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Ray A, Rowbotham E. Radiosynovectomy in haemophilic synovitis and arthropathy of the knee: A scoping review. Haemophilia 2024; 30:617-627. [PMID: 38439131 DOI: 10.1111/hae.14966] [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: 08/07/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Radiosynovectomy is an established treatment for chronic synovitis in patients with haemophilia. Although its role in rheumatological diseases has diminished, it remains an accepted therapy for haemophilic synovitis. AIM The aim of this scoping review was to map and summarise the evidence surrounding radiosynovectomy in haemophilic knees, identify gaps in the literature and inform future research. RESULTS Forty-three manuscripts and abstracts were identified for this review. Evidence was limited to observational studies and Yttrium-90 was the most studied licensed radioisotope. Radiosynovectomy was associated with a reduction in bleeding frequency and pain, improvements in range of motion and a reduction in the use of factor replacement. CONCLUSION The literature reviewed lacks studies of sufficient methodological quality to permit systematic review and meta-analysis. Systematic review using risk of bias assessment for observational studies should be undertaken to better evaluate the efficacy and safety of radiosynovectomy. A causal relationship between RSV and key clinical outcomes remains undetermined.
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Affiliation(s)
- Aaron Ray
- Department of Radiology, York Hospital, York and Scarborough Teaching Hospitals NHS Trust, York, UK
| | - Emma Rowbotham
- Musculoskeletal Radiology Department, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Taylor S, Barker K, Stephensen D, Williamson E. Using evidence-based co-design to develop a hybrid delivered exercise intervention that aims to increase confidence to exercise in people with haemophilia. Haemophilia 2024; 30:817-826. [PMID: 38462814 DOI: 10.1111/hae.14972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Due to advances in treatments, people with haemophilia (PWH) are living longer. They are not as active as the general population due to joint damage and lack confidence to be active due to concerns about further bleeds and pain. There is a need to facilitate healthy aging through promotion of physical activity (PA) and exercise. Changing patient beliefs and increasing physical literacy and confidence to move are thought to be key to helping PWH become more active. AIM This paper describes the development of an exercise and behaviour change intervention to improve confidence to exercise in PWH. METHODS The 4-stage Medical Research Council framework for complex intervention development was used. RESULTS Stakeholders included 17 PWH and 7 physiotherapists working in haemophilia. Seven online focus group meetings were held. The final intervention is a hybrid 12-week physiotherapist led progressive exercise programme. Classes are 45 min including Pilates, High intensity interval training and balance elements, together with discussion sessions focusing on PA recommendations, the types and benefits of different exercise styles and the effects of PA, together with the effects of aging for PWH. The COM-B model of behaviour change was used to develop the intervention. CONCLUSION Co-design helps to produce an intervention that understands the stakeholders needs. Through this process the intervention developed to incorporate not only increasing PA but also confidence to exercise. The use of behaviour change theory identified the behaviour techniques included in the intervention and aims to increase physical literacy in this population.
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Affiliation(s)
- Stephanie Taylor
- Oxford Haemophilia and Thrombosis Centre, Churchill Hospital, Oxford, UK
| | - Karen Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford, UK
- NDORMS (Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences), University of Oxford, Oxford, UK
| | - David Stephensen
- Faculty of Medicine Health and Social Care, Canterbury Christ Church University, Canterbury, UK
| | - Esther Williamson
- NDORMS (Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences), University of Oxford, Oxford, UK
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Donoso-Úbeda E, Ucero-Lozano R, Meroño-Gallut J, Cuesta-Barriuso R, Pérez-Llanes R. Safety and efficacy of myofascial release therapy in the treatment of patients with hemophilic ankle arthropathy. Single-blind randomized clinical trial. Physiother Theory Pract 2024:1-10. [PMID: 38530214 DOI: 10.1080/09593985.2024.2334752] [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: 12/20/2023] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Hemophilia is characterized by degenerative joint damage. Patients with hemophilic arthropathy present joint damage, reduced range of motion, and decreased strength and functional capacity. Myofascial release therapy aims to decrease pain and improve tissue mobility and functionality. OBJECTIVES To evaluate the safety and efficacy of myofascial release therapy in patients with hemophilic ankle arthropathy. METHOD Single-blind randomized controlled trial. Fifty-eight adult patients with hemophilia were randomly allocated to the experimental group (myofascial release therapy with foam roller) or the control group (no intervention whatsoever). The daily home protocol of myofascial release therapy for the lower limbs using a foam roller lasted eight consecutive weeks. The primary variable was the safety of myofascial release therapy (weekly telephone follow-up). The secondary variables were pain intensity (visual analog scale), range of motion (goniometer), functional capacity (2-Minute Walk Test) and muscle strength (dynamometer), at baseline and at 8 and 10 weeks. RESULTS During the experimental phase, none of the patients in the experimental group developed ankle hemarthrosis. There were statistically significant changes in time*group interaction in ankle dorsal flexion (F[1.75] = 10.72; p < .001), functional capacity (F[1.16] = 5.24; p = .009) and gastrocnemius strength (F[2] = 26.01; p < .001). The effect size of the changes after the intervention was medium-large in pain intensity (d = -1.77), functional capacity (d = 1.34) and gastrocnemius strength (d = 0.76). CONCLUSION Myofascial release therapy is a safe form of physical therapy for patients with hemophilia. Myofascial release therapy can effectively complement prophylactic pharmacological treatment in patients with hemophilic arthropathy, improving range of motion in dorsal flexion, functional capacity and gastrocnemius strength.
