfunction of clotting factor VIII or IX. Clinical manifestations are generally secondary to recurrent bleeding episodes mainly in the musculoskeletal system. Bleeding symptoms appear early in life and, when the disease is severe (when plasma factor VIII or IX activity is <1% of normal), joint and muscle bleeding may occur spontaneously. A pseudotumour is a recurrent, chronic, encapsulated, slowly expanding, muscle hematoma. Haemophilic pseudotumour is a rare complication of haemophilia which occurs, as a condition either from repeated spontaneous bleeding or coming from a traumatic origin, in 1–2% of haemophilic patients. Case report: A 32-year-old man with severe haemophilia A referred to our Clinic with a massive right iliac wing pseudotumour complicated by Staphylococcus aureus superinfection and skin fistulisation. In this report we describe the medical management and surgical treatment by the adoption of a novel surgical technique which involves the use of a pedicle-screw and rod system (PSRS), a polyglycolic acid MESH and bone cement in order to build up an artificial ilium-like bony mass. This case report highlights the importance of interdisciplinary approach and the efficacy of eradicating surgery as treatment, especially in the case of large and long-lasting lesions.
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25
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Improving assessment and management of pain in hemophilia: an Italian Delphi consensus statement. Blood Rev 2021; 51:100885. [PMID: 34544642 DOI: 10.1016/j.blre.2021.100885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 08/06/2021] [Accepted: 08/26/2021] [Indexed: 12/12/2022]
Abstract
Comprehensive evidence-based guidelines and well-validated assessment scales for pain in people with hemophilia (PwH) are needed. Here, we report 28 statements covering five topics on pain assessment and management in pediatric and adult PwH that were developed by 60 Italian hemophilia specialists during a Delphi consensus process. Overall, a clear consensus was achieved for 19 of the 28 statements. Consensus was reached on all statements on the topic of pain assessment and quality of life (QoL), including the need for regular pain assessment on a quantitative scale, the importance of distinguishing between different pain types, and the need to evaluate the impact of pain on patient QoL. The other four topics concerned acute and chronic pain management in adults and in children. Consensus was reached on statements regarding non-pharmacologic treatment and the use of first-line paracetamol (acetaminophen). There was a lack of consensus regarding the use of non-steroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, or opioids.
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26
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Hotea I, Brinza M, Blag C, Zimta AA, Dirzu N, Burzo C, Rus I, Apostu D, Benea H, Marian M, Mester A, Pasca S, Iluta S, Teodorescu P, Jitaru C, Zdrenghea M, Bojan A, Torok-Vistai T, Niculescu R, Tarniceriu C, Dima D, Truica C, Serban M, Tomuleasa C, Coriu D. Current therapeutic approaches in the management of hemophilia-a consensus view by the Romanian Society of Hematology. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1091. [PMID: 34423003 PMCID: PMC8339806 DOI: 10.21037/atm-21-747] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/17/2021] [Indexed: 12/28/2022]
Abstract
Hemophilia A (HA) and hemophilia B (HB) are rare disorders, being caused by the total lack or under-expression of two factors from the coagulation cascade coded by genes of the X chromosome. Thus, in hemophilic patients, the blood does not clot properly. This results in spontaneous bleeding episodes after an injury or surgical intervention. A patient-centered regimen is considered optimal. Age, pharmacokinetics, bleeding phenotype, joint status, adherence, physical activity, personal goals are all factors that should be considered when individualizing therapy. In the past 10 years, many innovations in the diagnostic and treatment options were presented as being either approved or in development, thus helping clinicians to improve the standard-of-care for patients with hemophilia. Recombinant factors still remain the standard of care in hemophilia, however they pose a challenge to treatment adherence because they have short half-life, which where the extended half-life (EHL) factors come with the solution, increasing the half-life to 96 hours. Gene therapies have a promising future with proven beneficial effects in clinical trials. We present and critically analyze in the current manuscript the pros and cons of all the major discoveries in the diagnosis and treatment of HA and HB, as well as identify key areas of hemophilia research where improvements are needed.
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Affiliation(s)
- Ionut Hotea
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania.,Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Melen Brinza
- Department of Hematology, Fundeni Clinical Institute, Bucharest, Romania.,Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina Blag
- Department of Pediatrics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Emergency Clinical Children's Hospital, Cluj Napoca, Romania
| | - Alina-Andreea Zimta
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Noemi Dirzu
- Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Corina Burzo
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Ioana Rus
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Dragos Apostu
- Department of Orthopedics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Orthopedics, Emergency Clinical County Hospital, Cluj Napoca, Romania
| | - Horea Benea
- Department of Orthopedics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Orthopedics, Emergency Clinical County Hospital, Cluj Napoca, Romania
| | - Mirela Marian
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Alexandru Mester
- Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Sergiu Pasca
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Sabina Iluta
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Patric Teodorescu
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Ciprian Jitaru
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Mihnea Zdrenghea
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Anca Bojan
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Tunde Torok-Vistai
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Radu Niculescu
- Department of Hematology, Fundeni Clinical Institute, Bucharest, Romania
| | - Cristina Tarniceriu
- Department of Anatomy, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Hematology, St. Spiridon County Clinical Emergency Hospital, Iasi, Romania
| | - Delia Dima
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania
| | - Cristina Truica
- Department of Hematology, Constantin Opris Emergency Hospital, Baia Mare, Romania
| | - Margit Serban
- Department of Hematology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania.,European Haemophilia Treatment Center, Timisoara, Romania
| | - Ciprian Tomuleasa
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania.,Department of Hematology, Ion Chiricuta Clinical Cancer Center, Cluj Napoca, Romania.,Medfuture Research Center for Advanced Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Daniel Coriu
- Department of Hematology, Fundeni Clinical Institute, Bucharest, Romania.,Department of Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Lobet S, Timmer M, Königs C, Stephensen D, McLaughlin P, Duport G, Hermans C, Mancuso ME. The Role of Physiotherapy in the New Treatment Landscape for Haemophilia. J Clin Med 2021; 10:jcm10132822. [PMID: 34206923 PMCID: PMC8267623 DOI: 10.3390/jcm10132822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 12/21/2022] Open
Abstract
The physiotherapist plays an essential role for people with haemophilia, an inherited bleeding disease responsible for musculoskeletal complications. Yet, with the advent of new and advanced therapies, the medical landscape is changing, and physiotherapy must adapt alongside. This paper considers whether there will still be a need for physiotherapy in the era of advanced therapies, and discusses ways in which services should evolve to complement emerging treatment paradigms for haemostasis in people with haemophilia. Ultimately, physiotherapy will remain an important element of care, even for people with little joint damage and low risks in the era of the new mild phenotype. However, competencies will need to evolve, and physiotherapists in both primary care and specialist treatment centres should work with haematology colleagues to develop more sensitive tools for detecting early joint changes. Physiotherapists will also play a crucial role in counselling and physically coaching, monitoring the musculoskeletal status of people with haemophilia who have transitioned to new treatments.
