EFETIVIDADE DA VISCOSSUPLEMENTAÇÃO NO TRATAMENTO DA ARTROPATIA HEMOFÍLICA: UMA REVISÃO SISTEMÁTICA

MARTINS, SAMILLY CONCEIÇÃO MAIA; DE ANDRADE JUNIOR, ERION; SILVA, MAYARA BRANCO E; OZELO, MARGARETH CASTRO; CAMPOS, GUSTAVO CONSTANTINO DE; PAGNANO, RODRIGO GONÇALVES

SAMILLY CONCEIÇÃO MAIA MARTINS

development of this article

designed the research

collated

analyzed the data

wrote the paper

approved the submitted paper

Universidade Estadual de Campinas, Faculdade de Ciencias Medicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil

https://orcid.org/0000-0001-8669-3896

ERION DE ANDRADE JUNIOR

development of this article

designed the research

collated

analyzed the data

wrote the paper

approved the submitted paper

Universidade Estadual de Campinas, Faculdade de Ciencias Medicas, Departamento de Neurologia e Neurocirurgia, Campinas, SP, Brazil

https://orcid.org/0000-0001-9071-4688

MAYARA BRANCO E SILVA

development of this article

revised critically

gave final approval of the manuscript

approved the submitted paper

Universidade Estadual de Campinas, Faculdade de Ciencias Medicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil

https://orcid.org/0000-0003-4323-8281

MARGARETH CASTRO OZELO

development of this article

revised critically

gave final approval of the manuscript

approved the submitted paper

Universidade Estadual de Campinas, Centro de Hematologia e Hemoterapia, Unidade de Hemofilia “Claudio Luiz Pizzigatti Correa”, Campinas, SP, Brazil

Universidade Estadual de Campinas, Faculdade de Ciencias Medicas, Departamento de Medicina Interna, Campinas, SP, Brazil

https://orcid.org/0000-0001-5938-0675

GUSTAVO CONSTANTINO DE CAMPOS

development of this article

revised critically

gave final approval of the manuscript

approved the submitted paper

Universidade Estadual de Campinas, Faculdade de Ciencias Medicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil

https://orcid.org/0000-0001-7811-7354

RODRIGO GONÇALVES PAGNANO

development of this article

revised critically

gave final approval of the manuscript

approved the submitted paper

Universidade Estadual de Campinas, Faculdade de Ciencias Medicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil

https://orcid.org/0000-0002-6064-2027

Correspondence: Samilly Conceição Maia Martins. Rua Carlos Gomes, 241, Campinas, SP, Brazil, 13083970. samilly.maia@hotmail.com

MCO has received grants from BioMarin, Novo Nordisk, Pfizer, Sanofi, Roche, and Takeda, and has participated as speaker and/or in advisory boards sponsored by Bayer, BioMarin, Novo Nordisk, Pfizer, Roche, and Takeda. SCMM, EJA, MBS, GCC and RGP declare no potential conflict of interest related to this article.

