The role of intraarticular injections of hyaluronic acid in joint pain relief in hemophilic arthropathy

ABSTRACT

Introduction

Chronic pain in hemophilic patients is due to joint degeneration associated with hemophilic arthropathy. In addition to appropriate hematological treatment (primary prophylaxis), pharmacologic management and Physical Medicine and Rehabilitation should be indicated. When such measures are not sufficient, intraarticular injections (IAIs) of hyaluronic acid (HyA) may be considered.

Areas covered

In order to determine whether IAIs of HyA are effective in terms of pain relief in individuals with painful moderate hemophilic arthropathy, a PubMed and Cochrane Library search using ‘hemophilia hyaluronic acid’ as keywords was performed on 18 July 2023.

Expert opinion

In a study of individuals with hemophilic arthropathy (elbows, knees and ankles), 91% of them improved pain after a mean follow-up of 6 years. In another study of individuals with knee arthropathy, after a 7-year follow-up 82% reported an improvement in pain. As for hemophilic ankle arthropathy, in a study 67% of patients showed relief of joint pain at 6-month follow-up. Although the literature on the subject is very heterogeneous and difficult to interpret, it appears that IAIs of HyA can relieve the joint pain of painful moderate hemophilic arthropathy for months. Moreover, the IAIs can be repeated every 6–12 months.

KEYWORDS:

• Hemophilic arthropathy
• hyaluronic acid
• intraarticular injections
• results
• efficacy

Article highlights

• The literature on the efficacy of intraarticular injections (IAIs) of hyaluronic acid (HyA), also called viscosupplementation, in painful moderate hemophilic arthropathy is very heterogeneous, although it appears that the technique can relieve joint pain for months.

• During the procedure, hemostasis should be monitored by hematology specialists to avoid the risk of iatrogenic joint bleeding.

• Between 9% and 18% of hemophiliac patients do not achieve sufficient pain relief with viscosupplementation, eventually requiring surgical treatment.

• IAIs of HyA can be repeated every 6-12 months.

• It remains to be determined which of the different HyA modalities is the most appropriate.

• To definitively confirm the true efficacy of visco supplementation in hemophilic arthropathy, better designed studies should be performed.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.