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Affiliation(s)
- Elena Donoso-Úbeda
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
- InHeFis Research Group, Instituto Asturiano de Investigación ,Sanitaria (ISPA), Oviedo, Spain
| | - Roberto Ucero-Lozano
- InHeFis Research Group, Instituto Asturiano de Investigación ,Sanitaria (ISPA), Oviedo, Spain
- Department of Physiotherapy, European University of Madrid, Madrid, Spain
| | - Javier Meroño-Gallut
- InHeFis Research Group, Instituto Asturiano de Investigación ,Sanitaria (ISPA), Oviedo, Spain
- Tú. Bienestar 360°, Physiotherapy and Medical Center, San Javier, Murcia, Spain
| | - Rubén Cuesta-Barriuso
- InHeFis Research Group, Instituto Asturiano de Investigación ,Sanitaria (ISPA), Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Oviedo, Spain
| | - Raúl Pérez-Llanes
- InHeFis Research Group, Instituto Asturiano de Investigación ,Sanitaria (ISPA), Oviedo, Spain
- Department of Physiotherapy, University of Murcia, Murcia, Spain
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Beckers G, Massé V, Vendittoli PA, Morcos MW. Primary total knee arthroplasty in hemophilic arthropathy. EFORT Open Rev 2023; 8:830-840. [PMID: 37909693 PMCID: PMC10646519 DOI: 10.1530/eor-23-0101] [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: 11/03/2023] Open
Abstract
Advanced hemophilic knee arthropathy is a frequent and devastating manifestation of severe hemophilia with significant implications for activities of daily living. Hemophilic arthropathy is caused by repeated bleeding, resulting in joint degeneration, pain, deformity and disability. In patients with hemophilia and advanced disease, total knee arthroplasty (TKA) has proven to be the most successful intervention, improves physical function and reduces knee pain. Hemophilic patients carry additional risks for complications and required specific pre/postoperative considerations. Expert treatment center should be used to improve patient outcome. Hemophilic patients present significant surgical challenges such as joint destruction, bone loss, severe ankylosis and oligoarticular involvement. The surgeon performing the arthroplasty must be experienced to manage such problems.