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Affiliation(s)
- Sébastien Lobet
- Hemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium;
- Neuromusculoskeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 53, 1200 Brussels, Belgium
- Secteur de Kinésithérapie, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
- Correspondence:
| | - Merel Timmer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, 3584 Utrecht, The Netherlands;
| | - Christoph Königs
- Department of Paediatrics and Adolescent Medicine, Haemophilia Treatment Centre, Goethe University, 60323 Frankfurt, Germany;
| | - David Stephensen
- Kent Haemophilia Centre, East Kent Hospitals University NHS Trust, Canterbury CT1 3NG, UK;
- Haemophilia Centre, Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Paul McLaughlin
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London NW3 2QG, UK;
| | - Gaetan Duport
- Association Française des Hemophiles, 75739 Paris, France;
| | - Cédric Hermans
- Hemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium;
| | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy;
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Hermans C, Mancuso ME, Nolan B, Pasi KJ. Recombinant factor VIII Fc for the treatment of haemophilia A. Eur J Haematol 2021; 106:745-761. [PMID: 33650192 PMCID: PMC8252769 DOI: 10.1111/ejh.13610] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/24/2021] [Indexed: 12/13/2022]
Abstract
Prophylaxis with factor VIII (FVIII) is the current therapeutic approach for people with haemophilia A. However, standard half-life (SHL) FVIII products must be injected frequently, imposing a substantial burden on the individual and making it difficult to tailor therapy according to patient need and lifestyle, which could impact adherence. Recombinant FVIII Fc fusion protein (rFVIIIFc; Elocta® , Sobi; Eloctate® , Sanofi) is a recombinant fusion protein that undergoes slower clearance from the body than SHL FVIII products. This pharmacokinetic property of rFVIIIFc allows prophylactic administration every 3-5 days, or once weekly in selected patients, with doses adjusted to patient needs and clinical outcomes. Higher FVIII levels can be achieved maintaining dosing frequency similar to that usually applied with SHL FVIII. This review provides a summary of recent data from the A-LONG, Kids A-LONG, ASPIRE and PUPs A-LONG studies and recently published real-world experience relevant to rFVIIIFc use in individualised regimens. The review also introduces ongoing studies of rFVIIIFc, including its use for induction of immune tolerance, and discusses some aspects to consider when switching patients to rFVIIIFc and managing ongoing treatment. In summary, rFVIIIFc is suitable for individualised prophylaxis regimens that can be tailored according to patient clinical needs and lifestyle.
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Affiliation(s)
- Cedric Hermans
- Haemostasis and Thrombosis UnitDivision of HaematologyCliniques Universitaires Saint‐LucUniversité catholique de Louvain (UCLouvain)BrusselsBelgium
| | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic DiseasesHumanitas Clinical and Research Center ‐ IRCCSRozzanoItaly
| | | | - K. John Pasi
- Royal London Haemophilia CentreBarts and the London School of Medicine and DentistryLondonUK
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Zhao Y, Weyand AC, Shavit JA. Novel treatments for hemophilia through rebalancing of the coagulation cascade. Pediatr Blood Cancer 2021; 68:e28934. [PMID: 33577709 PMCID: PMC8751759 DOI: 10.1002/pbc.28934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/19/2020] [Accepted: 01/12/2021] [Indexed: 11/11/2022]
Abstract
Hemophilia A and B are inherited hemorrhagic disorders that result from alterations in the coagulation cascade. Aside from spontaneous bleeding, the main complication of hemophilia is hemarthrosis. Progress over the last three decades, specifically prophylaxis using recombinant factor, has prevented hemarthrosis and lengthened patient life expectancies. However, many treatments require frequent dosing up to three times a week, and alloantibodies (inhibitors) against replacement factor continues to be an issue. These problems call for novel treatments for patients with hemophilia. Although there has been progress in extended half-life factors and mimetics of factor VIII, an alternative treatment methodology is to rebalance the activities of pro- and anticoagulant factors through inhibition of the natural anticoagulants: antithrombin, tissue factor pathway inhibitor, protein C, and protein S. This review will explore the efficacy of targeting these inhibitory pathways from preclinical development through clinical trials, and delve into concerns of thrombotic risk.
