study: Anakinra injections dissolve refractory knee arthrofibrosis

[Douglas_Firs]

Very interesting study. Apparently they took 4 patients with chronic refractory knee arthrofibrosis with ROM deficits and injected Anakinra (Interleukin-1). All the patients had substantial improvements in ROM, pain, and stiffness -- after failing multiple other treatments, MUA, PT.

https://journals.healio.com/doi/10.3928 ... 0101021-09


Here also is an older kneeguru thread documenting someone's overwhelmingly positive experience with this injection, which gave him back full knee extension and function:

viewtopic.php?p=701901#p701901

Just an update since my Anakinra injection on August 19th 2019. I am now totally pain free day to day, can walk without clunking clicking or locking, no pain what so ever. I can also stand after sleeping or sitting down with just a tiny bit of stiffness but nothing like the stiffness before the injection, where I had to literally push my leg straight.
I am back running 4 miles a day, well jogging and it is almost without pain, I actually think most of the discomfort is in my head now. So I am so pleased I invested in the injection and that I trusted Mr Glynn Evans, he has quite literally changed my life.
Happy to take any questions or offer and help I can. One happy person.

[The_KNEEguru]

It is great that you are taking an academic interest in this. My own understanding is that knee arthrofibrosis triggers via several 'pathways' -

• 1. a person who has had a knee intervention, such as a knee replacement, but in whom the postop period was complicated perhaps by a bleed into the knee or postop infection

• 2. a person who has had a problem requiring that the knee be immobilised for a prolonged time, eg a tibial plateau fracture, and in whom there had perhaps also been a big bleed into the joint

• 3. another group, again perhaps after a knee replacement, progresses initially in a normal way, but suddenly the knee becomes stiff, and the stiffness gets progressively worse.

My understanding of immunology is very basic, but it seems that certain chemicals called cytokines can trigger the inflammatory process we all know and fear in arthrofibrosis, but some people have a genetic predisposition to this trigger (number 3), while others require more of a challenge (numbers 1 and 2).

Anakinra is, as I understand, a chemical that can block this pathway from triggering. So far, so good. What I do not understand is why it is apparently effective in refractory arthrofibrosis, where I would have thought that the chemical cascade would have calmed down a bit?? But it is great if patients do respond even at a late stage.

The immunologists are discovering 'biomarkers' (eg BMP-2) in the blood and synovial fluid that will, it seems, identify those people like our (3) above who are at risk of going stiff after knee replacement even without the complicating extras of (1 and 2). That would allow the possibility of interfering with the chemical cascade presumably with injections like the Anakinra.

The big issue seems still to be one of awareness....

[samlau21]

Really interesting, would be great to hear if anyone else has had experience of Anakinra or how/where you can get this in the UK, especially as it's not officially prescribed for arthrofibrosis.

Another case and type of arthrofibrosis is for those that develop a 'stiff knee' or hoffa fat pad syndrome/ hoffa disease which is also related to scar tissue/ fibrosis. Is there any evidence Anakinra would help with this condition?

[vickster]

As linked by Kneeguru a previous poster received Anakinra from Glyn Evans.
https://londonkneeclinic.com/about/mr-glyn-evans

Likely it won’t be available on NHS or probably via any private health insurance as an experimental therapy as you say

[Douglas_Firs]

Anakinra is, as I understand, a chemical that can block this pathway from triggering. So far, so good. What I do not understand is why it is apparently effective in refractory arthrofibrosis, where I would have thought that the chemical cascade would have calmed down a bit?? But it is great if patients do respond even at a late stage.

This was my thought as well. Small sample size in the study, so who knows. Maybe placebo. But interesting.

[bobsweatsuit]

As linked by Kneeguru a previous poster received Anakinra from Glyn Evans.
https://londonkneeclinic.com/about/mr-glyn-evans basket random

Likely it won’t be available on NHS or probably via any private health insurance as an experimental therapy as you say

I actually couldn't find this information on the NHS.

[The_KNEEguru]

This doesn't answer the question but is still of interest, documenting the effects/side effects of this medication - https://bnf.nice.org.uk/drugs/anakinra/

[othersirate]

Thanks for the info