Joint protection in haemophilia

Area of Science:

• Hematology
• Orthopedics
• Radiology

Background:

• Haemarthroses (intra-articular haemorrhages) are common in haemophilia patients.
• Prompt diagnosis and intensive treatment are essential to prevent joint degeneration (haemophilic arthropathy).
• Subclinical bleeds can also contribute to arthropathy, particularly in ankles.

Purpose of the Study:

• To review the diagnosis and management of haemarthroses in haemophilia.
• To highlight the importance of early and intensive treatment strategies.
• To discuss prophylactic measures and treatment options for inhibitor patients.

Main Methods:

• Review of current diagnostic techniques, including ultrasonography (US) and magnetic resonance imaging (MRI).
• Discussion of treatment modalities such as joint aspiration, enhanced on-demand treatment, and prophylaxis.
• Exploration of management strategies for patients with inhibitors, including bypassing agents and immune tolerance induction (ITI).

Main Results:

• Early diagnosis and intensive treatment, including joint aspiration for profuse bleeds, are vital.
• Primary prophylaxis is the most effective method to prevent haemarthrosis and subsequent arthropathy.
• Secondary prophylaxis and enhanced on-demand treatment are alternatives when primary prophylaxis is not feasible.

Conclusions:

• Effective management of haemarthroses requires a multi-faceted approach, prioritizing prophylaxis.
• Treatment strategies must be tailored to individual patient needs, including those with inhibitors.
• Minimizing bleeding episodes is key to preserving joint function and preventing long-term complications in haemophilia.