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.
Highlights
If the patients’ joint conditions do not respond well to non-surgical management and less-invasive surgical treatments, such as arthroscopic synovectomy, joint arthroplasty has been the surgical treatment of choice
Owing to the aforementioned issues, we aimed to develop a novel, effective, and less-invasive treatment for hemophilic arthropathy
Patients were excluded from this study if they were diagnosed with acquired hemophilia or other inflammatory diseases that might affect joints, had received intra-articular injection of hyaluronic acid or steroid treatment previously, had tumors involving the knee or adjacent tissue, or had acute joint bleeding episodes in the previous week
Summary
Patients with severe hemophilia are severely deficient in coagulation factors, and spontaneous joint or muscle bleeding often occurs, especially in the knee and ankle joints. Repeated episodes of joint bleeding result in joint synovial hyperplasia, cartilage damage, bone destruction, bone spurs, joint swelling, and deformation, and this condition is called hemophilic arthropathy [1,2,3]. Treatments for hemophilic arthropathy include prophylactic coagulation factors injection, steroid and non-steroidal anti-inflammatory drug (NSAID) administration, rehabilitation, localized steroid injection, isotopic synovectomy, chemical synovectomy, and arthroscopic synovectomy [4,5,6,7]. If the patients’ joint conditions do not respond well to non-surgical management and less-invasive surgical treatments, such as arthroscopic synovectomy, joint arthroplasty has been the surgical treatment of choice. Owing to the aforementioned issues, we aimed to develop a novel, effective, and less-invasive treatment for hemophilic arthropathy
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