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Affiliation(s)
- Yakun Zhao
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Angela C. Weyand
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Jordan A. Shavit
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
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30
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le Doré S, Grinda N, Ferré E, Roussel-Robert V, Frotscher B, Chamouni P, Meunier S, Bayart S, Dolimier E, Truong-Berthoz F, de Raucourt E. The Hemarthrosis-Simulating Knee Model: A Useful Tool for Individualized Education in Patients with Hemophilia (GEFACET Study). J Blood Med 2021; 12:133-138. [PMID: 33727876 PMCID: PMC7955736 DOI: 10.2147/jbm.s280032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/22/2021] [Indexed: 01/04/2023] Open
Abstract
Background Hemophilic arthropathy is a major complication in patients with severe hemophilia. A plastic knee model has been developed for the therapeutic education of patients to promote improved care management and self-treatment skills. The objective of this study was to evaluate the impact of this hemarthrosis-simulating artificial knee (HSAK) on patients’ knowledge of their disease and its treatment. Methods In this observational study, the impact of HSAK was assessed during individualized education in patients with severe/moderately severe hemophilia A or B at seven hemophilia treatment centers in France. Participants provided written informed consent and completed questionnaires to assess knowledge of their disease (score range: 0–7) and knowledge of their treatment (score range: 0–4). Questionnaires were completed before, immediately after and 6 months after HSAK use. The scores obtained before and after the use of the HSAK were compared. Results The participants comprised 32 children, 29 teenagers, and 31 adults. The mean (SD) disease knowledge score increased significantly in all age groups of patients from 4.5 (2.0) to 5.9 (1.5; p<0.001) immediately after the training and remained unchanged at 6 months. Mean (SD) treatment knowledge scores were unchanged, but Wilcoxon signed rank testing showed a significant increase after the training course that was maintained at 6 months in children and teenagers. Conclusion These findings suggest that an individualized training course can enhance the understanding of hemophilia in patients of all ages, especially in children and teenagers, and that the HSAK may assist in improving patients’ management of their disease.
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Affiliation(s)
- Sophie le Doré
- Haemophilia Treatment Centre, Hôpital Mignot, Versailles, France
| | - Nathalie Grinda
- Regional Hemophilia Centre, Hôpital de Bicêtre (AP-HP), Kremlin-Bicêtre, France
| | - Emmanuelle Ferré
- Haemophilia Treatment Centre, Hôpital Mignot, Versailles, France
| | | | - Birgit Frotscher
- Haemophilia Treatment Centre, Hôpital de Brabois, Vandoeuvre-Les-Nancy, France
| | - Pierre Chamouni
- Regional Hemophilia Treatment Centre, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Sandrine Meunier
- Hospices Civils de Lyon - Unité d'Hémostase Clinique, Hôpital Cardiologique Louis Pradel, Bron, France
| | - Sophie Bayart
- Haemophilia Treatment Centre, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France
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Cuesta-Barriuso R, Pérez-Llanes R, López-Pina JA, Donoso-Úbeda E, Meroño-Gallut J. Manual therapy reduces the frequency of clinical hemarthrosis and improves range of motion and perceived disability in patients with hemophilic elbow arthropathy. A randomized, single-blind, clinical trial. Disabil Rehabil 2021; 44:3938-3945. [PMID: 33684015 DOI: 10.1080/09638288.2021.1894607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the effectiveness of manual therapy in reducing the frequency of clinical hemarthrosis, increasing range of motion and improving the perception of disability in the upper limbs in patients with hemophilic elbow arthropathy. MATERIALS AND METHODS Sixty-nine patients were randomized into experimental (N = 35) and control group (N = 34). The outcome measures were: frequency of clinical hemarthrosis, the elbow range of motion and the perception of disability in the upper limbs (DASH questionnaire). The intervention included one 50 min weekly session, for three weeks, of upper limb fascial therapy according to our treatment protocol. RESULTS There were differences (p < 0.001) in the repeated measures analysis for frequency of elbow clinical hemarthrosis (F = 20.64) and range of motion in flexion (F = 17.37) and extension (F = 21.71). No differences were found in the overall perceived disability (F = 0.91; p = .37). We found group interaction with the (p < 0.001) in the frequency of elbow clinical hemarthrosis, range of motion and overall perceived disability. CONCLUSIONS Manual therapy is safe in patients with hemophilia and elbow arthropathy. Fascial therapy reduces the frequency of hemarthrosis, increases the range of motion and improves the perceived disability in the upper limbs. Trial registration number: id NCT03009591IMPLICATIONS FOR REHABILITATIONImpairments in the range of motion, pain and disability may occur in patients with hemophilic elbow arthropathy since early age.There is a need to validate safe and effectiveness protocols of rehabilitation to treat these patients.Prophylactic replacement is the most effective treatment for the prevention of hemarthrosis.Physiotherapists need to be trained in the specific management of patients with hemophilia.Manual therapy can be a safe and effective tool in the treatment of hemophilic arthropathy.
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Affiliation(s)
- Rubén Cuesta-Barriuso
- Department of Physiotherapy, Faculty of Sport Sciences, European University of Madrid, Madrid, Spain.,Royal Victoria Eugenia Foundation, Madrid, Spain.,Fishemo CEE, Spanish Federation of Hemophilia, Madrid, Spain
| | - Raúl Pérez-Llanes
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
| | | | - Elena Donoso-Úbeda
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
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Tat NM, Can F, Sasmaz HI, Tat AM, Antmen AB. The effects of manual therapy on musculoskeletal system, functional level, joint health and kinesiophobia in young adults with severe haemophilia: A randomized pilot study. Haemophilia 2021; 27:e230-e238. [PMID: 33423376 DOI: 10.1111/hae.14031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The effects of manual therapy (MT) on joint health and functional level in haemophilic arthropathy (HA) have relatively under-explored. AIM To investigate the effects of MT in HA of lower limb joints on musculoskeletal system, functional level, Functional Independence Score in Hemophilia (FISH), Hemophilia Joint Health Score (HJHS) and kinesiophobia. METHODS Seventeen patients were randomized to the control group (CG = 9) and manual therapy group (MTG = 8). The number of haemarthrosis (NoH) was recorded from the diaries. Range of motion (ROM), strength and pain intensity were measured using goniometer, digital dynamometer and visual analogue scale, respectively. Joint health was evaluated with HJHS, functional independence with FISH, and kinesiophobia with Tampa Scale. Functional Reach (FR), Timed Up-Go (TUG) and 5-Times Sit-to-Stand (5*STS) tests were used to evaluate functional level. Home exercises were given to both groups. Additionally, myofascial release techniques and mobilizations were applied to MTG. Interventions were applied 3 d/weekly for 5 weeks. Assessments were performed at baseline and after treatment. RESULTS ROM, strength, activity pain, HJHS and FISH were improved in MTG (p˂0.05). Ankle NoH, 5*STS and FR were developed in both groups (p˂0.05), but kinesiophobia, TUG and knee NoH were not significant. Although improvements were observed in favour of MTG in HJHS, FR, activity pain and ankle strength/ROM (p˂0.05), no significant difference was found in FISH, kinesiophobia, TUG, 5*STS, resting pain and knee strength. CONCLUSION Reduction in ankle NoH indicated that both interventions were safe. The use of MT in HA of lower limb joints was an effective physiotherapy approach to improve functional level, joint health and functional independence.
