Abstract
OBJECTIVE: To assess whether viscosupplementation with hyaluronic acid in patients with severe hemophilic arthropathy associated with triamcinolone after washing with saline improves joint pain, stiffness, function and quality of life. METHODS: Eleven patients with hemophilic arthritis of the knee with and without involvement of other joints (elbows and ankles) underwent joint lavage with saline and subsequent injection of Hylan and triamcinolone in all affected joints. The patients answered the algo-functional (Lequesne and WOMAC), visual analog scale for pain (VAS) and SF-36 (quality of life) questionnaires preoperatively, and at one and three months postoperatively. RESULTS: Pain (VAS and WOMAC pain) and stiffness (WOMAC stiffness) did not show significant improvement (p = 0.3, p = 0.2, p = 0.1, respectively). However function had significant improvement given by WOMAC total and function (averaging 11 points, p = 0.04 and p = 0.001). There was no significant variation in scores in Lequesne's questionnaire (p = 0.1), yet both mental and physical components of SF-36 presented clinically relevant and significant improvements (p = 0.002). CONCLUSION: Joint lavage with saline followed by injection of corticosteroids and Hylan is effective in the treatment of hemophilic arthropathy, especially in functional improvement and quality of life. Level of Evidence IV, Case series.
Highlights
The aim of this study is to assess the efficacy of the treatment, consisting of joint lavage followed by an injection of corticosteroid and hylan G-F 20, by a program of exercises to be done at home and/or in a gym depending on the previous level of the hemophiliac patient, in relation to pain relief and improvement of function and of quality of life
There were a total of 14 knees, nine ankles and four elbows in this sample. (Chart 1) When both ankles or both knees were not involved, the involvement was crossed, i.e., if left knee, they had the right ankle involved and vice versa
Owing to the fact that there is no correlation between the degree of arthritis and the symptoms, as well as the fact that hemophiliac patients are young, arthritic and low-demand individuals, the initial hypothesis of this study was that viscosupplementation would improve the function and the quality of life of these patient regardless of the degree of arthritis.[9,10]
Summary
The aim of this study is to assess the efficacy of the treatment, consisting of joint lavage followed by an injection of corticosteroid and hylan G-F 20, by a program of exercises to be done at home and/or in a gym depending on the previous level of the hemophiliac patient, in relation to pain relief and improvement of function and of quality of life.
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