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Affiliation(s)
- Gautier Beckers
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montréal University, Montréal, Quebec, Canada
- Personalized Arthroplasty Society, Atlanta, Georgia, USA
| | - Vincent Massé
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montréal University, Montréal, Quebec, Canada
- Personalized Arthroplasty Society, Atlanta, Georgia, USA
- Clinique Orthopédique Duval, Laval, Quebec, Canada
| | - Pascal-André Vendittoli
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montréal University, Montréal, Quebec, Canada
- Personalized Arthroplasty Society, Atlanta, Georgia, USA
- Clinique Orthopédique Duval, Laval, Quebec, Canada
| | - Mina W Morcos
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montréal University, Montréal, Quebec, Canada
- Personalized Arthroplasty Society, Atlanta, Georgia, USA
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Tedeschi R. Acquired haemophilia A in an elderly patient: A case report of functional recovery through physiotherapy. Int J Surg Case Rep 2023; 110:108769. [PMID: 37666165 PMCID: PMC10510055 DOI: 10.1016/j.ijscr.2023.108769] [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: 08/16/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Acquired haemophilia-A, although uncommon in elderly patients, poses significant clinical challenges, especially when associated with profound musculoskeletal complications. The potential mimicry of hematomas as tumors further complicates the diagnostic process. CASE PRESENTATION An 85-year-old male, with a remote history of hypertension, benign prostatic hyperplasia, and right inguinal hernia, presented with acute pain in the left lower limb, functional limitation, and deep hematomas in the ileopsoas and axillary region. Initial suspicions of a sarcomatous lesion in the ileopsoas, based on radiological findings, were refuted following histopathological examinations, which confirmed the presence of necrotic hemorrhagic tissue. The patient underwent a one-month physical therapy regimen, targeting lower extremity muscles, especially around the hip joint. CLINICAL DISCUSSION The severity of the presentation and the involvement of vital muscles like the ileopsoas and quadriceps underscored the importance of comprehensive rehabilitation. Consistent therapeutic interventions, targeting muscle strength and joint function, demonstrated marked improvement as evidenced by the HJHS, HAL, and FISH scores. The multidisciplinary approach, entailing hematological, rehabilitative, and supportive measures, was paramount in ensuring holistic patient recovery. CONCLUSIONS Acquired haemophilia-A in the elderly necessitates an integrative care approach, encompassing accurate diagnosis and tailored therapeutic interventions. This case emphasizes the transformative potential of dedicated physiotherapy in managing the musculoskeletal implications of this bleeding disorder, underscoring the value of early intervention and comprehensive care.
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Affiliation(s)
- Roberto Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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Alito A, Bellone F, Portaro S, Leonardi G, Cannavò V, Coppini F, Leonetti D, Catalano A, Squadrito G, Fenga D. Haemophilia and Fragility Fractures: From Pathogenesis to Multidisciplinary Approach. Int J Mol Sci 2023; 24:ijms24119395. [PMID: 37298347 DOI: 10.3390/ijms24119395] [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: 04/21/2023] [Revised: 05/13/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Haemophilia A (HA) and haemophilia B (HB) are X-linked inherited bleeding disorders caused by the absence or deficiency of coagulation factors VIII (FVIII) and IX (FIX), respectively. Recent advances in the development of effective treatments for haemophilia have led to a significant increase in life expectancy. As a result, the incidence of some comorbidities, including fragility fractures, has increased in people with haemophilia (PWH). The aim of our research was to perform a review of the literature investigating the pathogenesis and multidisciplinary management of fractures in PWH. The PubMed, Scopus and Cochrane Library databases were searched to identify original research articles, meta-analyses, and scientific reviews on fragility fractures in PWH. The mechanism underlying bone loss in PWH is multifactorial and includes recurrent joint bleeding, reduced physical activity with consequent reduction in mechanical load, nutritional deficiencies (particularly vitamin D), and FVIII and FIX deficiency. Pharmacological treatment of fractures in PWH includes antiresorptive, anabolic and dual action drugs. When conservative management is not possible, surgery is the preferred option, particularly in severe arthropathy, and rehabilitation is a key component in restoring function and maintaining mobility. Appropriate multidisciplinary fracture management and an adapted and tailored rehabilitation pathway are essential to improve the quality of life of PWH and prevent long-term complications. Further clinical trials are needed to improve the management of fractures in PWH.