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Affiliation(s)
- Necati Muhammed Tat
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Necmettin Erbakan University, Konya, Turkey
| | - Filiz Can
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Hatice Ilgen Sasmaz
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ayse Merve Tat
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Necmettin Erbakan University, Konya, Turkey
| | - Ali Bulent Antmen
- Department of Pediatric Hematology and Oncology, Acıbadem University, Adana, Turkey
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Khami A, Roostayi MM, Parhampour B, Heidari Z, Baharlouei H, Hoorfar H. Effect of Pulsed Electromagnetic Fields on Clinical Signs and Quality of Life in Patients with Hemophilic Arthropathy of the Knee Joint: A Randomized Controlled Trial. Adv Biomed Res 2020; 9:81. [PMID: 33912497 PMCID: PMC8059452 DOI: 10.4103/abr.abr_244_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/07/2019] [Accepted: 06/01/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hemophilic arthropathy (HA) causes severe joint damage and impairs the quality of life (QoL) of hemophiliacs. This study was undertaken to evaluate the effect of pulsed electromagnetic fields (PEMFs) on the clinical signs and QoL of patients with severe hemophilia A experiencing moderate HA in the knee joint. MATERIALS AND METHODS Thirty-six severe hemophiliacs with HA of the knee joint were randomly assigned into the PEMF (n = 20) or placebo (n = 16) groups. The PEMF group received 60 min of PEMF (2 Hz, 25 Gauss for 30 min and 70 Hz, 30 Gauss for 30 min) on the knee joint, three times per week for 6 weeks. The clinical signs, QoL, and pain intensity were measured by the Hemophilia Joint Health Score, A36 Hemofilia-QoL Questionnaire, and visual analog scale, respectively, before and after treatment. RESULTS In the PEMF group, a significant difference before and after intervention in terms of clinical signs, QoL, and pain intensity (P < 0.05) was founded. Between-group analysis showed a significant improvement in clinical signs (except for atrophy, strength, and swelling duration), QoL, and pain intensity in the PEMF versus control group (P < 0.05). CONCLUSIONS PEMF can improve the clinical signs, QoL, and pain intensity of severe hemophilia A patient with moderate knee hemophilic arthropathy.
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Affiliation(s)
- Azam Khami
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohsen Roostayi
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrouz Parhampour
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamzeh Baharlouei
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Hoorfar
- Hemophilia Treatment Center, Clinic Seiedshohada Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Andreisek G. Editorial for "Understanding Early Hemophilic Arthropathy in Children and Adolescents Through MRI T2 Mapping". J Magn Reson Imaging 2020; 53:838-839. [PMID: 33098133 DOI: 10.1002/jmri.27404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Gustav Andreisek
- Cantonal Hospital Munsterlingen, Spital Thurgau AG, Münsterlingen, Switzerland
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Cuesta-Barriuso R, Gómez-Conesa A, López-Pina JA. 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. Haemophilia 2020; 27:e110-e118. [PMID: 33094898 DOI: 10.1111/hae.14181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/11/2020] [Accepted: 09/24/2020] [Indexed: 12/01/2022]
Abstract
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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Affiliation(s)
- Rubén Cuesta-Barriuso
- Department of Physiotherapy, Faculty of Sport Sciences, European University of Madrid, Madrid, Spain.,Royal Victoria Eugenia Foundation, Madrid, Spain.,Fishemo CEE, Spanish Federation of Hemophilia, Madrid, Spain
| | - Antonia Gómez-Conesa
- Research Group in Physiotherapy and Health Promotion, Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia, Murcia, Spain
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Pasta G, Annunziata S, Forini G, Jannelli E, Minen A, Preti P, Mosconi M, Benazzo F. A rare case of a patient with hemophilia presenting elbow-ankylosing heterotopic ossification: surgery and functional outcomes. JSES Int 2020; 4:1021-1025. [PMID: 33345251 PMCID: PMC7738587 DOI: 10.1016/j.jseint.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Gianluigi Pasta
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, Pavia, Italy
| | - Salvatore Annunziata
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, Pavia, Italy
| | - Guido Forini
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, Pavia, Italy
| | - Eugenio Jannelli
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, Pavia, Italy
| | - Alessandro Minen
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, Pavia, Italy
| | - Paola Preti
- Clinica Medica II, Department of Internal Medicine, Fondazione Policlinico IRCCS San Matteo, University of Pavia, Pavia, Italy
| | - Mario Mosconi
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, Pavia, Italy
| | - Francesco Benazzo
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, Pavia, Italy
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Li S, Qu B, Ma W, Li Y. Perioperative anaesthesia and coagulation management of haemophilia patients receiving total hip and knee replacement arthroplasty: Experience from a case series. J Orthop Surg (Hong Kong) 2020; 27:2309499019874931. [PMID: 31554469 DOI: 10.1177/2309499019874931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To report 13 consecutive cases of successful triad of anaesthesia, blood and coagulation management (ABC protocol) in haemophilic total joint arthroplasty (TJA) and its feasibility and safety on haemophilic TJA. METHODS All the clinical data of 13 consecutive cases were descend from electronic medical record. Patients who suffered from haemophilia A, undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) with ABC protocol at the academic hospital from December 2014 to November 2018 were included, and demographic, perioperative characteristics according to the classified method were further analysed. RESULTS All 13 haemophilic patients had undergone successful surgery with ABC protocol. No massive blood loss was observed in perioperative period. The mean external blood loss was 876.92 ± 592.86 mL. The mean change in haemoglobin was 5.42 ± 2.43 g dL-1 at 5 days post-operatively. The mean allogeneic transfusion volume was 1.23 ± 1.35 units, and the mean volume of autotransfusion was 237.5 ± 76.93 mL. The average clotting factor consumption for per operated joint was 458.26 ± 226.45 IU kg-1 in all cases. No severe perioperative complications were occurred. CONCLUSION ABC-related series of measures were appropriate management mode for patients received THA and/or TKA with mild or moderate haemophilia. However, more robust evidence came from larger samples is needed.
