Haemophilic arthritis

Article Abstract:

Rheumatologists have few patients with arthritis secondary to hemophilia, but the prevalence of cases is increasing due to greater availability of clotting factor concentrates. Hemophilia is caused by an inherited inability to make one of two factors, or proteins, important in the mechanism of blood clotting. Bleeding into joints causes arthritis, and weight-bearing joints and those on the patient's dominant side are more likely to be affected. Severity of hemophilia, or frequency of bleeding episodes, is dependent on blood levels of clotting factors. Patients whose conditions are severe bleed spontaneously, especially in the joints, muscles, and kidneys. Patients with higher factor levels bleed only after trauma or during surgery. Arthritis is the single major cause of illness in hemophiliacs, and 90 percent of patients with severe disease have joint dysfunction. Arthritis progresses from frank bleeding to chronic synovitis (inflammation of the joint lining), and then to arthritis with degeneration of joint cartilage and other tissues. The response of joint tissues to bleeding and the changes underlying disease progression are not well understood. Iron, derived from blood cells and deposited in joint tissues, may play a role in the disease process. Treatment, as with any other arthritis, is aimed at relieving pain and other symptoms, preventing progression of damage, and maintaining function. In the acute stage, stopping bleeding and pain relief are primary goals. Unfortunately, pain relief in patients with degenerative arthritis is difficult. Chronic synovitis is treated with the aim of preventing further cartilage damage, but this is difficult to suppress. Injection of steroids or osmic acid into the joints may be helpful, and penicillamine may also have some benefit. Although clotting factor concentrates decrease the frequency of bleeding episodes, this therapy tends to delay rather than prevent arthritis. Illness in hemophiliacs due to contamination of clotting factors with two types of hepatitis or HIV-1 (human immunodeficiency virus, the cause of AIDS) is significant, but decreasing with newer methods of factor preparation. While anti-inflammatory agents may be helpful if used cautiously, joint replacement with prosthetic joints is successful when precautions are taken. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Joint diseases

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Long term follow up of radiosynovectomy with yttrium-90 silicate in haemophilic haemarthrosis

Article Abstract:

Radiosynovectomy with yttrium-90 silicate may be effective and safe for the treatment of recurrent hemarthrosis in hemophilia patients. Hemarthrosis is escape or discharge of blood into a joint or its cavity. Radiosynovectomy is irradiation of the lining of a joint by injection of radioactive material to destroy inflamed tissue. A study examined bleeding frequency and joint mobility in 16 joints of 14 hemophilia patients one year before and three to six years after radiosynovectomy with yttrium-90 silicate. One year after treatment, radiosynovectomy had decreased the frequency of bleeding in 94% of the joints. Mobility was also improved by more than 10 deg in nine joints. Three to six years after radiosynovectomy, bleeding was still infrequent in 63% of the joints. Only one patient developed a complication as a result of treatment with radiosynovectomy.

Isotopes, Yttrium

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Bloody arthritis

Article Abstract:

Patients with blood disorders such as hemophilia may develop joint conditions that mimic arthritis. A 25-year-old hemophiliac suddenly developed severe pain in the left ankle. Magnetic resonance imaging (MRI) and X-rays revealed joint degeneration similar to that seen in patients with arthritis but blood test results did not indicate any arthritic condition. A patient's history, blood tests, and imaging screens including computed tomography, MRI, and X-ray are all important factors in identifying patients with hemophiliac arthropathy.

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