Hemophiliac Arthritis

• Christmas disease is indistinguishable except milder  

• Females can develop hemophilia if hemophiliac male marries female carrier  

• Hemarthrosis most common in hinge joints, e.g. knee, elbow, ankle  

• Chronic synovitis develops from repeated intra-articular hemorrhages

• Thickened synovium produces marginal erosions

• Multiple subchondral cysts may develop secondary to intraosseous hemorrhage
  

• Conventional Imaging

  • X-ray changes due to synovial proliferation and hyperemia

  • Widening of the intercondylar notch of the femur

  • Chronic hyperemia produces enlargement of epiphyses

    • Especially medical condyle

  • Secondary trabeculae are resorbed leaving linear striations in the bone

  • Sometimes hemosiderin in soft tissues may make them appear dens

• From the increased blood to the epiphyses, the epiphyses may appear too early, grow too large, and fuse early  

• Juvenile rheumatoid arthritis may simulate hemophilia changes in bone

  • JRA occurs more often in females