Pain status of patients with severe haemophilic arthropathy

Patients with severe haemophilia A growing up before the establishment of p rophylactic treatment frequently developed significant haemarthropathies. T he goal of the following study was to clarify the role of haemarthropathic pain for haemophilic patients. Furthermore, we aimed to determine to what d egree daily activities are influenced by the impairment and which therapeut ic modalities are used in pain management. Using a questionnaire we consult ed 71 haemophiliacs concerning their complaints and how they were treated i n 1999 (average age 43 years; range 21-63 years). The pain in the large joi nts and spine and the effect of specific treatment was estimated by a visua l analogue scale. On average, there were four joints with major pain and 0. 5 with minor pain. The most frequent sources of pain were the ankle joints (45%), followed by the knee (39%), spine (14%) and elbow (7%). Fifty percen t of all patients complained of pain throughout the day if no treatment was applied. In 29% of patients, pain persisted after application of factor VI II (FVIII), while 12% claimed that pain still remained after use of FVIII a nd painkillers. Restriction in activities of daily life was reported by 89% of the group and 85% reported on an impact of pain on their mood. Patients primarily used FVIII to decrease pain, followed in frequency by use of ant i-inflammatory drugs, orthopaedic footwear, liniments and bandages. Haemoph ilic patients with haemarthropathy are chronic pain patients. By means of t he questionnaire, it is possible to reveal the 'silent' sufferers. Sufficie nt pain treatment is essential so as to increase the patient's quality of l ife and avoid inadvertent abnormal postures possibly resulting in increased loading of joints and subsequent bleeding episodes.