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Affiliation(s)
- Sibei Li
- Guangzhou University of Chinese Medicine, Guangdong, China
| | - Bo Qu
- Guangzhou University of Chinese Medicine, Guangdong, China
| | - Wuhua Ma
- Department of Anaesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Yuhui Li
- Department of Anaesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
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Chowdary P, Mullins ES, Konkle BA, McGuinn C, Park YS, Stasyshyn O, Zulfikar B, Engl W, Tangada S. Long-term safety and efficacy results from the phase 3b, open-label, multicentre Continuation study of rurioctocog alfa pegol for prophylaxis in previously treated patients with severe haemophilia A. Haemophilia 2020; 26:e168-e178. [PMID: 32597029 DOI: 10.1111/hae.14052] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/28/2020] [Accepted: 05/12/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Previous studies reported the efficacy and safety profile of extended half-life PEGylated recombinant factor VIII (FVIII) rurioctocog alfa pegol (TAK-660, SHP660, BAX 855) in preventing bleeding in haemophilia A patients. AIM This study evaluated long-term safety and efficacy of rurioctocog alfa pegol for prophylaxis and treatment of bleeding in previously treated children and adults. METHODS In this phase 3b, prospective, open-label, multicentre study (NCT01945593), eligible patients ≤ 75 years with severe haemophilia A (FVIII < 1%) received prophylactic rurioctocog alfa pegol in a fixed dose (FD, twice-weekly or less frequent) or pharmacokinetic (PK)-tailored dose regimen. Co-primary endpoints were incidence of confirmed FVIII inhibitory antibody development and spontaneous annualized bleed rate (ABR), analysed using a generalised linear model. Secondary endpoints included overall haemostatic efficacy, occurrence of adverse events and health-related quality of life (HRQoL). RESULTS Overall, 216 patients were included; mean (SD) age at enrolment was 22.8 (15.7) years. No patients developed confirmed FVIII inhibitors. The point estimate (95% CI) of mean spontaneous ABR was 1.20 (0.92-1.56) among 186 patients receiving twice-weekly FD prophylaxis and 0.96 (0.54-1.71) among 25 patients receiving PK-tailored prophylaxis. Overall haemostatic efficacy was rated good or excellent in 88.6% of all bleeds. No new safety signals were observed. Patients reported improvements in HRQoL measures of pain, and physical and mental well-being. CONCLUSION These results highlight the long-term safety and efficacy of rurioctocog alfa pegol prophylaxis in previously treated children and adults with severe haemophilia A, with a safety profile similar to previous studies and continuing ABR reduction.
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Affiliation(s)
- Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Eric S Mullins
- Division of Hematology, Cincinnati Children's Hospital Medical Center and Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Barbara A Konkle
- Bloodworks Northwest and University of Washington, Seattle, WA, USA
| | | | | | | | - Bülent Zulfikar
- Department of Pediatric Hematology, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Werner Engl
- Baxalta Innovations GmbH, a Member of the Takeda Group of Companies, Vienna, Austria
| | - Srilatha Tangada
- Baxalta US Inc., a Member of the Takeda Group of Companies, Cambridge, MA, USA
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PÉRez-Llanes R, Donoso-ÚBeda E, MeroÑO-Gallut J, Lopez-Pina JA, Cuesta-Barriuso R. Manual Therapy Effectively Decreases the Frequency of Joint Bleeding Improves Joint Health and Reduces Pain in Hemophilic Elbow Arthropathy: A Prospective Cohort Study. JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2020; 3:1000035. [PMID: 33884137 PMCID: PMC8008725 DOI: 10.2340/20030711-1000035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To verify the safety and effectiveness of manual therapy intervention using fascial therapy in adult patients with haemophilic elbow arthropathy. METHODS Prospective cohort study. A total of 28 patients with haemophilic elbow arthropathy was recruited in 3 cities in Spain. Patients received one-fascial therapy session per week for 3 weeks. The dependent variables were: frequency of joint bleeding, joint pain (visual analogue score) and joint status (Hemophilia Joint Health Score). Outcomes were measured at baseline (T0), post-treatment (T1) and after 3 months' follow-up (T2). Using Student's t-test, the means obtained in the evaluations were compared. The analysis of variance (ANOVA) test of repeated measures provided the intra-subject effect. The chosen level of significance was p < 0.05. RESULTS A total of 28 patients were recruited according to the selection criteria. No joint bleeding occurred during or after the intervention. The primary outcome, frequency of bleeding, improved after intervention (p <0.001). The secondary variables joint status and joint pain improved after the experimental period (p <0.001). There were significant changes in the repeated measures factor in the frequency of haemarthrosis (F = 20.61; p = 0.00), joint status (F = 64.11; p = 0.00) and perceived pain (F = 33.15; p = 0.00). CONCLUSION Manual therapy using fascial therapy did not produce haemarthrosis in patients with haemophilic elbow arthropathy. Fascial therapy can improve the perception of pain and joint state,maintaining this improvement after a follow-up period of 3 months.
