
hemophilic arthropathy
jaromir priborsky, zora antalovska
the authors report their experience with joint
diseases in 54 patients suffering from hemo-
philia, 49 of them being cases of hemophilia a,
5 of hemophilia b.  21 patients were children
up to the age of 14 years.  bleeding into the joints
occurred in 66.6% of patients.  in the age
group over 14 years the cases of bleeding into
the joints were more frequent (78.8%) than
in the age group up to 14 years (47.7%).
there were no differences as to bleeding into the
joints and the seriousness of articular changes
between the cases of hemophilia a and hemo-
philia b.  in most cases the bleeding into the
joints began between the 6th and the 14th year
of age.  bleeding into the joints as the first
manifestation of a hemophilic condition occurred
only in 9.3% of patients; in most cases other
hemophilic manifestations preceded.  in spite of
this fact the joint manifestations were often
wrongly diagnosed as tuberculous arthritis, rheumatic
fever, progressive arthritis, and were treated
accordingly.  most usually the large joints (knee,
elbow, ankle) were affected with bleeding and in
them the changes were also the most serious.  the
joints of both halves of the body were
affected uniformly.  in most cases several joints were
affected while monoarticular localization
was observed in 16.6%.  the seriousness of articular
changes was dependent mainly on the
number of repeated bleedings into one and the same
joint, although other factors (weight bearing
of the joint, complexity of the joint, treatment) may be
of decisive importance in the individual
cases as well.
according to clinical (especially from
the functional point of view) and x-ray criteria the
articular findings were classified into three
groups: in the first group the function of the joint
is preserved, in the second limited and
in the third practically extinguished.  the following
laboratory tests were carried out: erythrocyte
sedimentation reaction, latex test for the rheu-
matoid factor, c-reactive protein, mecoprotein
tyrosine and weltmann's coagulation test.
the findings were normal even in cases of
irreparable articular changes unless acute bleeding
into the joint or in some other localization,
or some other complicating disorder was present
simultaneously.
the therapy of hemophilic arthropathy
remains troublesome owing especially to a frequent
occurrence of articular bleeding.
a close cooperation of the hematologist
and the rheumatologist or the orthopedist may con-
tribute to the improvement of the fate of
these patients.
