The main clinical manifestations of hemophilia are muscle and joint bleeding. Recurrent bleeding leads to a degenerative process known as hemophilic arthropathy. The development of inhibitors (antibodies against FVIII/FIX concentrates) is the main complication in the treatment of hemophilia. The objective was to assess the safety and efficacy of manual therapy treatment in a patient with hemophilia and inhibitor.
A 26-year-old patient with hemophilia B and inhibitor received physiotherapy treatment based on manual therapy for 3 months, with a frequency of 2 sessions per week. The joint status was evaluated using the Hemophilia Joint Health Score; pain was assessed with the Visual Analog Scale; and the range of movement was evaluated using a universal goniometer. The patient developed no joint bleeding in the knees or ankles as a result of the physiotherapy treatment. Following treatment, improvements were noted in the range of movement of knees and ankles, the perception of pain in both knees, and ankle functionality.
Until now, manual therapy using joint traction was contraindicated in patients with hemophilia and inhibitor, as it was feared to cause possible joint bleeding. This is the first case study to address the safety and efficacy of manual therapy in a patient with hemophilia and an inhibitor. The results of this study may help to establish which manual therapy treatments are indicated in patients with hemophilic arthropathy and inhibitors. Thus, a physiotherapy program based on manual therapy may be safe in patients with hemophilia and inhibitor and such therapy may improve joint condition, pain, and joint range of motion in patients with hemophilia and inhibitor. Randomized clinical trials are needed to confirm the results of this case study.
Valentino LA, Hakobyan N, Enockson C. Blood-induced joint disease: the confluence of dysregulated oncogenes, inflammatory signals and angiogenic cues. Semin Hematol. 2008;45:50–7. CrossRef
Cuesta-Barriuso R, Gómez-Conesa A, López-Pina JA. Effectiveness of two modalities of physiotherapy in the treatment of haemophilic arthropathy of the ankle: a randomized pilot study. Haemophilia. 2014;20:e71–e78. CrossRef
Querol F. Exploración clínica de la artropatía hemofílica. Palmero ediciones: Valencia; 2008.
Norkin C, White J. Goniometría. Marban: Evaluación de la movilidad articular. Madrid; 2006.
Feldman BM, Funk SM, Bergstrom BM, et al. Validation of a new pediatric joint scoring system from the international hemophilia prophylaxis study group: validity of the hemophilia joint health score. Arthritis Care Res. 2011;63(2):223–30. CrossRef
Schafer GS, Valderramas S, Gomes AR, Budib MB, Wolff ALP, Ramos ATT. Physical exercise, pain and musculoskeletal function in patients with haemophilia: a systematic review. Haemophilia. 2016;22:e119–e129. CrossRef
Cuesta-Barriuso R, Gómez-Conesa A, López-Pina JA. Physiotherapy treatment in patients with hemophilia and chronic ankle arthropathy: a systematic review. Rehabil Res Pract. 2013;2013(305249)
- Manual therapy in the treatment of patients with hemophilia B and inhibitor
Roberto O. Trelles-Martínez
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
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