PDF(Pubmed)
Abstract：
Hemophilia is an inherited X-linked bleeding condition with predominant joint involvement due to intra-articular bleeding, hemosiderin deposition and the synovial hypertrophy that is responsible for cartilage destruction, joint deformity and malalignment, pain and functional restriction. Management of chronic arthropathy includes conservative and surgical approaches. Conservative therapies consist of pain modulation, oral drugs, physiotherapy and intra-articular agents. For the present review, the literature was searched for intra-articular agents and 20 papers on the use of corticosteroids (CS), hyaluronic acid (HA) and platelet-rich plasma (PRP), with different regimes of administration, were included. CS had a longer record of injection, with statistically significant pain reduction and functional improvement in the short-term and moderate persistence in the long-term. HA was able to improve the clinical and functional status of joints with moderate or severe hemophilia. PRP was relatively recently introduced to joint management and the results remain controversial. Different associations between the above-mentioned agents were proposed by studies including a small number of patients, producing comparable results. It was concluded that there is a need for extensive research on intra-articular agents, with stratification according to the severity of joint involvement. The lack of a blinded or placebo-controlled arm due to ethical aspects makes the task challenging.
摘要：
血友病是一种遗传性X连锁出血疾病，主要是关节内出血，含铁血黄素沉积和滑膜肥大是软骨破坏的原因，关节畸形和畸形，疼痛和功能限制。慢性关节病的治疗包括保守和手术方法。保守治疗包括疼痛调节，口服药物,物理治疗和关节内药物。对于本次审查，在文献中搜索关节内药物和20篇关于皮质类固醇（CS）使用的论文，透明质酸（HA）和富血小板血浆（PRP），不同的管理制度，包括在内。CS有更长的注射记录，在短期和长期的中度持久性中，具有统计学意义的疼痛减轻和功能改善。HA能够改善中度或重度血友病关节的临床和功能状态。PRP最近被引入联合管理，结果仍然存在争议。包括少数患者在内的研究提出了上述药物之间的不同关联，产生可比较的结果。结论是，有必要对关节内药物进行广泛的研究，根据关节受累的严重程度进行分层。由于道德方面的原因，缺乏盲目或安慰剂对照的手臂使得这项任务具有挑战性。
