Predicting Recovery After Joint Bleeding in Persons With Bleeding Disorders

Joint bleeds are burdensome and recovery differs from bleed to bleed. Identifying predictors of recovery could enable personalized treatment and monitoring; aiming to prevent long-term joint deterioration, and facilitate faster return to activities.

To identify predictors of time to recovery after joint bleeding in people with haemophilia.

Regular care data on recovery of joint bleeds were collected from people with haemophilia who attended the Van Creveldkliniek between 2016 and 2025. The primary outcome was time to recovery, defined as the normalization of all clinical symptoms. Kaplan-Meier survival curves and Cox proportional hazard regression were conducted. Independent variables were as follows: trough level, joint status, cause of the bleed, joint location, limitation in ROM, effusion on ultrasound, time between start of symptoms and start of treatment, treatment days and emicizumab treatment.

Sixty-four bleeds in 44 individuals were included. Most of the patients had haemophilia A (87.9%). Median time to recovery was 32.5 days. Joint bleeds without limitation in range of motion (<15 degrees limitation in flexion or extension) at presentation recovered 2.3 times faster (p = 0.007) than bleeds with a limitation. Patients with severe haemophilia A on emicizumab prophylaxis recovered 2.7 times faster than those on factor-prophylaxis (p = 0.027).

Joint bleeds with significant limitation in ROM at presentation needed more time to recover. Patients with severe haemophilia on emicizumab showed shorter recovery after joint bleeding. Follow-up should be personalized and extended beyond one month.