New Developments in the Management of Hemophilic Arthropathy and Chronic Pain in Patients with Hemophilia

Introduction

Bleeding into a joint (hemarthrosis) is the most common clinical complication of severe hemophilia, occurring in nearly all patients and often beginning in the first year of life. Major joint bleeds constitute approximately 75% of bleeding complications in these patients,1 and hemarthrosis is the leading risk factor for development of hemophilic arthropathy. Repeated bleeding episodes, in the absence of early treatment, can result in chronic joint degeneration and eventual arthropathy. Without replacement therapy, patients with severe hemophilia will on average have 5 joints with irreversible damage by age 20.2 This Clinical Consults review discusses the multidisciplinary approach to management of arthropathy and related pain in patients with hemophilia, including strategies for early detection and treatment, pharmacologic and nonpharmacologic means of pain management, and surgical and nonsurgical methods to support and educate patients with arthropathy.

To begin, please answer the following polling question about your practice.

Why is early diagnosis of hemophilic arthropathy important, and what are the primary methods for diagnosis and imaging?

Buckner