title: Differentiating between signs of intra-articular joint bleeding and chronic arthropathy in haemophilia: a narrative review of the literature.
abstract: BACKGROUND
  Elderly patients with haemophilia (PWH) suffer from both haemarthrosis and haemophilic arthropathy (HA). Diagnosis of haemarthrosis in PWH is currently based on clinical presentation. No diagnostic protocols or validated criteria are available to identify haemarthrosis or to differentiate haemarthrosis from HA.
  
  
  OBJECTIVE
  The aim of this study is to identify symptoms and signs that can be used to differentiate haemarthrosis from HA.
  
  
  METHODS
  A narrative literature review was performed on symptoms associated with haemarthrosis and symptoms associated with HA. Additionally, literature on the diagnosis of haemarthrosis in patients without haemophilia, imaging techniques and biomarkers was searched.
  
  
  RESULTS
  This review shows that there is no consensus about the symptoms associated with haemarthrosis and that there is limited literature about the symptoms associated with HA. Additionally, symptoms associated with haemarthrosis partly overlap with symptoms of HA, particularly those symptoms associated with flare-ups of HA. Due to the overlap in symptoms differentiating between these conditions is complex. Furthermore, differentiating based on imaging techniques or biomarkers causes practical difficulties.
  
  
  CONCLUSIONS
  Despite the overlap in symptoms, differentiating between joint bleeds and flare-ups of HA based on clinical presentation still seems the most convenient and practical solution. Further research is necessary to identify specific symptoms that can be used to differentiate between the two conditions.
authors: Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands.|Physical Therapy Research, Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: M A
authors: MA
authors: Timmer
authors: Physical Therapy Research, Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.|Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands.
authors: M F
authors: MF
authors: Pisters
authors: Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands.|Physical Therapy Research, Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: P
authors: P
authors: de Kleijn
authors: Physical Therapy Research, Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.|Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
authors: R A
authors: RA
authors: de Bie
authors: Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: K
authors: K
authors: Fischer
authors: Van Creveldkliniek, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: R E
authors: RE
authors: Schutgens
mesh_terms: D015415:Biomarkers; D001707:Biopsy, Needle; D002908:Chronic Disease; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods; D006395:Hemarthrosis / Q000175:diagnosis* / Q000209:etiology*; D006467:Hemophilia A / Q000150:complications*; D002836:Hemophilia B / Q000150:complications*; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis* / Q000209:etiology*
chemical_list: D015415:Biomarkers
keywords: arthropathy; diagnosis; haemarthrosis; haemophilia; symptoms