An expert from the Hospital La Paz Institute for Health Research in Spain argues in the Expert Review of Hematology that intra-articular platelet-rich plasma (PRP) injections should not be used in patients with hemophilia until there is further evidence of its benefits. 

Intra-articular bleeding is a major source of morbidity in patients with hemophilia, often leading to a reduced range of motion. Studies indicate that chronic synovitis significantly reduces the health-related quality of life of adults with severe hemophilia. 

The main thrust of hemophilia treatment is prevention, but nonadherence to prophylaxis is common. This often leads to breakthrough bleeding, which can occur even with excellent adherence. Therefore, chronic joint disease remains a widespread problem in hemophilia. 


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Intra-articular PRP injections have emerged as a possible solution to this problem, although this form of treatment remains controversial. Some researchers have indicated that platelet-derived growth factor may play a role in cartilage repair; however, the precise mechanism of how remains largely undefined. 

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Huang et al proposed that intra-articular PRP injections into the knee may be useful in the symptomatic management of knee osteoarthritis in its early stages. Intra-articular PRP was compared to intra-articular hyaluronic acid/corticosteroids in its clinical effectiveness. 

A literature review by E. Carlos Rodriguez-Merchan of La Paz University Hospital, Spain covered studies that analyzed the potential role of PRP in alleviating joint disease, as well as possible mechanisms underlying any proposed benefit. 

A 2019 narrative literature review found that the evidence for intra-articular PRP injections in hemophilic arthropathy was lacking and could therefore not be recommended. In total, 4 case series supported the use of PRP, while 2 literature reviews did not. 

“Taking into account this disparity of results, it is this author’s considered opinion that intra-articular PRP injections should not be used in joints with hemophilic arthropathy (elbows, knees, ankles) until there is more evidence of its possible benefits,” Rodriguez-Merchan found. 

Reference

Rodriguez-Merchan EC. Intra-articular injection of platelet-rich plasma in patients with hemophilia and painful knee joint cartilage degenerationExpert Rev Hematol. 2023;1-10. doi:10.1080/17474086.2023.2166922