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Bleeding In Joints A Common Symptom Of Haemophilia: Here's How To Prevent Joint Degeneration

Bleeding In Joints A Common Symptom Of Haemophilia: Here's How To Prevent Joint Degeneration
Bleeding In Joints A Common Symptom Of Haemophilia: Preventing Joint Degeneration

Joint injury (haemophilia arthropathy) is the most common haemophilia consequence. Here's how to prevent the progression of chronic joint disease.

Written by Editorial Team |Updated : April 18, 2022 11:50 AM IST

Joint injury (haemophilia arthropathy) is the most common haemophilia consequence. Prophylaxis has been shown to reduce joint bleeding and prevent joint damage. In patients with haemophilia, regular replacement therapy with clotting factor concentrates (prophylaxis), is beneficial in preventing recurrent bleeding episodes in joints and muscles. Despite this progress, intra-articular and intramuscular bleeding continue to be a common clinical symptom of the condition.

Each joint bleed should be treated as soon as possible to avoid chronic joint illness, functional impairment, and disability, as synovium, bone, cartilage, and blood vessel changes all play a role in the development of haemophilic arthropathy.

Joint bleeding tends to repeat if not treated properly, creating a vicious cycle that must be halted to avoid the development of persistent synovitis and degenerative arthritis. Early, vigorous prophylaxis with factor replacement therapies, as well as elective operations such as restorative physical therapy, analgesia, aspiration, synovectomy, and orthopaedic surgery, are all effective ways to avoid and manage haemophilic arthropathy.

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Chronic Joint Disease Prevention

Many people, particularly the elderly, were not aware of the benefit of using factor replacement medications to treat their bleeding early and effectively. As a result, the majority of people have target joints, and many of them have severe joint disease. Haemophilia arthropathy has a physical and emotional impact on patients, affecting their stride, physical abilities, body image, relationships, masculinity perceptions, feelings of vulnerability, and time away from school and work. Chronic pain is also a symptom of arthropathy. The related impairments and discomfort from joint illness have become significant concerns for many people as this demographic matures.

Primary prophylaxis should be recommended

  • Recommended for children to avoid recurring joint bleeding
  • Initiated prior to a second or third episode of joint bleeding (hemarthrosis) in cases of severe haemophilia
  • Reduces the incidence of joint bleeding and chronic joint illness

Treat the haemorrhage as soon as it appears

The most critical step in lowering the risk of chronic joint disease is to treat bleeding as soon as it occurs. Prior to the appearance of pain, oedema, or restricted motion, treatment must be completed. The goal is to halt the bleeding before the synovium is damaged by blood collection in the joint area.

During the acute period of a bleed, splinting can be used to immobilize the injured joint for a brief time. In addition, crutches or other assistive devices might be utilized to rest an afflicted joint during this time. Patients should be encouraged to resume routine activities gradually.

Muscle atrophy can develop after a haemorrhage causing pain, oedema, and limited motion before activities return to normal. Increased muscle strength, range of motion, and balance are all benefits of physical therapy. The physical therapist can assist in assessing the musculoskeletal system and functional limitations, as well as determining the best therapy options.

Promote a healthy body weight

  • Stronger muscles can protect joints from harm
  • Maintaining a healthy weight may be a crucial step in avoiding joint illness
  • Routine physical therapy exams and careful monitoring of a patient's weight and BMI can assist a patient build a strategy for overall fitness and joint function maintenance

Perform physical examinations

A routine evaluation by a physician, nurse, or physical therapist can help with the physical assessment of joint status. The following items are included in a joint evaluation:

  • Patient's medical history
  • Motion-capacity
  • Circumference of the joints or muscular girth
  • Muscle endurance
  • X-rays of the joint anatomy or additional diagnostic imaging if any abnormalities are discovered
  • In some circumstances, magnetic resonance imaging (MRI) may be necessary

(The article is contributed by Dr Narayan Hulse, Director - Department of Orthopedics, Bone & Joint Surgery, Fortis Hospitals, Bannerghatta Road, Bengaluru)