Haemophilic arthropathy in the joints of the hands and feet

Musculo-skeletal problems of the hand in haemophilia

Musculo-skeletal complications of the hand in the haemophilia patient are rare, and they include synovitis, arthropathy, pseudotumours, carpal tunnel syndrome and vascular aneurysms and pseudoaneurysms.

The best way to prevent the aforementioned musculo-skeletal complications is early continuous haematological primary prophylaxis (intravenous infusion of the deficient coagulation factor, ideally from cradle to death).

There is a wide range of procedures that a hand surgeon treating these patients should be able to manage, including synovectomy, prosthetic replacement of small joints, removal or curettage of pseudotumours, release of carpal tunnel and, occasionally, vascular reconstruction of aneurysms.

The treatment of these patients should be made at an institution with close collaboration between haematologists and hand surgeons (all surgical procedures must always be performed under cover of the deficient coagulation factor).

Cite this article: EFORT Open Rev 2020;5:328-333. DOI: 10.1302/2058-5241.5.190078

Subtalar and intertarsal joint involvement in hemophilia and juvenile chronic arthritis: frequency and diagnostic significance of radiographic abnormalities

Because radiological distinction between hemophilia and juvenile chronic arthritis can be difficult, the ankle and foot radiographs of patients affected by these two disorders were evaluated to compare the frequency and pattern of joint involvement. No statistical difference was noted between the frequency of posterior subtalar joint involvement in the two disorders, but, in the juvenile chronic arthritis group, more than 90% of the abnormal posterior subtalar joints were associated with intertarsal involvement. This association was never found in patients with hemophilia. Isolated tibiotalar joint involvement without subtalar abnormalities was significantly more frequent in hemophilia than in juvenile chronic arthritis. Although clinical differentiation between the two disorders is easily made, intertarsal joint involvement could be a useful feature in the radiological distinction of hemophilia and juvenile chronic arthritis.