Haemophilic arthropathy

Last revised by Henry Knipe on 13 Oct 2022

Haemophilic arthropathy refers to permanent joint disease occurring in hemophilia sufferers as a long-term consequence of repeated hemarthrosis

Around 50% of patients with hemophilia will develop severe arthropathy.

Presents similarly to osteoarthritis, with chronic joint pain, reduced range of motion and function, and reduced quality of life.

Hemophilia is an X-linked recessive disease affecting mainly males. Haemarthroses may be spontaneous or result from minor trauma and typically first occurs before the age of two and continues to occur into adolescence. It is usual for the same joint to be repeatedly involved. In adulthood, haemarthroses are uncommon. However, proliferative chronically-inflamed synovium results in the development of haemophilic arthropathy.

Repeated haemarthroses result in the intra-articular deposition of iron, which leads to the proliferation of the synovium, neoangiogenesis, and ultimately damage to both the articular cartilage and subchondral bone 8.

Haemophilic arthropathy is characterized by synovial hyperplasia, chronic inflammation, fibrosis, and hemosiderosis. The synovium mass erodes cartilage and subchondral bone leading to subarticular cyst formation 3.

Haemophilic arthropathy is often monoarticular or oligoarticular. Large joints are most commonly involved in the following order of frequency 2:

  • knee

  • elbow

  • ankle

  • hip

  • shoulder

  • joint effusion is seen in the setting of hemarthrosis

  • periarticular osteoporosis: from hyperemia

  • epiphyseal enlargement with associated gracile diaphysis: from hyperemia (appearances can be similar to juvenile rheumatoid arthritis and paralysis)

  • secondary degenerative disease: symmetrical loss of joint cartilage involving all compartments equally with periarticular erosions and subchondral cysts, osteophytes and sclerosis

  • knee 3

  • elbow 2

    • enlarged radial head

    • widened trochlear notch

  • ankle 1

    • talar tilt: relative undergrowth of the lateral side of the tibial epiphysis leads to a pronated foot

  • good for detection of early disease

  • thickened synovium with low signal due to hemosiderin susceptibility effect: siderotic synovitis

  • enhancing synovium due to synovitis

  • joint effusion

  • cartilage loss and erosions can be well seen

  • bone scintigraphy

    • sensitive for detecting areas of disease over the entire skeleton

    • follow-up scans can monitor treatment response

  • radiosynoviorthesis

    • radioisotopes can be injected therapeutically into a joint to decrease bleeding and synovitis

    • rhenium186 is emerging as the preferred isotope over phosphorus32 and yttrium90 particularly in medium-sized joints 5

Early factor VIII or IX replacement may prevent or delay joint destruction. Radiosynoviorthesis has been shown to be effective in reducing bleeding and effusion in selected cases. Surgical arthrodesis 6 or joint replacement 7 can be an effective treatment for the end-stage disease.

  • mono- or oligoarticular involving large joints

  • joint effusion: may show fluid-fluid levels related to the blood products

  • chronic haemarthroses and hyperemia leading to growth deformities (e.g. epiphyseal enlargement, widened intercondylar notch of the knee)

  • chronic periarticular erosions and subchondral cysts

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1
    Drag here to reorder.
  • Case 2
    Drag here to reorder.
  • Case 3: left side
    Drag here to reorder.
  • Case 4
    Drag here to reorder.
  • Case 4
    Drag here to reorder.
  • Case 5
    Drag here to reorder.
  • Case 6
    Drag here to reorder.
  •  Case 7
    Drag here to reorder.
  • Case 8: elbow haemophilic arthropathy
    Drag here to reorder.
  • Case 9
    Drag here to reorder.
  • Case 10
    Drag here to reorder.
  • Case 12
    Drag here to reorder.
  • Case 13
    Drag here to reorder.
  • Case 14
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.