Joint protection in haemophilia
(2011) In Haemophilia 17. p.1-23- Abstract
- Haemarthroses (intra-articular haemorrhages) are a frequent finding typically observed in patients with haemophilia. Diagnosis and treatment of these bleeding episodes must be delivered as early as possible. Additionally, treatment should ideally be administered intensively (enhanced on-demand treatment) until the resolution of symptoms. Joint aspiration plays an important role in acute and profuse haemarthroses as the presence of blood in the joint leads to chondrocyte apoptosis and chronic synovitis, which will eventually result in joint degeneration (haemophilic arthropathy). Ultrasonography (US) is an appropriate diagnostic technique to assess the evolution of acute haemarthrosis in haemophilia, although magnetic resonance imaging... (More)
- Haemarthroses (intra-articular haemorrhages) are a frequent finding typically observed in patients with haemophilia. Diagnosis and treatment of these bleeding episodes must be delivered as early as possible. Additionally, treatment should ideally be administered intensively (enhanced on-demand treatment) until the resolution of symptoms. Joint aspiration plays an important role in acute and profuse haemarthroses as the presence of blood in the joint leads to chondrocyte apoptosis and chronic synovitis, which will eventually result in joint degeneration (haemophilic arthropathy). Ultrasonography (US) is an appropriate diagnostic technique to assess the evolution of acute haemarthrosis in haemophilia, although magnetic resonance imaging remains the gold standard as far as imaging techniques are concerned. Some patients experience subclinical haemarthroses, which eventually tend to result in some degree of arthropathy, especially in the ankles. Nowadays, the most effective way of protecting these patients is primary prophylaxis, which in practice changes severe haemophilia into moderate haemophilia, preventing or at least minimizing the occurrence of haemarthrosis. If primary prophylaxis is, for whatever reason not an option, secondary prophylaxis and enhanced on demand treatment should be considered. Two alternatives are available for inhibitor patients: (i) control of haemostasis using by-passing agents (rFVIIa or aPCCs) either as enhanced on demand treatment or secondary prophylaxis, as appropriate, following the same basic principles used for non-inhibitor patients and (ii) immune tolerance induction (ITI) to eradicate the inhibitor. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/2254464
- author
- organization
- publishing date
- 2011
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- haemarthrosis, haemophilia, inhibitor, joint, prophylaxis, protection
- in
- Haemophilia
- volume
- 17
- pages
- 1 - 23
- publisher
- Wiley-Blackwell
- external identifiers
-
- wos:000296466200001
- scopus:79961176998
- pmid:21819491
- ISSN
- 1351-8216
- DOI
- 10.1111/j.1365-2516.2011.02615.x
- language
- English
- LU publication?
- yes
- id
- 4501e6e5-2dbb-4fe1-9a10-2ff810503feb (old id 2254464)
- date added to LUP
- 2016-04-01 10:48:27
- date last changed
- 2022-05-25 06:54:31
@article{4501e6e5-2dbb-4fe1-9a10-2ff810503feb, abstract = {{Haemarthroses (intra-articular haemorrhages) are a frequent finding typically observed in patients with haemophilia. Diagnosis and treatment of these bleeding episodes must be delivered as early as possible. Additionally, treatment should ideally be administered intensively (enhanced on-demand treatment) until the resolution of symptoms. Joint aspiration plays an important role in acute and profuse haemarthroses as the presence of blood in the joint leads to chondrocyte apoptosis and chronic synovitis, which will eventually result in joint degeneration (haemophilic arthropathy). Ultrasonography (US) is an appropriate diagnostic technique to assess the evolution of acute haemarthrosis in haemophilia, although magnetic resonance imaging remains the gold standard as far as imaging techniques are concerned. Some patients experience subclinical haemarthroses, which eventually tend to result in some degree of arthropathy, especially in the ankles. Nowadays, the most effective way of protecting these patients is primary prophylaxis, which in practice changes severe haemophilia into moderate haemophilia, preventing or at least minimizing the occurrence of haemarthrosis. If primary prophylaxis is, for whatever reason not an option, secondary prophylaxis and enhanced on demand treatment should be considered. Two alternatives are available for inhibitor patients: (i) control of haemostasis using by-passing agents (rFVIIa or aPCCs) either as enhanced on demand treatment or secondary prophylaxis, as appropriate, following the same basic principles used for non-inhibitor patients and (ii) immune tolerance induction (ITI) to eradicate the inhibitor.}}, author = {{Rodriguez-Merchan, E. C. and Jimenez-Yuste, V. and Aznar, J. A. and Hedner, Ulla and Knobe, Karin and Lee, C. A. and Ljung, Rolf and Querol, F. and Santagostino, E. and Valentino, L. A. and Caffarini, A.}}, issn = {{1351-8216}}, keywords = {{haemarthrosis; haemophilia; inhibitor; joint; prophylaxis; protection}}, language = {{eng}}, pages = {{1--23}}, publisher = {{Wiley-Blackwell}}, series = {{Haemophilia}}, title = {{Joint protection in haemophilia}}, url = {{http://dx.doi.org/10.1111/j.1365-2516.2011.02615.x}}, doi = {{10.1111/j.1365-2516.2011.02615.x}}, volume = {{17}}, year = {{2011}}, }