Do recurrent hemarthroses have any long term consequences in patients with hemophilia?
As the patient approaches adulthood, acute hemarthroses become less frequent but chronic joint symptoms supervene. Recurrent hemarthroses lead to accumulation of hemosiderin in the joint lining tissues. The joint cartilage is degraded, and proliferative synovitis can develop which is thought due to local trauma as well as potentially locally-generated inflammation. The end result is a chronically swollen joint, less painful than seen in acute hemarthroses, with decreased range of motion. Surrounding muscles become atrophic and joint contracture is a frequent complication. Examination reveals bony enlargement, coarse crepitus, and deformity. Patients may be significantly disabled by chronic hemophilic arthropathy. The regular administration of factor replacement prophylactically has reduced the risk of developing subsequent chronic arthropathy. Newer systemic and local therapies that could potentially alter joint inflammation are also being evaluated.
