Pain May Predict Impaired Outcomes in Patients With Hemophilia and Ankle Hemarthropathy

Hemarthropathy in multiple joints is a common feature of more severe forms of hemophilia, with the ankle joint often being reported as the main site of pain.

Patients with hemophilia who experience ankle hemarthropathy experience diminished health-related quality of life (HRQOL) and patient-reported outcomes, shows a new study published in Journal of Foot and Ankle Research, suggesting that pain may be predictive of changes in the outcomes.

Hemarthropathy in multiple joints is a common feature of more severe forms of hemophilia, with the ankle joint often being reported as the main site of pain. However, the researchers note that, to date, little is known about how ankle hemarthropathy affects overall musculoskeletal heath, HRQOL, and patient-reported outcome measures (PROMs) specific to the foot and ankle.

These new study findings were based on insights from 243 patients, which showed that ankle pain over a 6-month period was independently associated with reductions in HRQOL and PROMs.

Levels of hemarthropathy varied across different disease characteristics, although foot and ankle PROM scores remained consistent across hemophilia type and severity. HRQOL was impaired across the board. Patients with hemophilia B and those with moderate hemophilia were as affected as patients with hemophilia A and those with severe disease. These findings differed from previous research indicating that how much patients are affected depends on the severity of their disease and that patients with hemophilia A have a higher frequency, intensity, and level of hemarthropathy.

“Whilst these study results are interpreted with caution, it is apparent that when the physical manifestation at the ankle report moderate to severe haemarthropathy, the impact on HRQOL is equivalent across disease types and severity,” explained the researchers. “It remains unclear as to what point arthropathic joint changes lead to decline in HRQOL.”

Patients included in the study, who were recruited from 18 centers across the United Kingdom, completed 2 questionnaires: the HAEMO-QoL-A questionnaire, with a score of 100 indicating best health, and Manchester-Oxford Foot Questionnaire (MOXFQ) (hand and foot) questionnaire, with a score of 0 indicating best health.

Total and individual domain HRQOL scores were generally poor, with a mean score of 35.3 for the 214 patients with severe hemophilia and a mean score of 35.8 for the 29 patients with moderate hemophilia. MOXFQ scores were high, with a mean total score of 50.5 for patients with severe hemophilia and a mean total score of 45.8 among patients with moderate hemophilia.

Over a 6-month period, the severity of ankle pain was consistent across both hemophilia type and severity. Fifty-six percent of patients reported not using pain medication regularly, while the remaining patients commonly used paracetamol and COX2 inhibitors.

“Coping with high levels of pain and management without pain relief is therefore synonymous with chronic haemarthropathy. Study findings raise valid questions as to the pain in haemophilia and the need for target pharmacological and nonpharmacological interventions especially in the presence of multijoint haemarthropathy where the ankle joint has been reported to account for 45% of all joint pain,” the study authors concluded.


Wilkins RA, Siddle HJ, Chapman GJ, Horn E, Walwyn R, Redmond AC . Decline in health-related quality of life and foot and ankle patient reported outcomes measures in patients with haemophilia and ankle haemarthropathy. J Foot Ankle Res. Published online March 10, 2023. doi:10.1186/s13047-023-00611-5

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