{{Short description|Medical condition}} {{Infobox medical condition (new) | name = Hemarthrosis | synonyms = Haemarthrosis | image = Lipohemarthrosis.png | caption = Lipohemarthrosis (blood and fat in the joint space) seen in a person with a subtle tibial plateau fracture. The arrow indicates a fluid level between the upper fat component and the lower blood component. | pronounce = | field = Rheumatology | symptoms = Joint pain, swelling, and redness | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} '''Hemarthrosis''' is a bleeding into joint spaces. It is a common feature of hemophilia.
==Causes== It usually follows injury but occurs mainly in patients with a predisposition to hemorrhage such as those being treated with warfarin (or other anticoagulants) and patients with hemophilia.{{cn|date=June 2022}}
It can be associated with knee joint arthroplasty.<ref name="pmid14973857">{{cite journal |vauthors=Ohdera T, Tokunaga M, Hiroshima S, Yoshimoto E, Matsuda S |title=Recurrent hemarthrosis after knee joint arthroplasty: etiology and treatment |journal=J Arthroplasty |volume=19 |issue=2 |pages=157–161 |year=2004 |pmid=14973857 |doi= 10.1016/j.arth.2003.09.009}}</ref>
It has also been reported as a part of hemorrhagic syndrome in the Crimean-Congo Hemorrhagic Fever, suggesting a viral cause to the bleeding in a joint space.<ref name="aa.cchf">{{cite journal|last1=Ahmeti|first1=Salih|last2=Ajazaj-Berisha|first2=Lindita|last3=Halili|first3=Bahrije|last4=Shala|first4=Anita|title=Acute arthritis in Crimean-Congo hemorrhagic fever|journal=Journal of Global Infectious Diseases|volume=6|issue=2|pages=79–81|doi=10.4103/0974-777X.132052|pmc=4049045|pmid=24926169|date=Apr 2014 |doi-access=free }}</ref><ref>{{cite journal|last1=Heyman|first1=Paul|last2=Cochez|first2=Christel|last3=Hofhuis|first3=Agnetha|last4=van der Giessen|first4=Joke|last5=Sprong|first5=Hein|last6=Porter|first6=Sarah Rebecca|last7=Losson|first7=Bertrand|last8=Saegerman|first8=Claude|last9=Donoso-Mantke|first9=Oliver|last10=Niedrig|first10=Matthias|last11=Papa|first11=Anna|title=A Clear and Present Danger: Tick-borne Diseases in Europe|journal=Expert Rev Anti Infect Ther|year=2010|volume=8|issue=1|pages=33–50|url=http://www.medscape.com/viewarticle/717730_11|pmid=20014900|doi=10.1586/eri.09.118|s2cid=28038692|url-access=subscription}}</ref>
==Diagnosis== {{Synovial fluid analysis}} Hemarthrosis is diagnosed through the methods listed below:
A physical examination is the first step, with the joints of the patient moved and bent to study possible loss of functioning.
Synovial fluid analysis is another method to diagnose Hemarthrosis. It involves a small needle being inserted into the joint to draw the fluid.<ref>{{Cite news|url=https://www.drugs.com/cg/hemarthrosis.html|title=Hemarthrosis – What You Need to Know|work=Drugs.com|access-date=2017-11-21|language=en-US}}</ref> Reddish-colored hue of the sample is an indication of the blood being present. Imaging tests are normally done. The tests also include MRI, ultrasound and X-ray test, which give better information about the joint inflammation.<ref>{{Cite journal|last=Baker|first=C. L.|date=June 1992|title=Acute hemarthrosis of the knee|journal=Journal of the Medical Association of Georgia|volume=81|issue=6|pages=301–305|issn=0025-7028|pmid=1607844}}</ref> Although MRI is superior method for this assessment, the US using the HEAD-US method performed by paediatric radiologists is a reliable tool for detection and quantification of haemophilic arthropathy in children in comparison to MRI.<ref>{{cite journal |last1=Plut |first1=Domen |last2=Kotnik |first2=Barbara Faganel |last3=Pusnik |first3=Luka |last4=Slak |first4=Peter |last5=Snoj |first5=Ziga |last6=Salapura |first6=Vladka |title=Reliability of haemophilia early arthropathy detection with ultrasound (HEAD-US) in children: a comparative magnetic resonance imaging (MRI) study |journal=Radiology and Oncology |date=20 October 2022 |volume=56 |issue=4 |pages=471–478 |doi=10.2478/raon-2022-0040|pmid=36259311 |s2cid=252972051 |pmc=9784372 }}</ref>
==Treatment== In hemophilia it may occur spontaneously, and recurrent hemarthroses are a major cause of disability in that patient group due to hemophilic arthropathy, requiring synovectomy, joint replacement<ref>{{cite journal |author=Dunn AL |title=Management and prevention of recurrent hemarthrosis in patients with hemophilia |journal=Current Opinion in Hematology |volume=12 |issue=5 |pages=390–394 |date=Sep 2005 |pmid=16093785 |doi= 10.1097/01.moh.0000169285.66841.c8|s2cid=26117110 }}</ref> and increased medical therapy to prevent further bleeding episodes.
Reducing hemarthroses events using intravenous administration of blood clotting factor concentrate on a regular basis starting in early childhood, reduces joint deterioration and increases the person's quality of life compared to "on demand" treatment (treating after a bleed).<ref name=Iorio2011>{{Cite journal|last1=Iorio|first1=Alfonso|last2=Marchesini|first2=Emanuela|last3=Marcucci|first3=Maura|last4=Stobart|first4=Kent|last5=Chan|first5=Anthony Kc|date=2011-09-07|title=Clotting factor concentrates given to prevent bleeding and bleeding-related complications in people with hemophilia A or B|journal=The Cochrane Database of Systematic Reviews|issue=9|article-number=CD003429|doi=10.1002/14651858.CD003429.pub4|issn=1469-493X|pmid=21901684|url=https://air.unimi.it/bitstream/2434/231551/2/Iorio_Cochrane%20Dtabase%20Syst%20Rev_2011.pdf|hdl=2434/231551|hdl-access=free}}</ref> The minimal effective dose and best dosage frequency have not been established.<ref name=Iorio2011 /> It is not clear, due to lack of sufficient data, if preventative therapy with clotting factor concentrate is also effective at reducing joint deterioration if treatment is started after joint damage has occurred.<ref name=Iorio2011 />
==Complications== Up to a quarter of all severe ligament or capsular knee injuries leading to a hemarthrosis are associated with cartilage damage that can lead to progressive degenerative arthritis.<ref>Goldberg A, Stansby G "Surgical Talk" 2nd edition</ref> <gallery> File:Medical_X-Ray_imaging_JDH05_nevit.jpg|X-ray of Hemarthrosis File:Medical_X-Ray_imaging_JDG05_nevit.jpg|X-ray of Hemarthrosis </gallery>
==References== {{Reflist}}
== External links == {{Medical resources | DiseasesDB = 29653 | ICD10 = {{ICD10|M|25|0|m|20}} | ICD9 = {{ICD9|719.1}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = D006395 }} {{Diseases of the musculoskeletal system and connective tissue}} {{Bleeding and clotting disorders|us=y}}
Category:Arthropathies Category:Bleeding