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Affiliation(s)
- Raúl PÉRez-Llanes
- Department of Physiotherapy, Faculty of Health Sciences, Catholic University San Antonio-UCAM, Murcia, Spain
| | | | | | - Jose Antonio Lopez-Pina
- Department of Basic Psycology and Methodology, Faculty of Psycology, University of Murcia, Murcia, Spain
| | - Rubén Cuesta-Barriuso
- Department of Physiotherapy, European University of Madrid, Madrid, Spain
- Real Fundaciόn Victoria Eugenia, Madrid, Spain
- Fishemo CEE, Spanish Federation of Hemophilia, Madrid, Spain
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van Vulpen LFD, Thomas S, Keny SA, Mohanty SS. Synovitis and synovectomy in haemophilia. Haemophilia 2020; 27 Suppl 3:96-102. [PMID: 32490595 PMCID: PMC7984224 DOI: 10.1111/hae.14025] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/17/2020] [Indexed: 12/25/2022]
Abstract
Joint bleeds cause major morbidity in haemophilia patients. The synovial tissue is responsible for removal of blood remnants from the joint cavity. But blood components, especially iron, lead to a series of changes in the synovial tissue: inflammation, proliferation and neovascularization. These changes make the synovium vulnerable to subsequent bleeding and as such a vicious cycle of bleeding-synovitis-bleeding may develop leading to chronic synovitis. The initial step in the treatment is adequate clotting factor supplementation and immediate physiotherapeutic involvement. If these measures fail, synovectomy may be indicated. Non-surgical options are chemical and radioactive synovectomy. This is a relatively non-invasive procedure to do synovectomy, leading to a reduction in pain and joint bleeds. Radioactive synovectomy seems more effective than chemical synovectomy in larger joints. Surgical options are open and arthroscopic synovectomy. Open synovectomy has been found to decrease the incidence of breakthrough bleeds but at the cost of loss of joint motion. Use of arthroscopic synovectomy has been advocated to reduce bleeding episodes with less morbidity to extra-articular tissue and preservation of joint motion. Use of a continuous passive motion (CPM) machine and early mobilization can decrease the postoperative stiffness and promote early recovery. This review addresses the current understanding of synovitis and its treatment options with specific emphasis on chemical and radioactive synovectomy and surgical options.
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Affiliation(s)
- Lize F D van Vulpen
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sylvia Thomas
- Nuclear Medicine Department, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Swapnil A Keny
- Department of Orthopaedics, King Edward Memorial Hospital, Mumbai, India
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Chin B, Wee I, Syn NLX, Yap ES, Koh PL. Surgery for chronic arthropathy in people with haemophilia. Hippokratia 2020. [DOI: 10.1002/14651858.cd013634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Brian Chin
- Faculty of Medicine; University of New South Wales; Sydney Australia
| | - Ian Wee
- Department of Haematology-Oncology; National University Cancer Institute; Singapore Singapore
| | - Nicholas LX Syn
- Department of Haematology-Oncology; National University Cancer Institute; Singapore Singapore
| | - Eng Soo Yap
- Department of Laboratory Medicine; National University Hospital; Singapore Singapore
| | - Pei Lin Koh
- Department of Paediatrics; National University Health System; Singapore Singapore
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Eerdekens M, Peerlinck K, Staes F, Hermans C, Lobet S, Deschamps K. The biomechanical behaviour of ankle and foot joints during walking with shoes in patients with haemophilia. Haemophilia 2020; 26:726-734. [PMID: 32364326 DOI: 10.1111/hae.14017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients with haemophilia (PwH) often prefer shod walking over barefoot walking as footwear offers ankle joint stability and comfort during gait. Yet, the biomechanical mechanisms contributing to the latter remain poorly understood. AIM To explore the effect of shoes on the biomechanical functioning of the ankle and foot complex in PwH with and without haemophilic ankle arthropathy and to determine the amount of ankle joint loading during shod walking. METHODS We analysed data of PwH without haemophilic ankle arthropathy (n = 5) and PwH with severe haemophilic ankle arthropathy (n = 17) and a control group (n = 17). During 3D gait analysis, a four-segment kinetic foot model was used to calculate kinematic and kinetic parameters of the ankle, Chopart, Lisfranc and first metatarsophalangeal (MTP 1) joints during both barefoot and shod walking. RESULTS We found a significantly greater ankle joint power generation during shod walking compared to barefoot walking in PwH with severe haemophilic ankle arthropathy (P < .001). Chopart joint biomechanics were significantly lowered in all three groups during shod walking compared to barefoot walking. During shod walking, the ankle joint load was significantly lowered in both PwH groups (P = .039 and P = .002), but not in the control group (P = .952). CONCLUSION Explorations in this study uncover a tendency that shoes alter the biomechanical functioning of the ankle and foot complex in PwH and simultaneously lower the ankle joint load during walking.
