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Hemarthrosis is bleeding inside joints, which can cause serious damage when it happens repeatedly. Left untreated, recurrent bleeding in the joints can lead to hemophilic arthritis, which is a chronic joint condition involving stiffness, swelling, and joint pain.
People with bleeding disorders are especially prone to hemarthrosis. While the exact numbers are difficult to pin down, research has shown that around half of people with hemophilia will experience hemarthrosis. It’s more likely to develop in larger hinge joints, like your knees and elbows.
Read on to learn how hemophilia causes hemarthrosis and how it affects those living with bleeding disorders.
If you or a loved one is living with hemophilia, it means your blood has trouble clotting because it doesn’t have enough clotting factors (proteins that make your blood harden to start the injury healing process). This trouble with clotting leads to excessive bleeding with both internal and external injuries, including injuries in the joints.
Hemarthrosis in people with hemophilia can happen because of an injury or trauma inside the joint space, or it can happen spontaneously, with no clear trigger. Hemarthrosis can cause blood to build up in the synovium, which is the protective barrier around your joints that reduces friction between the bones. The synovium then becomes inflamed, which causes the bone and cartilage to break down. This is called hemophilic arthropathy or hemophilic arthritis.
Although hemarthrosis is more common in people with hemophilia, not everyone with hemophilia will get it. Certain risk factors can make you more likely to experience hemarthrosis than someone else who also has hemophilia.
You can develop hemarthrosis with any type of hemophilia, but joint damage tends to be more severe in people with hemophilia A. Joint damage is also more common in people with severe hemophilia. However, hemarthrosis can appear very differently even between two people with the same type and severity of hemophilia.
Hemarthrosis symptoms are very similar to arthritis symptoms. Joint pain, stiffness, and swelling are very common, along with tightness and a reduced range of motion. You might also notice warmth coming from the affected joint or see some bruising.
Symptoms can evolve when hemarthrosis becomes hemophilic arthropathy or arthritis. The muscles around the joint can shrink, and the joint can change shape. Hemophilic arthropathy is also a cause of chronic pain and disability.
Researchers believe that some people with hemophilia experience asymptomatic hemarthrosis, or hemarthrosis without symptoms. They’ve observed people with extensive joint damage who reported few or no joint bleeds leading up to this observation.
Hemarthrosis doesn’t affect all joints equally. It most commonly affects larger joints you use often and joints that bear weight, such as your:
Hemarthrosis is more common in hinge joints (like your elbows and knees) than in ball-and-socket joints (like your hips and shoulders). This is because ball-and-socket joints have more mobility, meaning they can move in multiple directions instead of just back-and-forth.
It’s less common, but still possible, to experience bleeding in the joints in your hands and feet. These smaller joints are less likely to bleed often and develop chronic damage.
Some people with hemophilia experience repeated bleeding in one or more particular joints. These are sometimes referred to as target joints. One definition of target joint is any joint in which you have four bleeds within six months.
Kids with hemophilia commonly experience pediatric hemarthrosis, which can also cause permanent joint damage and restricted movement if left untreated.
Pediatric hemarthrosis has similar symptoms to adult hemarthrosis, like joint pain, warmth, and visible swelling. Your child might mention that their joints feel tingly, or they may not want to move their arms or legs because of their discomfort.
MyHemophiliaTeam members often discuss ways that joint pain from hemarthrosis affects their daily lives.
Walking and even standing become difficult for some members with hemarthrosis. “My right knee seems to be damaged by the previous knee bleeds,” shared a member. “It hurts if I stand for more than 10 minutes.” Another member with chronic joint problems wrote, “I’m sick of not being able to walk. I’ve been fighting with this knee for five years now.”
Joint pain can affect sleep quality too. “I can’t seem to get enough sleep anymore,” wrote one member. “Some days my joints hurt so bad I can hardly move, and I’m experiencing a terrible burning sensation around different joints when I move them.” Another member with hemarthrosis said, “I don’t sleep well because of pain. And I wake up tired because of my pain med.”
Joint pain can also linger, causing discomfort and trouble months after a bleeding episode. “My knee swelling didn’t go down for a few months after dislocation,” one member said. “Although it did increase overnight a month later after walking on it aggressively after it locked up while walking.” Another member said, “I had a hip bleed where I was on bedrest in the hospital for two months and another two months of rehab at home.”
Your healthcare team at your hematology treatment center determines the most effective approach for treating your hemarthrosis according to whether your pain is short-term or chronic. They may also perform regular joint assessments with X-ray imaging or magnetic resonance imaging (MRI) scans to monitor joint damage as it progresses.
Your hematology specialist can recommend other ways to manage joint problems with severe hemophilia. They might suggest prophylaxis treatments, such as preventive factor replacement therapy, to reduce instances of joint bleeding. Physical therapy may also be recommended.
Some members of MyHemophiliaTeam have shared advice and support with others experiencing hemarthrosis. “Take your factor and ice it down,” recommended one member to another with knee pain. “Knee bleeds are the absolute worst. I’m praying for you because I’ve been there all too often.”
Braces have helped some members. “While wearing my brace at work my knee is tolerable pain wise,” a member said. “But swollen as hell. After therapy I feel good. This knee bleed is a work in progress.”
Other members have related their experiences with surgery such as joint replacement for severe joint disease. “Good luck on the knee,” said a member. “I had my knee replaced 40 years ago and still have the same hardware that was installed back then.” Another related, “I had both my knees replaced at the same time. It was the best thing I ever did!”
On MyHemophiliaTeam, people share their experiences with hemophilia, get advice, and find support from others who understand.
How has hemarthrosis impacted your quality of life? Let others know in the comments below.
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