Study	Year	N	Age in years (mean)	BMI (mean)	Clinical Evaluation Timeframe	Follow-up range
Carulli et al. ⁽⁷7. Carulli C, Civinini R, Martini C, Linari S, Morfini M, Tani M, Innocenti M. Viscosupplementation in haemophilic arthropathy: a long-term follow-up study. Haemophilia. 2012;18(3):e210-4.	2012	46	39	26.7	0, 6, 12, 24 m	24-132 m
Carulli et al. ⁽²⁰20. Carulli C, Matassi F, Civinini R, Morfini M, Tani M, Innocenti M. Intra-articular injections of hyaluronic acid induce positive clinical effects in knees of patients affected by haemophilic arthropathy. Knee. 2013;20(1):36-9.	2013	27	42	26.45	0, 6, 12, 24 m	60 m
Rezende et al. ⁽²¹21. Rezende MU, Rosa TBC, Pasqualin T, Frucchi R, Okazaki E, Villaça PR. Subjective results of joint lavage and viscosupplementation in hemophilic arthropathy. Acta Ortop Bras. 2015;23(3):162-6.	2015	14	23.7	NR	0, 1, 3, 6, 12 m	12 m
Zelada et al. ⁽²²22. Zelada F, Almeida AM, Pailo AF, Bolliger Neto R, Okazaki E, Rezende MU. Viscosupplementation in patients with hemophilic arthropathy. Acta Ortop Bras. 2013;21(1):12-7.	2013	14	23.7	NR	0,1,3 m	3 m
Li et al. ⁽²³23. Li TY, Wu YT, Chen LC, Cheng SN, Pan RY, Chen YC. An exploratory comparison of single intra-articular injection of platelet-rich plasma vs hyaluronic acid in treatment of haemophilic arthropathy of the knee. Haemophilia. 2019;25(3):484-92.	2019	11	38.8	25.4	0, 1, 3, 6, 12 m	6 m
Carulli et al. ⁽²⁴24. Carulli C, Rizzo AR, Innocenti M, Civinini R, Castaman G, Innocenti M. Viscosupplementation in symptomatic haemophilic arthropathy of the knee and ankle: experience with a high molecular weight hyaluronic acid. Haemophilia. 2020;26(4):e198-200.	2020	14	45.8	NR	0, 1, 3, 6, 18 m	20 m
Li et al. ⁽²⁵25. Li TY, Wu YT, Chen LC, Cheng SN, Pan RY, Chen YC. Efficacy, safety, and synovial effects of intra-articular hyaluronic acid in treating recalcitrant hemophilic arthropathy of knee joint. J Med Sci. 2019;39(1):28-35.	2019	20	38.2	24.2	0, 1, 3, 6 m	6 m
Fernández-Palazzi et al. ⁽²⁶26. Fernández-Palazzi F, Viso R, Boadas A, Ruiz-Sáez A, Caviglia H, De Bosch NB. Intra-articular hyaluronic acid in the treatment of haemophilic chronic arthropathy. Haemophilia. 2002;8(3):375-81.	2002	25	29.7	NR	1-10 m	1-12 m
Wallny et al. ⁽²⁷27. Wallny T, Brackmann HH, Semper H, Schumpe G, Effenberger W, Hess L, Seuser A. Intra-articular hyaluronic acid in the treatment of haemophilic arthropathy of the knee. Clinical, radiological and sonographical assessment. Clinical, radiological and sonographical assessment. Haemophilia. 2000;6(5):566-70.	2000	20	35-56	NR	0, 3, 24 m	26 m

