Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany.
Institute for Paediatric Research and Further Education, Blaubeuren, Germany.
Haemophilia. 2024 May;30(3):827-835. doi: 10.1111/hae.15011. Epub 2024 Apr 10.
Patients with haemophilia (PwH) suffer from chronic pain due to joint alterations induced by recurring haemorrhage.
This study aimed to investigate the relationship between structural alterations and pain perception at the ankle joint in PwH.
PATIENTS/METHODS: Ankle joints of 79 PwH and 57 healthy controls (Con) underwent ultrasound examination (US) and assessment of pain sensitivity via pressure pain thresholds (PPT). US discriminated between joint activity (synovitis) and joint damage (cartilage and/or bone degeneration) applying the HEAD-US protocol. Based on US-findings, five subgroups were built: PwH with activity/damage, PwH with activity/no damage, PwH with no activity/no damage, controls with activity/no damage and controls with no activity/no damage.
Joint activity and joint damage were significantly increased in ankles of PwH compared to Con (p ≤.001). Subgroup analysis revealed that structural alterations negatively impact pain perception. This is particularly evident when comparing PwH with both activity/damage to PwH with no activity/no damage at the tibiotalar joint (p = .001). At the fibulotalar joint, no significant differences were observed between PwH subgroups. Further analysis showed that both joint activity and joint damage result in an increase in pain sensitivity (p ≤.001).
The data suggest a relation between joint activity, joint damage and pain perception in PwH. Even minor changes due to synovitis appear to affect pain perception, with the effect not intensifying at higher levels of inflammation. In terms of joint damage, severe degeneration leads to a sensitised pain state most robustly, whereas initial changes do not seem to significantly affect pain perception.
患有血友病（PwH）的患者由于反复出血引起的关节改变而遭受慢性疼痛。
本研究旨在探讨 PwH 踝关节结构改变与疼痛感知的关系。
患者/方法：79 例 PwH 和 57 例健康对照者（Con）接受踝关节超声检查（US）和疼痛敏感压力疼痛阈值（PPT）评估。US 采用 HEAD-US 方案区分关节活动（滑膜炎）和关节损伤（软骨和/或骨退变）。根据 US 结果，构建了五个亚组：有活动/损伤的 PwH、有活动无损伤的 PwH、无活动无损伤的 PwH、有活动无损伤的 Con 和无活动无损伤的 Con。
与 Con 相比，PwH 的踝关节活动度和关节损伤明显增加（p≤.001）。亚组分析表明，结构改变会对疼痛感知产生负面影响。当将有活动/损伤的 PwH 与无活动/无损伤的 PwH 进行比较时，这种影响在距下关节尤为明显（p=.001）。在腓距关节，PwH 亚组之间没有观察到显著差异。进一步分析表明，关节活动度和关节损伤均导致疼痛敏感性增加（p≤.001）。
数据表明 PwH 中关节活动度、关节损伤和疼痛感知之间存在关系。即使由于滑膜炎引起的微小变化似乎也会影响疼痛感知，而在炎症水平较高时，这种影响不会加剧。就关节损伤而言，严重退变导致最明显的敏化疼痛状态，而初始变化似乎不会显著影响疼痛感知。
