Kundu Tapas, Ghosh Kanjaksha, Shaikh Afroz, Singh Priyanka, Shaikh Aafiya, Shah Hiral, Kumat Omkar, Kulkarni Sudhir, Kulkarni Ranjana, Nalavade Aparna
Complement Med Res. 2018;25(5):306-312. doi: 10.1159/000486557. Epub 2018 May 29.
Hemarthrosis is a common clinical presentation of patients with severe and moderately severe hemophilia. Severe pain, swelling, and loss of function involving knee, ankle, elbow, and shoulder joints are commonly seen. In India, except for paracetamol and some non-steroidal anti-inflammatory drugs (NSAIDs), opiate analgesics are not easily available even in the mainstay of treatment; i.e., factor concentrates are also not available regularly. Hence, there is an unmet need for exploring alternative management strategies in this condition in India.
To assess the effect of homeopathic medicines on pain and acute hemarthrosis in hemophilia when factor concentrates are not available and paracetamol in adequate doses proves inadequate.
343 patients with hemophilia (PWH) from Nashik, Mumbai, and Surat presenting with hemarthrosis were prescribed homeopathic medicines in addition to paracetamol and RICE (rest, immobilization, cold application, and elevation). They were assessed using standard techniques.
1,679 episodes of hemarthrosis in major joints were encountered between December 2007 and March 2014, in 343 patients. In 1,580 of the 1,679 hemarthrosis episodes (94.1%), bleeding/inflammation was arrested and pain relieved with homeopathic medication. Additional factor concentrate was required in 99 patients (4.48%). The mean pain score improved from 6.88 ± 2.118 to 1.5 ± 0.34 over 6-24 h following the homeopathic medicines (p < 0.0001). The swellings were also substantially reduced (p < 0.001). The number of joint bleeds per month was reduced significantly under the influence of therapy (p < 0.0001), showing the long-term disease-modifying effect of the treatment.
Homeopathic medicines without factor concentrates appeared to reduce bleeding and pain in PWH presenting with hemarthrosis and could have influenced the long-term frequency of bleeding.
关节积血是重度和中度血友病患者常见的临床表现。膝关节、踝关节、肘关节和肩关节出现的剧痛、肿胀及功能丧失较为常见。在印度，除对乙酰氨基酚和一些非甾体抗炎药（NSAIDs）外，即使在主要治疗手段中，阿片类镇痛药也不易获取；即凝血因子浓缩剂也无法定期获得。因此，在印度，探索针对这种情况的替代管理策略存在未满足的需求。
在无法获得凝血因子浓缩剂且足量对乙酰氨基酚疗效不佳时，评估顺势疗法药物对血友病患者疼痛和急性关节积血的影响。
来自纳西克、孟买和苏拉特的343例出现关节积血的血友病患者（PWH），除对乙酰氨基酚和RICE（休息、固定、冷敷和抬高）外，还被开具了顺势疗法药物。采用标准技术对他们进行评估。
2007年12月至2014年3月期间，343例患者共出现1679次大关节积血发作。在1679次关节积血发作中的1580次（94.1%），顺势疗法药物使出血/炎症得到控制且疼痛缓解。99例患者（4.48%）需要额外的凝血因子浓缩剂。服用顺势疗法药物后6 - 24小时内，平均疼痛评分从6.88±2.118降至1.5±0.34（p<0.0001）。肿胀也显著减轻（p<0.001）。在治疗影响下，每月关节出血次数显著减少（p<0.0001），显示出该治疗的长期疾病改善效果。
在没有凝血因子浓缩剂的情况下，顺势疗法药物似乎可减少血友病关节积血患者的出血和疼痛，并可能影响出血的长期频率。
