Hemophilic Arthropathy

David I Rose, MD
Piran Aliabadi, MD

May 3, 1996

Presentation

A 27-year-old man with hemophilia presented with elbow pain and swelling.

Imaging Findings

Radiograph of the elbow, AP view

Radiograph of the elbow, lateral view

Anteroposterior and lateral radiographs demonstrate radiodense effusion, osteoporosis, and cartilaginous and osseous destruction of the elbow joint. The trochlear and radial notches of the ulna are widened (black arrows), and the radial head is mildly enlarged (white arrow).

Differential Diagnosis

Radiodense effusions may be seen with any hemarthrosis due to trauma, myeloproliferative disorders, anticoagulant administration, bleeding diathesis, or scurvy. The articular abnormalities associated with hemophilia most resemble juvenile rheumatoid arthritis, and they can often simulate the abnormalities of pigmented villonodular synovitis or infection.

Diagnosis

Hemophilic arthropathy

Discussion

The arthropathy in hemophilia is presumed to result from intra-articular and periarticular hemorrhage. Hypertrophy and inflammation of the synovium with subsequent synovial fibrosis and hemosiderin deposition are thought to occur in response to the hemarthrosis that occurs with this disease. The osseous aberrations seen in hemophilia may be secondary to elevation of intra-articular pressure (from the hamarthrosis) and intramedullary pressure. Hyperemia may be responsible for epiphyseal overgrowth and osteoporosis. The knee, ankle, and elbow are the joints that are involved most frequently. Intra-articular bleeding distal to the elbow and knee is rare. Bilateral joint involvement is common.

References

Resnick D. Diagnosis of bone and joint disorders, 3rd ed. Philadelphia: WB Saunders, 1995: 2295-2313.

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