Haemophilic arthropathy: Diagnosis, management, and aging patient considerations.

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Abstract

[Indexed for MEDLINE] 17. Semin Hematol. 2016 Jan;53(1):10-9. doi: 10.1053/j.seminhematol.2015.10.005. Epub 2015 Oct 26. Advances and challenges in hemophilic arthropathy. Wyseure T(1), Mosnier LO(1), von Drygalski A(2). Author information: (1)The Scripps Research Institute, Department of Molecular and Experimental Medicine, La Jolla, CA, USA. (2)The Scripps Research Institute, Department of Molecular and Experimental Medicine, La Jolla, CA, USA; University of California at San Diego, Department of Medicine, San Diego, CA, USA. Electronic address: avondrygalski@ucsd.edu. Hemophilic arthropathy is a form of joint disease that develops secondary to joint bleeding and presents with synovial hypertrophy, cartilage and bony destruction. The arthropathy can develop despite clotting factor replacement and is especially disabling in the aging population. Pathobiological tissue changes are triggered by release of hemoglobin and iron deposition in the joint, but the sequence of events and the molecular mechanisms resulting in joint deterioration are incompletely understood. Treatment options other than clotting factor replacement are limited. Improvements in the treatment of hemophilia necessitate a better understanding of the processes that lead to this disabling condition and better diagnostic tools. Towards that end, studies of the molecular mechanisms leading to the arthropathy, as well as the development of sensitive imaging techniques and biomarkers are needed. These will pave the way to identify the cause of acute pain such as joint bleeding or synovitis, detect early, potentially reversible structural changes, and predict progression of disease. This review describes current imaging techniques and the development of high resolution musculoskeletal ultrasound with power Doppler to afford point-of-care diagnosis and management, the potential utility of diagnostic biomarkers, and summarizes our current knowledge of the pathobiology of hemophilic arthropathy. Copyright © 2016 Elsevier Inc. All rights reserved. DOI: 10.1053/j.seminhematol.2015.10.005 PMCID: PMC5034876