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Affiliation(s)
- Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98100 Messina, Italy
| | - Federica Bellone
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98100 Messina, Italy
| | - Simona Portaro
- Department of Physical and Rehabilitation Medicine, University Hospital "G. Martino", 98100 Messina, Italy
| | - Giulia Leonardi
- Department of Physical and Rehabilitation Medicine, University Hospital "G. Martino", 98100 Messina, Italy
| | - Vittorio Cannavò
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98100 Messina, Italy
| | - Francesca Coppini
- Department of Orthopaedics and Traumatology, University Hospital A.O.U. "G. Martino", 98100 Messina, Italy
| | - Danilo Leonetti
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 98100 Messina, Italy
| | - Antonino Catalano
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98100 Messina, Italy
| | - Giovanni Squadrito
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 1, 98100 Messina, Italy
| | - Domenico Fenga
- Department of Orthopaedics and Traumatology, University Hospital A.O.U. "G. Martino", 98100 Messina, Italy
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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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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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Horneff S, Boddenberg-Pätzold B. The value of radiosynoviorthesis for treatment of chronic synovitis in hemophilic joint disease. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:334-344. [PMID: 36106913 DOI: 10.23736/s1824-4785.22.03474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Chronic synovitis is contributing to the development of arthropathy in hemophilia A and B. In most patients with severe and moderate hemophilia, during lifetime, joint damage progresses despite early prophylaxis and intense treatment with coagulation factor concentrates. Recurrent hemorrhages into the joints and subclinical bleeding lead to chronic inflammation of the synovium, neoangiogenesis and remodeling, sustaining a vicious circle of bleeding-remodeling-bleeding and progression of osteochondral damage. Imaging techniques including ultrasound and MRI are able to early visualize synovitis and osteochondral changes. Early detection and sustained therapy of synovitis are important preconditions to prevent further deterioration of joint status. Chronic synovitis requires intensified substitution of coagulation factors and concomitant analgetic, antiphlogistic and physical therapy. The value of early radiosynoviorthesis (RSO) as effective method to control ongoing synovitis is discussed here. RSO is recommended as first choice therapy in case of persistant chronic synovitis, recorded in both national and international guidelines.
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Affiliation(s)
- Silvia Horneff
- Institute for Experimental Hematology and Transfusional Medicine, Clinical University of Bonn, Bonn, Germany -
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Chowdary P, Holmström M, Mahlangu J, Ozelo MC, Pabinger I, Pasi KJ, Ragni M, Shapiro A, Barnowski C, Lethagen S. Managing surgery in hemophilia with recombinant factor VIII Fc and factor IX Fc: Data on safety and effectiveness from phase 3 pivotal studies. Res Pract Thromb Haemost 2022; 6:e12760. [PMID: 35910942 PMCID: PMC9326287 DOI: 10.1002/rth2.12760] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/09/2022] [Accepted: 05/19/2022] [Indexed: 01/19/2023] Open
Abstract
Background Surgical procedures impose hemostatic risk to people with hemophilia, which may be minimized by optimal factor (F) replacement therapy. Methods This analysis evaluates the efficacy and safety of extended half-life factor replacement recombinant FVIII and FIX Fc fusion proteins (rFVIIIFc and rFIXFc) during surgery in phase 3 pivotal (A-LONG/Kids A-LONG and B-LONG/Kids B-LONG) and extension (ASPIRE and B-YOND) studies. Dosing regimens were determined by investigators. Injection frequency, dosing, blood loss, transfusions, and hemostatic response were assessed. Results Forty-five major (n = 31 subjects) and 90 minor (n = 70 subjects) procedures were performed in hemophilia A; 35 major (n = 22) and 62 minor (n = 37) procedures were performed in hemophilia B. Unilateral knee arthroplasty was the most common major orthopedic procedure (hemophilia A: n = 15/34; hemophilia B: n = 8/24). On the day of surgery, median total dose in adults/adolescents was 81 IU/kg for rFVIIIFc and 144 IU/kg for rFIXFc; most major procedures required ≤2 injections (including loading dose). Through days 1-14, most major procedures had ≤1 injection/day. Hemostasis was rated excellent (rFVIIIFc: n = 39/42; rFIXFc: n = 29/33) or good (n = 3/42; n = 4/33) in evaluable major surgeries, with blood loss comparable with subjects without hemophilia. Most minor procedures in adults/adolescents required one injection on the day of surgery, including median loading dose of 51 IU/kg (rFVIIIFc) and 80 IU/kg (rFIXFc). No major treatment-related safety concerns were identified. No subjects developed inhibitors or serious vascular thromboembolic events. Conclusions rFVIIIFc and rFIXFc were efficacious and well tolerated for the management of perioperative hemostasis across a wide spectrum of major and minor surgeries in hemophilia.
