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Three Part Question

In [patients with pain and Christmas Disease] is [acupuncture] [contraindicated]?

Clinical Scenario

A 68 year old attends the department with knee pain. The knee appears swollen and he tells you he has Christmas disease. He has considerable pain and has been told by a relative that acupuncture is wonderful. You wonder whether it is a good or bad thing in this condition.

Search Strategy

Medline 1966-December Week 1 2006 using the OVID interface
[{exp Hemophilia B/ OR exp Factor IX/ OR christmas.af. OR haemophilia.af. OR hemophilia.af. OR (factor adj5 IX).af.} AND {exp Acupuncture Therapy OR acupuncture.af. OR accupuncture.af.}]

Search Outcome

6 papers were found. No relevant papers were identified.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

Christmas disease is actually caused by a mutation in the gene that encodes for clotting factor IX. Deficiency may lead to haemorrhage, particularly into joints or soft tissues in response to mild trauma. It is also known as haemophilia B (haemophilia A, or classic haemophilia, being associated with factor VIII deficiency). Clinical presentation is indistinguishable to that of classic haemophilia. The name is derived from the first patient reported to have the disease (Stephen Christmas, who was 10 years old at the time). The disease was first reported in the Christmas edition of the British Medical Journal (Biggs et al, 1952). Management should focus upon traditional analgesic techniques and infusion of recombinant factor IX, as guided by a haematologist. Despite a case report of its successful use for analgesia in haemophilia-associated arthropathy (Rosted and Jorgensen, 2002), the use of acupuncture in acute exacerbations of Christmas disease is probably a bad idea and could precipitate further haemorrhage.

Clinical Bottom Line

Acupuncture is not indicated in painful conditions in patients with Christmas disease.

Level of Evidence

Level 2 - Studies considered were neither 1 or 3.

References

1. Rosted P. Jorgensen V. Acupuncture used in the management of pain due to arthropathy in a patient with haemophilia Acupuncture in Medicine 2002; 20(4):193-5
2. Biggs RA, Douglas AS, MacFarlane RG, Dacie JV, Pittney WR, Merskey C, O'Brien JR. Christmas disease: a condition previously mistaken for haemophilia British Medical Journal 1952;2:1378-1382