Platelet-Rich Plasma Intra-Articular Injection in Treating Hemophilic Arthropathy
Condition: Hemophilia; Hemophilic Arthropathy
MeSH terms: Joint Diseases; Hemophilia A
Study type: Interventional

Summary: 
      Severe hemophilia is characterized by frequent and lifelong bleeding, with more than 60% of
      bleeds occurring into joints . Repeated joint bleeding leads to chronic synovitis, cartilage
      damage and bony destruction. Currently available treatment of hemophilic arthropathy, such as
      analgesics, NSAIDs, and hyaluronic acid (HA), are predominantly directed toward the
      symptomatic relief of pain and inflammation, but they do little to reduce joint cartilage
      degeneration.

      Platelet-Rich Plasma (PRP) is a simple and minimally invasive method that provides a natural
      concentrate of autologous growth factors from the blood. This method is now being
      increasingly applied in clinical practice to treat musculoskeletal disorders, such as tendon
      repairment and osteoarthritis. To the best of our knowledge, no study applies PRP for
      arthropathy of knee joint in hemophilia patients. The aim of the study is to investigate the
      efficacy, safety and duration of benefit of single PRP injection versus five weekly
      intra-articular injections of HA in patients with hemophilic arthropathy of knee.
    

Detailed description: 
      Severe haemophilia is characterized by frequent and lifelong bleeding, with more than 60% of
      bleeds occurring into joints. Repeated joint bleeding leads to chronic synovitis, cartilage
      damage and bony destruction, which are associated with limitation of range of motion (ROM),
      pain, muscle atrophy, functional impairment, and poor quality of life. The knee, elbow, and
      ankle are the most commonly involved joints and arthropathy could worsen in adolescence or
      young adulthood. Hemophilic arthropathy is a multifactorial event and there is evidence to
      suggest that iron may play a major role with release of cytokines such as Interleukin (
      IL)-1, IL-6, and tumour necrosis factor alpha (TNF-α) leading to chronic proliferative
      synovitis, hypervascularity, and progressive arthropathy. These effects on cartilage and
      subchondral bone are inflammatory and degenerative in nature and management of chronic
      hemophilic arthropathy is difficult.

      Currently available drugs for the treatment of hemophilic arthropathy, such as analgesics,
      corticosteroids, nonsteroid and steroid anti-inflammatory drugs, and hyaluronic acid (HA),
      are predominantly directed toward the symptomatic relief of pain and inflammation, but they
      do little to reduce joint cartilage degeneration.

      Platelet Rich Plasma (PRP) is a simple and minimally invasive method that provides a natural
      concentrate of autologous growth factors from the blood. This method is now being
      increasingly applied in clinical practice to treat musculoskeletal disorders, such as tendon
      repairment and osteoarthritis. Growth factors including platelet derived growth factor
      (PDGF), insulin growth factor (IGF), vascular endothelial growth factor, and transforming
      growth factor beta-1 are believed to be key components of PRP for structural repair. Although
      comparing PRP with other intra-articular and soft tissue injections has led to conflicting
      results, it seems that PRP has useful effects on healing and functional improvement of
      injured tissues. To the best of our knowledge, only one study applies PRP for arthropathy in
      haemophilia. Teyssler et al reported PRP could reduce pain of chronic ankle synovitis in
      hemophilia although the small sample size (n=6), short term follow-up and absence of a
      control group.

      Hyaluronic acid (HA) has some role in joint mechanical support and its metabolic effects,
      which causes endogenous HA synthesis, stimulation of chondrocyte metabolism, synthesis of
      cartilage matrix components, and inhibition of chondrodegenerative enzymes, as well as
      inflammatory process. In 1994 Fernandez-Palazzi et al firstly used intra-articular HA
      injection for haemophiliacs with arthropathy and reported its beneficial effects in 2002.
      Recently, Carulli et al reported 27 haemophilic patients with a mean seven-year follow-up who
      had excellent results in terms of pain relief and functional improvement in the knee
      following treatment with HA injection. Viscosupplementation is a safe and effective
      therapeutic strategy in haemophilic arthropathy of knee in order to delay of surgery.

      The aim of the study was to investigate the efficacy, safety and duration of benefit of
      single PRP injection versus five weekly intra-articular injections of HA in patients with
      haemophilic arthropathy of knee.
    

Intervention name(s): Platelet-Rich Plasma Intra-Articular Injection; Hyaluronic Acid Viscosupplementation
Intervention type(s): Biological; Drug
Intervention MeSH terms: Hyaluronic Acid
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Platelet Rich Plasma; Hemophilia; Hemophilic arthropathy