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Affiliation(s)
- Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis CentreRoyal Free HospitalLondonUK
| | - Margareta Holmström
- Coagulation Unit, Department of Hematology, Department of Medicine, Karolinska Institute SolnaKarolinska University HospitalStockholmSweden
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Johnny N. Mahlangu
- Hemophilia Comprehensive Care Centre, Department of Molecular Medicine and Haematology, Faculty of Health SciencesUniversity of the Witwatersrand and National Health Laboratory ServiceJohannesburgSouth Africa
| | | | - Ingrid Pabinger
- Clinical Division of Hematology and Hemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
| | - K. John Pasi
- Royal London Hospital Haemophilia CentreBarts and The London School of Medicine and DentistryLondonUK
| | - Margaret V. Ragni
- Division of Hematology/Oncology, and Hemophilia Center of Western PA, Department of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Amy Shapiro
- Indiana Hemophilia and Thrombosis CenterIndianapolisIndianaUSA
| | | | - Stefan Lethagen
- Swedish Orphan Biovitrum ABStockholmSweden
- Copenhagen UniversityCopenhagenDenmark
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Morla S, Deguchi H, Zilberman-Rudenko J, Gruber A, McCarty OJT, Srivastava P, Gailani D, Griffin JH. Skeletal muscle myosin promotes coagulation by binding factor XI via its A3 domain and enhancing thrombin-induced factor XI activation. J Biol Chem 2022; 298:101567. [PMID: 35007530 PMCID: PMC8856988 DOI: 10.1016/j.jbc.2022.101567] [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: 09/05/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 12/01/2022] Open
Abstract
Skeletal muscle myosin (SkM) has been shown to possess procoagulant activity; however, the mechanisms of this coagulation-enhancing activity involving plasma coagulation pathways and factors are incompletely understood. Here, we discovered direct interactions between immobilized SkM and coagulation factor XI (FXI) using biolayer interferometry (Kd = 0.2 nM). In contrast, we show that prekallikrein, a FXI homolog, did not bind to SkM, reflecting the specificity of SkM for FXI binding. We also found that the anti-FXI monoclonal antibody, mAb 1A6, which recognizes the Apple (A) 3 domain of FXI, potently inhibited binding of FXI to immobilized SkM, implying that SkM binds FXI A3 domain. In addition, we show that SkM enhanced FXI activation by thrombin in a concentration-dependent manner. We further used recombinant FXI chimeric proteins in which each of the four A domains of the heavy chain (designated A1 through A4) was individually replaced with the corresponding A domain from prekallikrein to investigate SkM-mediated enhancement of thrombin-induced FXI activation. These results indicated that activation of two FXI chimeras with substitutions of either the A3 domains or A4 domains was not enhanced by SkM, whereas substitution of the A2 domain did not reduce the thrombin-induced activation compared with wildtype FXI. These data strongly suggest that functional interaction sites on FXI for SkM involve the A3 and A4 domains. Thus, this study is the first to reveal and support the novel intrinsic blood coagulation pathway concept that the procoagulant mechanisms of SkM include FXI binding and enhancement of FXI activation by thrombin.
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Affiliation(s)
- Shravan Morla
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Hiroshi Deguchi
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA
| | - Jevgenia Zilberman-Rudenko
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA; Departments of Biomedical Engineering and Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - András Gruber
- Departments of Biomedical Engineering and Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Owen J T McCarty
- Departments of Biomedical Engineering and Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Priyanka Srivastava
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David Gailani
- Departments of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John H Griffin
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California, USA; Department of Medicine, University of California, San Diego, California, USA.
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12
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Kampen WU, Boddenberg-Pätzold B, Fischer M, Gabriel M, Klett R, Konijnenberg M, Kresnik E, Lellouche H, Paycha F, Terslev L, Turkmen C, van der Zant F, Antunovic L, Panagiotidis E, Gnanasegaran G, Kuwert T, Van den Wyngaert T. The EANM guideline for radiosynoviorthesis. Eur J Nucl Med Mol Imaging 2022; 49:681-708. [PMID: 34671820 PMCID: PMC8803784 DOI: 10.1007/s00259-021-05541-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/23/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Radiosynoviorthesis (RSO) using the intraarticular application of beta-particle emitting radiocolloids has for decades been used for the local treatment of inflammatory joint diseases. The injected radiopharmaceuticals are phagocytized by the superficial macrophages of the synovial membrane, resulting in sclerosis and fibrosis of the formerly inflamed tissue, finally leading to reduced joint effusion and alleviation of joint pain. METHODS The European Association of Nuclear Medicine (EANM) has written and approved these guidelines in tight collaboration with an international team of clinical experts, including rheumatologists. Besides clinical and procedural aspects, different national legislative issues, dosimetric considerations, possible complications, and side effects are addressed. CONCLUSION These guidelines will assist nuclear medicine physicians in performing radiosynoviorthesis. Since there are differences regarding the radiopharmaceuticals approved for RSO and the official indications between several European countries, this guideline can only give a framework that must be adopted individually.
