Hemophilia: a guide for the primary care physician

Hemophilic arthropathy: effect of home care on treatment patterns and joint disease

To evaluate the efficacy of home care therapy on hemophilic arthropathy, data were analyzed in 19 patients with hemophilia who had been on home therapy for more than four years. Usage of replacement material, number of bleeding episodes, and clinical and radiographic assessment of joint status were evaluated. Patients were divided into three treatment groups (prophylaxis, combination, and episodic care) for further comparison. In all treatment groups, a significant decrease in product usage occurred with age (P < 0.01). The number of bleeding episodes also decreased significantly with age (P < 0.01). The patients' joints which were clinically and radiographically normal on entry into home therapy remained free of arthropathic changes. The outcome of diseased joints varied across treatment groups, with a majority of these joints remaining stable. Younger patients evidenced new and progressive arthropathy, whereas older patients demonstrated stable arthropathy. Although no single treatment protocol appears to be indicated for all patients with hemophilpia, a treatment goal may be to treat younger patients actively in order to preserve normal joint status, stablize diseased joints, and prevent subsequent disability.