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Abstract
<p class="first" id="d12294842e81">Haemarthroses cause major morbidity in patients
with haemophilia. Blood has devastating
effects on all joint components, resulting in synovitis, osteochondral degeneration
and ultimately end-stage haemophilic arthropathy. Key players in this process are
iron and inflammation. Preventing joint bleeds is of utmost importance to maintain
joint health as targeted therapies directed against blood-induced inflammation and
iron-mediated processes are lacking. Joint bleeds result in acute pain as well as
chronic pain due to synovitis or arthropathy. Acute pain originates from nociceptors
activated by tissue damage. In chronic inflammation, central and peripheral sensitization
of nociceptors might occur resulting in chronic pain. This also triggers a series
of brain disorders such as emotional fear, anxiety, mood depression and impairment
of cognitive functions. Treatment of haemophilia-related pain not only consists of
analgesics, but also of exercise, education and in selected cases antidepressants
and anticonvulsants. For objective assessment of joint structural outcome and detecting
earlier changes of haemophilic arthropathy, both ultrasound (US) and magnetic resonance
(MR) imaging have shown valuable. Both can be considered equally able to reveal signs
of disease activity. MR imaging is able to visualize haemosiderin deposition and is
more comprehensive in depicting osteochondral changes. Disadvantages of MR imaging
are the duration of the examination, evaluation of a single joint at a time, costs
and may require sedation, and it may need intraarticular contrast injection to depict
initial osteochondral changes with accuracy. As such, US is a more useful screening
tool and can be used for repeated follow-up examinations.
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