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Affiliation(s)
- W U Kampen
- Nuklearmedizin Spitalerhof, Radiologische Allianz, Spitalerstraße 8, 20095, Hamburg, Germany
| | | | - M Fischer
- Praxis Für Radiologie Und Nuklearmedizin, Friedrich-Ebert-Straße 50, 34117, Kassel, Germany
| | - M Gabriel
- Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital Linz GmbH, Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz and Krankenhausstrasse 9, 4020, Linz, Austria
| | - R Klett
- ÜBAG Für Nuklearmedizin, Hanau-Frankfurt-Offenbach-Gießen, Standort Gießen, Paul-Zipp-Str. 171-173, 35398, Gießen, Germany
| | - M Konijnenberg
- Erasmus MC, Nucleaire geneeskunde, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - E Kresnik
- Privatklinik Villach, Institut Für Nuklearmedizin, Dr.-Walter-Hochsteinerstrasse 4, 9504, Warmbad Villach, Austria
| | - H Lellouche
- Unité Rhumatologique de Affections de La Main, Centre Viggo Petersen, Hôpital Lariboisiere, 2 rue Ambroise Paré, 75010, Paris, France
- Institut de Rhumatologie Interventionnelle, 13 rue Thouin, 75005, Paris, France
| | - F Paycha
- Service de Médecine Nucléaire, Hôpital Lariboisière, Assistance Publique- Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France
| | - L Terslev
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Valdemar Hansens Vej 17, 2600, Glostrup, Denmark
| | - C Turkmen
- Department of Nuclear Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, 34390, Turkey
| | - F van der Zant
- Nucleaire Geneeskunde, Noordwest Ziekenhuisgroep, Postbus 501, 1800 AM, Alkmaar, Netherlands
| | - L Antunovic
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Milan, 20089, Rozzano, Italy
| | - E Panagiotidis
- Department of Nuclear Medicine, Oncology Center 'Theageneio', Al Symeonidis 2 str, P.C 54007, Thessaloniki, Greece
| | - G Gnanasegaran
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - T Kuwert
- Clinic of Nuclear Medicine, Friedrich-Alexander-University, Erlangen-Nürnberg, Erlangen, Germany.
| | - T Van den Wyngaert
- Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
- Molecular Imaging Center Antwerp (MICA - IPPON), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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13
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Scaturro D, Benedetti MG, Lomonaco G, Tomasello S, Farella MGG, Passantino G, Frizziero A, Letizia Mauro G. Effectiveness of rehabilitation on pain and function in people affected by hemophilia. Medicine (Baltimore) 2021; 100:e27863. [PMID: 34918635 PMCID: PMC8677972 DOI: 10.1097/md.0000000000027863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Literature provides unclear evidence of the effectiveness of many physiotherapy interventions on pain intensity, quality of life, and functional ability in hemophilic patients, and suggests that rehabilitation programs should be focused on functional goals and the disability of patients. AIM The aim of the present study is to present the outcome of a case series of patients with hemophilia in which a rehabilitation program has been carried out on the basis of a specific individual patient's functional impairment. METHODS Fifty-one patients were enrolled: 32 patients (Rehab Group) received a rehabilitative treatment, 19 patients for different reasons (living far from the hospital, family problems) did not receive rehabilitation (Control Group). The rehabilitation program was planned with respect to the emergent problems: musculoskeletal pain, joint range of motion limitation, muscle flexibility, walking difficulties, the appearance of hematomas/hemartro, and postural problems. All the patients were assessed at baseline (T0), after 1 month (T1), and after 3 months (T2) through visual analogic scale for musculoskeletal pain, the Hemophilia Joint Health Score for joint range of motion, the Functional Independence Score in Hemophilia for disability, and postural assessment by visual inspection. RESULTS A significant reduction of pain and improvement of Hemophilia Joint Health Score and Functional Independence Score in Hemophilia score was found in the Rehab Group along with the follow-up. Pain in the Control Group was lower with respect to the other group at baseline and significantly decreased after 1 month. CONCLUSION A rehabilitation program focused on individual impairment of patients with hemophylia determined satisfying results in terms of pain control, functional, and disability improvement in 3 months follow-up.
