Hemophilic arthropathy: current treatment challenges and future prospects

Introduction: Arthropathy is the typical lesion of hemophilia, mainly occurring in the elbows, knees and ankles, and it is due to repetitive hemarthrosis secondary to the absence of any of the normal coagulation factors (factor VIII in hemophilia A, factor IX in hemophilia B). Areas covered: In this article, the current forms of prevention and management of joint problems in hemophilia (joint aspiration, radiosynovectomy, arthroscopic synovectomy, joint debridement, arthrodesis, and total joint prostheses) are reviewed. Besides prophylactic treatment with coagulation concentrate there are other tools that could detect and help to prevent joint status and function very early (ultrasonography, infrared thermography, gate analysis, surface electromyography). Early comprehensive evaluations of the musculoskeletal system should be made so that individualized physical therapy and sports therapy programs can be developed. Expert opinion: Primary hematological prophylaxis (intravenous infusion of the deficient coagulation factor several times a week and throughout life) is currently the gold standard for the treatment of hemophilia. Acute hemarthrosis requires aggressive hematological treatment and joint aspiration, until the intra-articular hemorrhage disappears completely. Joint status should be monitored by point of care ultrasonography. Chronic synovitis can be controlled by radiosynovectomy. In cases of joint degeneration, more aggressive surgical interventions might be necessary.