Haemophilic arthropathy: A narrative review on the use of intra‐articular drugs for arthritis

• Published in: Haemophilia : the official journal of the World Federation of Hemophilia Vol. 25; no. 6; pp. 919 - 927
• Main Authors: Buccheri, Enrico, Avola, Marianna, Vitale, Nicolò, Pavone, Piero, Vecchio, Michele
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-11-2019
• Subjects: Arthritis; Arthritis - complications; Arthritis - drug therapy; arthropathy; Corticosteroids; Degeneration; Drugs; haemophilia; Hemophilia; Hemophilia A - complications; Humans; Hyaluronic acid; Injections, Intra-Articular; Joint diseases; Mesenchyme; Osteoarthritis; Pain; Patients; Rehabilitation; Stem cells; Surgery; haemophilia; arthropathy; arthritis; drugs
• ISSN: 1351-8216; 1365-2516
• DOI: 10.1111/hae.13857

Introduction
Intra‐articular injections of various drugs are commonly used in patients with degenerative osteoarthritis and also in haemophilic patients. Haemophilic arthropathy is a particular type of secondary osteoarthritis (OA), but the degeneration of strong synovial, cartilaginous and subchondral constituents is provoked by the direct action of iron and blood in the joint.
Aim of the study
The aim of this study is to review the literature regarding the use of various intra‐articular drugs in joints affected by haemophilic arthropathy.
Methods
We reviewed the data from the literature; the search was performed on three medical electronic databases (PubMed, Cochrane Library and Scopus Web of Science) by three authors (B. E., A. M. and V. N.) from 3 December 2018 till 15 December 2018. The search string was as follows: (hyaluronic acid OR viscosupplementation OR platelet‐rich plasma OR corticosteroid OR mesenchymal stem cells) AND (haemophilia OR haemophilic arthropathy OR haemophilic arthritis).
Results
Once the research was performed, a total of 300 articles were identified. 47 selected articles were analysed by the reviewers, and the eligibility of the study inclusion was assessed independently. Twelve papers were included based on clear fulfilment of the inclusion criteria. Thirty‐five articles were excluded for the following reasons: no full text or accessible data for 14 of them, 15 involved surgery or rehabilitation therapy as the primary topic and 6 were systematic reviews (the main topics were beyond the haemophilic arthropathy).
Conclusion
Although the degree of scientific evidence of the publications on intra‐articular injections of various drugs (hyaluronic acid, corticosteriods, PRP and MSCs) in haemophilia is very low, it seems that intra‐articular injections of hyaluronic acid can relieve joint pain for months and can be repeated every 6‐12 months, which is why they can be recommended. Corticosteroid injections seem to relieve joint pain for a few weeks, but their routine use is not recommended in haemophilia. The efficacy of PRP and MSCs in haemophilic arthropathy is pending confirmation, which is why they are not currently recommended.