The repeated bleeding in and around the joint cavity associated with haemophilia causes damage to the joints. Known as haemophilic arthropathy, the damage is similar to that of a person with arthritis. Permanent damage can be caused by one serious joint bleed, however, the damage is usually the result of many bleeds into the same joint over a periods of years.
Bleeding into the joints causes the synovial membrane surrounding the joint to thicken and become inflamed. As a result, the synovial fluid no longer lubricates cartilage around the joint. This condition, called synovitis, causes problems ranging from pain and loss of motion to crippling arthritis. Joints most commonly affected are knees, ankles and elbows, and most adults with severe haemophilia suffer from arthropathy in one or more joints. The result is a loss of strength in the muscles around the joint, pain in the joint even when at rest and loss of motion. If the damage is in the knee or ankle, the person may be unable to walk without pain, drive a car or may need crutches or a wheelchair to get around.
The only way to prevent joint damage is to prevent bleeds into the joints. Bleeds should be treated immediately with factor concentrates and P.R.I.C.E (Protection, Rest, Ice, Compression, Elevation), thus limiting the amount of blood in the joint. As treatment options progress, and with the availability of prophylaxis therapy, is it hoped that the development of severe joint damage can be prevented in the younger generation.