Treatment of Chronic Articular Pain in Adult People with Hemophilia

Introduction: Adult People With Hemophilia (PWH) mainly use Factor VIII/Factor IX (FVIII/FIX) to lessen chronic articular pain, followed in frequency by nonsteroidal antiinflammatory drugs. Analgesics are used by only one-third of adult PWH. Limitations in activities of daily living are encountered in the large majority of PWH, and most describe pain as affecting their state of mind. A review of the literature on their treatment is important because the chronic pain in adult PWH is often undertreated or wrongly treated, causing psychological problems for these patients. Aim: To determine the optimal treatment for chronic articular pain in adult PWH. Methods: A review of the literature has been performed. Results: There are three main strategies to alleviate chronic pain secondary to hemophilic arthropathy: pharmacologic treatment (including intra-articular injections of corticosteroids and hyaluronic acid), physical medicine and rehabilitation. Pharmacologic treatment of chronic articular pain is inadequate in many PWH. The optimal pharmacologic treatment for chronic articular pain in these patients is paracetamol and COX-2 inhibitors (celecoxib and rofecoxib). Intra-articular injections of hyaluronic acid and corticosteroids should be second-line therapy. Conclusion: Most adult PWH experience limitations in activities of daily living, and chronic articular pain affects their mental health. Pharmacologic treatment of pain in adult PWH has frequently proven to be inadequate. The optimal pharmacologic treatment of chronic articular pain in these patients is the use of paracetamol and COX-2 inhibitors. Physical medicine, rehabilitation and intra-articular injections of hyaluronic acid and corticosteroids should be second-line therapy.