References	Description of Intervention Protocols
Carulli et al. ⁽⁷7. Carulli C, Civinini R, Martini C, Linari S, Morfini M, Tani M, Innocenti M. Viscosupplementation in haemophilic arthropathy: a long-term follow-up study. Haemophilia. 2012;18(3):e210-4.	3-5 intra-articular HAc administrations 1 to 4 weeks apart.
Carulli et al. ⁽²⁰20. Carulli C, Matassi F, Civinini R, Morfini M, Tani M, Innocenti M. Intra-articular injections of hyaluronic acid induce positive clinical effects in knees of patients affected by haemophilic arthropathy. Knee. 2013;20(1):36-9.	5 Intra-articular low molecular weight HAc applications 2 weeks apart. 3 Applications of high molecular weight HAc 4 weeks apart
Rezende et al. ⁽²¹21. Rezende MU, Rosa TBC, Pasqualin T, Frucchi R, Okazaki E, Villaça PR. Subjective results of joint lavage and viscosupplementation in hemophilic arthropathy. Acta Ortop Bras. 2015;23(3):162-6.	In single intra-articular administration: joint lavage with 0.9% SF followed by infiltration with HAc (1 ampoule/2 ml) + triamcinolone (1 ml) diluted in ropivacaine (5 ml for knees and 2 ml for ankles, elbows, and shoulders).
Zelada et al. ⁽²²22. Zelada F, Almeida AM, Pailo AF, Bolliger Neto R, Okazaki E, Rezende MU. Viscosupplementation in patients with hemophilic arthropathy. Acta Ortop Bras. 2013;21(1):12-7.	In single intra-articular administration: joint lavage with saline solution, followed by emptying and application of HAc (6 ml to the knee or 2 ml to the ankles, elbows, and shoulders) + triamcinolone (1 ml) + ropivacaine (5 ml to the knees or 1 ml to the ankles, elbows, and shoulders).
Li et al. ⁽²³23. Li TY, Wu YT, Chen LC, Cheng SN, Pan RY, Chen YC. An exploratory comparison of single intra-articular injection of platelet-rich plasma vs hyaluronic acid in treatment of haemophilic arthropathy of the knee. Haemophilia. 2019;25(3):484-92.	5 intra-articular applications of 2.5 ml of HAc with a 1-week interval.
Carulli et al. ⁽²⁴24. Carulli C, Rizzo AR, Innocenti M, Civinini R, Castaman G, Innocenti M. Viscosupplementation in symptomatic haemophilic arthropathy of the knee and ankle: experience with a high molecular weight hyaluronic acid. Haemophilia. 2020;26(4):e198-200.	3 intra-articular applications of HAc with monthly intervals in the knees and 2 applications with monthly intervals in the ankle.
Li et al. ⁽²⁵25. Li TY, Wu YT, Chen LC, Cheng SN, Pan RY, Chen YC. Efficacy, safety, and synovial effects of intra-articular hyaluronic acid in treating recalcitrant hemophilic arthropathy of knee joint. J Med Sci. 2019;39(1):28-35.	3 Intra-articular applications of HAc (2 ml) with weekly intervals,
Fernández-Palazzi et al. ⁽²⁶26. Fernández-Palazzi F, Viso R, Boadas A, Ruiz-Sáez A, Caviglia H, De Bosch NB. Intra-articular hyaluronic acid in the treatment of haemophilic chronic arthropathy. Haemophilia. 2002;8(3):375-81.	3 Intra-articular HAc administrations through standard portals, at weekly intervals.
Wallny et al. ⁽²⁷27. Wallny T, Brackmann HH, Semper H, Schumpe G, Effenberger W, Hess L, Seuser A. Intra-articular hyaluronic acid in the treatment of haemophilic arthropathy of the knee. Clinical, radiological and sonographical assessment. Clinical, radiological and sonographical assessment. Haemophilia. 2000;6(5):566-70.	5 applications of HAc (01 ampoule of 20 mg) intra-articular, with a weekly interval.

