It often starts small - slight discomfort while walking, stiffness that makes climbing stairs a little harder, or a joint that doesn’t move as freely as before. These changes may seem minor at first, but over time, they can begin to affect everyday life in meaningful ways.
In patients with haemophilia, such challenges are often linked to repeated bleeding within the joints. Because haemophilia is a lifelong, inherited condition, these episodes can build gradually, sometimes without clear warning signs.
Joint bleeds account for nearly 80% of spontaneous bleeding episodes in haemophilia, making them a major contributor to long-term disability.1 Repeated bleeding into the knees, elbows, and ankles can lead to haemophilic arthropathy (HA), a condition that causes pain, stiffness, and reduced mobility over time. While a single episode may seem manageable, repeated bleeds can trigger ongoing inflammation and damage to the joint surface, creating a cycle that gradually worsens.
Among all joints, the knee is most commonly affected in haemophilia, accounting for approximately 63.4% of cases.2 What makes this especially challenging is that the damage often occurs before symptoms become clearly noticeable, by which stage it may be difficult to reverse. Hence, a proactive approach centred on early and preventive treatment is the key to protecting joint health and improving long-term outcomes. Such approaches include:
o Early prophylaxis: Starting regular preventive treatment at a young age - ideally before joint problems begin and, where possible, before the age of 3 - can help reduce the risk of joint bleeds and long-term damage.3 Regular administration of clotting factors can help prevent bleeds and reduce complications. Extended half-life clotting factors provide extended protection and reduce infusion frequency.
o Subclinical detection: Tools such as musculoskeletal ultrasound (MSKUS) can help detect early changes like synovitis (inflammation of the joint lining caused by repeated bleeding), even before symptoms are noticeable. Additionally, advances such as AI-supported imaging are improving the ability to identify these changes at an earlier stage.
o Physiotherapy: Beginning physiotherapy soon after a bleed can support recovery, improve movement, and help maintain muscle strength.
o Synovitis management: If joint inflammation persists despite routine care, additional treatment options may be considered.
o Pain and orthotic support: The use of prescribed medications, along with supportive devices such as braces or insoles, can help improve comfort and mobility.4
When applied consistently, these approaches can help protect joint health and reduce the long-term impact of repeated bleeding and inflammation. Early attention to joint health can make a meaningful difference in maintaining mobility and supporting everyday activities.
In addition, prophylactic treatment of haemophilia has evolved in ways that support more practical and consistent management. For instance, prophylaxis with extended half-life factors, now available in innovative pen devices, are making administration simpler, convenient, and possible at home. As haemophilia is a chronic condition, regular monitoring remains important. Improvements in diagnostic tools, along with a coordinated approach involving clinicians, physiotherapists, and caregivers, support long-term care.
Embedding early intervention into routine haemophilia management remains essential, especially as the window to prevent irreversible damage can narrow over time. Ultimately, prioritising joint health in these patients is less about treatment, and more about enabling them to move comfortably, maintain independence, and carry out everyday activities with ease.
Disclaimer: The views expressed in this article are of the author and not of Health Dialogues. The Editorial/Content team of Health Dialogues has not contributed to the writing/editing/packaging of this article.