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Affiliation(s)
- Dalila Scaturro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo Rehabilitation Unit, Paolo Giaccone Hospital, Palermo, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, University of Bologna, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulia Lomonaco
- Physical Medicine and Rehabilitation Unit, University of Bologna, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sofia Tomasello
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo Rehabilitation Unit, Paolo Giaccone Hospital, Palermo, Italy
| | | | - Giuseppina Passantino
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo Rehabilitation Unit, Paolo Giaccone Hospital, Palermo, Italy
| | - Antonio Frizziero
- Physical and Rehabilitation Medicine, Department of Medicine and Surgery General Hospital, University of Parma, Italy
| | - Giulia Letizia Mauro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo Rehabilitation Unit, Paolo Giaccone Hospital, Palermo, Italy
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14
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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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15
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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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16
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Bago M, Butkovic A, Preloznik Zupan I, Faganel Kotnik B, Prga I, Bacic Vrca V, Zupancic Salek S. Association between reported medication adherence and health-related quality of life in adult patients with haemophilia. Int J Clin Pharm 2021; 43:1500-1507. [PMID: 33928481 DOI: 10.1007/s11096-021-01270-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
Background Medication adherence is an important issue, not just health-related, for patients with haemophilia. Poor medication adherence to long-term therapies limits the potential of effective treatments to improve patients' health-related quality of life. Objective The aim of this study was to investigate the association of reported medication adherence and health-related quality of life in patients with haemophilia. Setting Data were collected from patients at University Hospital Centre Zagreb, Croatia and at University Medical Centre Ljubljana, Slovenia. Method Adult male patients with severe or moderate haemophilia receiving prophylactic treatment were eligible for the study. Main outcome measure Implementation phase of medication adherence was assessed with the self-reported VERITAS-Pro instrument and health-related quality of life with SF-36v2. Results A total of 82 participants were included in the study (median age was 44.50, range 18-73 years). The majority of our participants reported being adherent to medication (83%). Participants showed better health in the mental health domains and Mental Component Summary than in the physical health domains and Physical Component Summary. After controlling for demographic, socioeconomic and clinical predictors, better reported medication adherence explained an additional 4-6% of better health variance in Bodily Pain and Social Functioning domains and Mental Component Summary. Conclusion We found that reported medication adherence can contribute to better health-related quality of life in patients with haemophilia. Since life with a chronic condition is demanding, it is an important finding that medication adherence to replacement therapy can improve life conditions for patients with haemophilia.
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Affiliation(s)
- Martina Bago
- Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia.
| | - Ana Butkovic
- Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Irena Preloznik Zupan
- University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Faganel Kotnik
- University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ivana Prga
- Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Vesna Bacic Vrca
- Clinical Hospital Dubrava, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Silva Zupancic Salek
- University Hospital Centre Zagreb, Zagreb, Croatia.,Faculty of Medicine, University of Zagreb, Zagreb, Croatia
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17
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Abstract
Musculo-skeletal complications of the hand in the haemophilia patient are rare, and they include synovitis, arthropathy, pseudotumours, carpal tunnel syndrome and vascular aneurysms and pseudoaneurysms. The best way to prevent the aforementioned musculo-skeletal complications is early continuous haematological primary prophylaxis (intravenous infusion of the deficient coagulation factor, ideally from cradle to death). There is a wide range of procedures that a hand surgeon treating these patients should be able to manage, including synovectomy, prosthetic replacement of small joints, removal or curettage of pseudotumours, release of carpal tunnel and, occasionally, vascular reconstruction of aneurysms. The treatment of these patients should be made at an institution with close collaboration between haematologists and hand surgeons (all surgical procedures must always be performed under cover of the deficient coagulation factor).
Cite this article: EFORT Open Rev 2020;5:328-333. DOI: 10.1302/2058-5241.5.190078
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Affiliation(s)
- Elena Bravo
- Plastic Surgery Department, Hospital Universitario La Paz, Madrid, Spain
| | - Raul Barco
- Upper Limb Unit, Orthopedic Surgery Department, Hospital Universitario La Paz, Madrid, Spain
| | - E Carlos Rodríguez-Merchán
- Haemophilia Orthopedic Unit, Orthopedic Surgery Department, Hospital Universitario La Paz, Madrid, Spain
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18
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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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