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Affiliation(s)
- Maarten Eerdekens
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium.,Clinical Motion Analysis Laboratorium (CMAL), UZ Leuven, Pellenberg, Belgium.,Haemophilia Center, UZ Leuven, Leuven, Belgium
| | - Kathelijne Peerlinck
- Haemophilia Center, UZ Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Filip Staes
- Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Heverlee, Belgium
| | - Cédric Hermans
- Service d'hématologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sébastien Lobet
- Service d'hématologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Neuromusculoskeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Kevin Deschamps
- Clinical Motion Analysis Laboratorium (CMAL), UZ Leuven, Pellenberg, Belgium.,Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Brugge, Belgium
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Bullement A, McMordie ST, Hatswell AJ, Li N, Wilson K. Cost-Effectiveness Analysis of Recombinant Factor VIII Fc-Fusion Protein (rFVIIIFc) for the Treatment of Severe Hemophilia A in Italy Incorporating Real-World Dosing and Joint Health Data. PHARMACOECONOMICS - OPEN 2020; 4:133-142. [PMID: 31280415 PMCID: PMC7018914 DOI: 10.1007/s41669-019-0158-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Patients with severe hemophilia A (SHA) in Italy are routinely treated with standard half-life recombinant factor VIII (rFVIII) products. rFVIII Fc-fusion protein (rFVIIIFc) is an extended half-life rFVIII product that enables less frequent administration than rFVIII, which may support improved adherence. Available data indicate low breakthrough bleed rates and potentially improved long-term joint health for patients treated with rFVIIIFc prophylaxis. OBJECTIVE This study assessed the cost effectiveness of rFVIIIFc versus rFVIII from an Italian healthcare perspective. METHODS A Semi-Markov model was constructed to assess the lifetime costs and benefits of rFVIII and rFVIIIFc prophylaxis. rFVIII product acquisition costs from a published Italian database were included for both prophylaxis and the resolution of breakthrough bleeding. Clinical outcomes within the model were determined based on published annualized bleeding rates and literature regarding the development of target joints (TJs) as the incidence of bleeds and TJs is associated with impaired health-related quality of life. Cost effectiveness was assessed using cost per quality-adjusted life-year (QALY) gained. RESULTS Compared with rFVIII, rFVIIIFc was associated with a per-patient cost saving of approximately €1.3 million and QALY gains of 0.39 over a lifetime horizon. Sensitivity analyses considering alternative efficacy, dosing, and structural assumptions each showed that rFVIIIFc dominated rFVIII (i.e., provided more QALYs at a reduced cost). CONCLUSIONS This cost-effectiveness analysis demonstrated that rFVIIIFc may offer a cost-effective treatment option for patients with SHA in Italy.
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Affiliation(s)
| | | | | | - Nanxin Li
- Bioverativ, a Sanofi Company, Waltham, MA, USA
| | - Koo Wilson
- Swedish Orphan Biovitrum AB (publ), 112 76, Stockholm, Sweden.
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Forsyth A, Blamey G, Lobet S, McLaughlin P. Practical Guidance for Non-Specialist Physical Therapists Managing People with Hemophilia and Musculoskeletal Complications. Health (London) 2020. [DOI: 10.4236/health.2020.122014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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45
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El Hawary MA, EL Dash HH, Foaud NA, Mohamed MH. Effect of joint range of motion on health-related quality of life in children with hemophilia. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2019. [DOI: 10.4103/err.err_18_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lobet S, Meité N, Koninckx MI, Van Overstraeten A, Kamagate AM, Hermans C, Lambert C. Implementation and assessment of a self- and community-based rehabilitation programme in patients with haemophilia from Côte d'Ivoire. Haemophilia 2019; 25:859-866. [PMID: 31393670 DOI: 10.1111/hae.13833] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/04/2019] [Accepted: 07/15/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In resource-constrained countries, few patients with haemophilia (PWH) have access to clotting factor concentrates (CFC), with increased musculoskeletal (MSK) complications. Physiotherapy actively contributes to preventing MSK complications, minimizing joint damage and reducing pain. AIM To assess the impact of a 20-week self- and community-based rehabilitation (CBR) programme in Ivorian PWH. METHODS Fifty participants underwent a clinical and functional baseline assessment with identification of joints' functional defects and initiation of an individualized exercise programme comprising exercises to improve strength, joint mobility and proprioception. Hemophilia Joint Health Score (HJHS), 2-minute walking test (2MWT), Timed Up and Go (TUG), goniometry and maximal isometric voluntary contractions using the MicroFET2 were performed at baseline (T1) and at Week 20 (T2). RESULTS At T2, there was a significant improvement in both the 2MWT and TUG tests. The HJHS total score decreased significantly from 23.6 ± 14.2 at T1 to 20.4 ± 13 at T2. A significant improvement in joint health was found in the left elbow, right knee and right ankle, with elements correlating with joint function responsible for these improvements. A strong programme adherence was observed, with 94% of participants reporting regular exercise performance and a high degree of satisfaction. CONCLUSION The programme with its encouraging results is meant to be the first step towards a more ambitious project. Self-based and CBR programmes are inexpensive and efficient treatment options designed to minimize the detrimental effects of joint and muscle bleedings, and to increase the functional independence and quality of life of PWH with limited access to CFC and physiotherapy.
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Affiliation(s)
- Sébastien Lobet
- Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal Lab, Université Catholique de Louvain, Bruxelles, Belgium.,Department of Physical medicine and rehabilitation, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.,Hemostasis and Thrombosis Unit, Department of Hematology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - N'Dogomo Meité
- Department of Clinical hematology, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Marie-Inès Koninckx
- Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Antoine Van Overstraeten
- Faculté des Sciences de la Motricité, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Amed Mama Kamagate
- Department of Physical medicine and rehabilitation, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Cédric Hermans
- Hemostasis and Thrombosis Unit, Department of Hematology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Catherine Lambert
- Hemostasis and Thrombosis Unit, Department of Hematology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
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Tuan SH, Hu LY, Sun SF, Huang WY, Chen GB, Li MH, Liou IH. Risk of osteoporotic fractures as a consequence of haemophilia: A nationwide population-based cohort study. Haemophilia 2019; 25:876-884. [PMID: 31282066 DOI: 10.1111/hae.13814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/04/2019] [Accepted: 06/10/2019] [Indexed: 01/07/2023]
Abstract
AIM Low bone mineral density occurs more commonly in patients with haemophilia (PWH) than the general population. However, the risk of haemophilia-related osteoporotic fractures has not been well established. We aim to explore the relationship between haemophilia and the development of osteoporotic fractures following haemophilia. METHODS This was a nationwide population-based cohort study based on the data in the Taiwan National Health Insurance Research Database (TNHIRD). Patients who were diagnosed with haemophilia were selected. A comparison cohort was formed of patients without haemophilia who were matched according to age and sex. The incidence rate and the hazard ratios (HRs) of new-onset osteoporotic fractures were calculated for both cohorts. RESULTS The haemophilia cohort consisted of 75 patients, and the comparison cohort comprised 300 matched control patients without haemophilia. The risk of osteoporotic fractures was higher in the haemophilia cohort than in the comparison cohort (HR = 5.41, 95% confidence interval [CI] = 2.42-12.1, P < 0.001). After adjustments for age, sex, comorbidities, urbanizations and socio-economic status, PWH were 4.37 times more likely to develop osteoporotic fractures (95% CI = 1.88-10.17, P = 0.001) as compared to matched cohort. In addition, the incidence of newly diagnosed osteoporotic fractures was significantly increased after 5-year follow-up durations. CONCLUSION Though our study by TNHIRD presented methodologic flaws by its design nature, we observed that haemophilia may increase the risk of osteoporotic fractures and the cumulative incidence was significantly higher for PWH diagnosed more than 5 years. Clinicians should pay particular attention to osteoporotic fractures following haemophilia in PWH as they age.
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Affiliation(s)
- Sheng-Hui Tuan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shu-Fen Sun
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wan-Yun Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Guan-Bo Chen
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Min-Hui Li
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - I-Hsiu Liou
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Abstract
Haemophilia is a group of coagulation disorders inherited in an X-linked recessive pattern. Nearly three-quarters of all haemorrhages in haemophilia occur in the musculoskeletal system, usually in the large muscles and joints of the lower extremity. While prevention of bleeding with active prophylaxis is the recommended optimal therapy for severe haemophilia, there are many patients suffering from musculoskeletal system complications subsequent to uncontrolled bleeding. Recombinant clotting factor concentrates led to home treatment of acute bleeding episodes as well as allowing for minor and major surgical interventions. Avoiding of further complications by radiosynoviorthesis is the first-line recommendation, and arthroplasty is regarded as the effective salvage procedure for patients presenting with severe disability. Physiotherapy and rehabilitation in haemophilia patients are important to return the normal status of joint motion, to regain the muscle strength, to obtain the optimal functional levels and to improve patients’ quality of life.
Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180068
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Affiliation(s)
- Bülent Atilla
- Hacettepe University Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey
| | - Hande Güney-Deniz
- Hacettepe University Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
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Accelerating recovery from acute hemarthrosis in patients with hemophilia: the role of joint aspiration. Blood Coagul Fibrinolysis 2019; 30:111-119. [PMID: 30958454 DOI: 10.1097/mbc.0000000000000803] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
: Arthrocentesis of an acute hemarthrosis in hemophilia remains a controversial issue. The purpose of this study is to define the role that joint aspiration can play in the recovery from acute hemarthrosis in patients with hemophilia. The study sample included 33 hemophilic patients (55 joints) with acute elbow, knee, and ankle hemarthrosis as confirmed by ultrasonography. Patients were distributed into a treatment group and a control group. Patients in the first group were subjected to joint aspiration, whereas patients in the second were not. Arthrocentesis was carried out immediately after diagnosis of acute hemarthrosis in liquid phase. Patients were infused with the deficient coagulation factor and were instructed to observe relative rest until resolution of hemarthrosis. The following parameters were analyzed: time to full resolution of hemarthrosis (determined by ultrasonography), duration of treatment with the deficient coagulation factor, time to pain relief, time to recovery of prebleed range of motion, and time to resumption of school/work (all of these measured in days). The joints treated with joint aspiration exhibited a significantly faster resolution of bleeding (fewer days). In addition, this group required fewer days of pharmacological treatment, with faster achievement of functional recovery and resumption of school/work activities. No complications were observed. This study shows that joint aspiration under hemostatic cover and in strictly aseptic conditions is a well-tolerated technique that makes the recovery of acute hemarthrosis of hemophilic patients faster.
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Mateo F, Carrasco JJ, Aguilar‐Rodríguez M, Soria‐Olivas E, Bonanad S, Querol F, Pérez‐Alenda S. Assessment of Kinect V2 for elbow range of motion estimation in people with haemophilia using an angle correction model. Haemophilia 2019; 25:e165-e173. [DOI: 10.1111/hae.13744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Fernando Mateo
- Department of Electronics Engineering University of Valencia Valencia Spain
- Intelligent Data Analysis Laboratory University of Valencia Valencia Spain
| | - Juan J. Carrasco
- Intelligent Data Analysis Laboratory University of Valencia Valencia Spain
- Department of Physiotherapy University of Valencia Valencia Spain
| | - Marta Aguilar‐Rodríguez
- Department of Physiotherapy University of Valencia Valencia Spain
- Rehabilitation Service University and Polytechnic Hospital La Fe Valencia Spain
| | - Emilio Soria‐Olivas
- Department of Electronics Engineering University of Valencia Valencia Spain
- Intelligent Data Analysis Laboratory University of Valencia Valencia Spain
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit University and Polytechnic Hospital La Fe Valencia Spain
| | - Felipe Querol
- Department of Physiotherapy University of Valencia Valencia Spain
- Haemostasis and Thrombosis Unit University and Polytechnic Hospital La Fe Valencia Spain
| | - Sofía Pérez‐Alenda
- Department of Physiotherapy University of Valencia Valencia Spain
- Haemostasis and Thrombosis Unit University and Polytechnic Hospital La Fe Valencia Spain
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