This section of Steps for Living focuses on joint health for children with bleeding disorders, including information on joint protection, how bleeding episodes can damage joints, and how to treat bleeding episodes in a joint.
This section of Joint Protection covers:
How Do Bleeding Episodes Damage Joints?
Treating Bleeding Episodes in Joints
The Basics of Joints
It is never too early to think about joint protection. Joints are points in the body where two bones come together. Synovial joints are the joints that allow the body to move freely. These joints are covered by dense tissue. They have a thin layer of fluid made by the synovial membrane to reduce friction between the bones. The end of each bone has tissue called articular cartilage to help provide a cushion.
Bleeding disorders can have a significant impact on your joints due to repeated bleeding episodes in a joint. A bleed in the joint is called hemarthrosis. When bleeding happens repeatedly in the same joint it is called a target joint. Bleeding in joints can cause lasting damage. Joint damage is a condition called hemophilic arthropathy.
Much like other forms of arthritis, hemophilic arthropathy is painful and debilitating. It can lead to mobility issues, pain, and decreased quality of life. One of the main goals of treatment is to prevent or lessen the impact of hemarthrosis. It is important to work with your Hemophilia Treatment Center (HTC) or health care provider to come up with the best treatment plan for your child.
How Do Bleeding Episodes Damage Joints?
Bleeding into the joints is a common problem of many bleeding disorders, but especially in hemophilia. Recurrent bleeding into the same joint will lead to ongoing damage and the development of hemophilic arthropathy.
Hemophilic arthropathy occurs from a combination of mechanical and chemical processes. Initially, the iron in the blood will lead to changes inside the cartilage. Next, the lining of the joint will become inflamed. This lining is called the synovium or synovial membrane. This process will release other substances, which will further damage the joint. There are several large synovial joints that often have bleeds: the elbows, knees, ankles, hips, and shoulders.
Treating Bleeding Episodes in Joints
There is a lot you can do to help lessen the long-term damage caused by bleeding in the joints. Here are a few treatment options that are used to address joint bleeds:
This is the foundation of treatment for a bleeding episode. It is recommended that you give factor as soon as possible after the onset of a bleed, within minutes or at least within a few hours. When giving factor it is important that the correct dosage is used. Talk with your health care provider or Hemophilia Treatment Center (HTC) team as soon as possible. They can help you decide if more intensive treatment is needed.
The P.R.I.C.E acronym stands for Protect, Rest, Ice, Compression, and Elevation.
If you want more information about P.R.I.C.E., please go to the Steps For Living brochure on P.R.I.C.E. or go to Pain Management.
For some severe bleeding episodes, particularly those that are extremely painful or not responding to factor, your child’s health care provider may consider a joint aspiration. During this procedure blood and fluid will be removed from the joint with a needle. Joint aspirations can help relieve severe swelling, severe pain, speed up improvement, and avoid long-term damage.
After the bleeding episode resolves and the pain symptoms have been controlled, your child’s health care provider may recommend rehabilitation or physical therapy to help protect joint function.
Bleeding episodes in joints can cause pain, but several options are available to manage pain. If you want more information about acute pain management, please go to Pain Management.
This may be a treatment option for bleeding episodes that do not respond to factor replacement therapy and for people without an inhibitor, low platelets, or other bleeding problems. However, this is an invasive procedure that must be done with caution and is only used when a person bleeds from an artery.
It's important to think about how to keep your child’s joints healthy every day—not just if they experience a bleeding episode. Some of the best ways to keep joints healthy for people with bleeding disorders are no different from those for people without bleeding disorders: exercise and staying active. If you want more information about staying safe while physically active, please go to Playing It Safe.
Take a look at this video for more information about joint bleeds.