STUDY	VAS		WOMAC		SF-36
STUDY	Pre	Post	Pre	Post	Pre	Post
Carulli et al. ⁽²⁰20. Carulli C, Matassi F, Civinini R, Morfini M, Tani M, Innocenti M. Intra-articular injections of hyaluronic acid induce positive clinical effects in knees of patients affected by haemophilic arthropathy. Knee. 2013;20(1):36-9.	5.52	1 m: 2.45	64.45	6 m: 21.2	52.57	1 m: NR
		12 m: 2.98		12 m: 54.2		2 m: NR
		24 m: 3.12		24 m: 56.6		3 m: NR
				36 m: 56.8		6 m: 72.5
						12 m: 72.5
						24 m: 66.1
						36 m: 47.4
Rezende et al. ⁽²¹21. Rezende MU, Rosa TBC, Pasqualin T, Frucchi R, Okazaki E, Villaça PR. Subjective results of joint lavage and viscosupplementation in hemophilic arthropathy. Acta Ortop Bras. 2015;23(3):162-6.	4.57	1 m: 3.56	34.4	1 m: 24.1	NR	1 m: NR
		3 m: 4.2		2 m: NR		2 m: NR
		6 m: 4.23		3 m: 23.5		3 m: NR
		12 m: 3.82		6 m: 23.5		6 m: NR
				12 m: 22,4		12 m: NR
				24 m: NR		24 m: NR
				36 m: NR		36 m: NR
Zelada et al. ⁽²²22. Zelada F, Almeida AM, Pailo AF, Bolliger Neto R, Okazaki E, Rezende MU. Viscosupplementation in patients with hemophilic arthropathy. Acta Ortop Bras. 2013;21(1):12-7.	44.6	1 m: 4.4	38,4	1 m: 23.5	32	1 m: 62.4
		2 m: NR		2 m: NR		2 m: NR
		3 m: 4.6		3 m: 26.5		3 m: 92.4
		6 m: NR		6 m: NR		6 m: NR
		12 m: NR		12 m: NR		12 m: NR
				24 m: NR		24 m: NR
				36 m: NR		36 m: NR
Li et al. ⁽²³23. Li TY, Wu YT, Chen LC, Cheng SN, Pan RY, Chen YC. An exploratory comparison of single intra-articular injection of platelet-rich plasma vs hyaluronic acid in treatment of haemophilic arthropathy of the knee. Haemophilia. 2019;25(3):484-92.	Knee: 4,1	1 m: 1.8**	38.3	1 m: 19.1	54.4	1 m: 58.5
		2 m: 1.6**		2 m: 21.3		2 m: 63.5
		3 m: 2.3**		3 m: 27.1		3 m: 63.3
		6 m: NR		6 m: 35.8		6 m: 58.3
		12 m: NR		12 m: NR		12 m: NR
				24 m: NR		24 m: NR
				36 m: NR		36 m: NR
Carulli et al. ⁽²⁴24. Carulli C, Rizzo AR, Innocenti M, Civinini R, Castaman G, Innocenti M. Viscosupplementation in symptomatic haemophilic arthropathy of the knee and ankle: experience with a high molecular weight hyaluronic acid. Haemophilia. 2020;26(4):e198-200.	8	1 m: 1*	NR	1 m: NR	NR	1 m: NR
		2 m: NR		2 m: NR		2 m: NR
		3 m: NR		3 m: NR		3 m: NR
		6 m: NR		6 m: NR		6 m: NR
		12 m: NR		12 m: NR		12 m: NR
				24 m: NR		24 m: NR
				36 m: NR		36 m: NR
Li et al. ⁽²⁵25. Li TY, Wu YT, Chen LC, Cheng SN, Pan RY, Chen YC. Efficacy, safety, and synovial effects of intra-articular hyaluronic acid in treating recalcitrant hemophilic arthropathy of knee joint. J Med Sci. 2019;39(1):28-35.	Knee: 5.7	1 m: 2.7	38.1	1 m: 22.3	48.8	1 m: 58.8
		2 m: 1.8		2 m: 21.3		2 m: 63.2
		3 m: 2.5		3 m: 24.8		3 m: 64.8
		6 m: 3.2		6 m: 26		6 m: 60.6
		12 m: NR		12 m: NR		12 m: NR
				24 m: NR		24 m: NR
				36 m: NR		36 m: NR
Fernández-Palazzi et al. ⁽²⁶26. Fernández-Palazzi F, Viso R, Boadas A, Ruiz-Sáez A, Caviglia H, De Bosch NB. Intra-articular hyaluronic acid in the treatment of haemophilic chronic arthropathy. Haemophilia. 2002;8(3):375-81.	Shoulder: 7,67	1 m: 3.7	NR	1 m: NR	NR	1 m: NR
	Elbow: 10	2 m: NR		2 m: NR		2 m: NR
	Knee: 8.47	3 m: NR		3 m: NR		3 m: NR
	Ankle: 8	6 m: NR		6 m: NR		6 m: NR
		12 m: NR		12 m: NR		12 m: NR
				24 m: NR		24 m: NR
				34 m: NR		36 m: NR
Wallny et al. ⁽²⁷27. Wallny T, Brackmann HH, Semper H, Schumpe G, Effenberger W, Hess L, Seuser A. Intra-articular hyaluronic acid in the treatment of haemophilic arthropathy of the knee. Clinical, radiological and sonographical assessment. Clinical, radiological and sonographical assessment. Haemophilia. 2000;6(5):566-70.	Knee: 5.4	1 m: 4.7	NR	1 m: NR	NR	1 m: NR
		2 m: NR		2 m: NR		2 m: NR
		3 m: NR		3 m: NR		3 m: NR
		6 m: NR		6 m: NR		6 m: NR
		12 m: NR		12 m: NR		12 m: NR
				24 m: NR		24 m: NR
				36 m: NR		36 m: NR

[1] Correspondence: Samilly Conceição Maia Martins. Rua Carlos Gomes, 241, Campinas, SP, Brazil, 13083970. samilly.maia@hotmail.com

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EFETIVIDADE DA VISCOSSUPLEMENTAÇÃO NO TRATAMENTO DA ARTROPATIA HEMOFÍLICA: UMA REVISÃO SISTEMÁTICA

RESUMO

Objetivo:

Métodos:

Resultados:

Conclusão: