Despite the tremendous benefit offered by primary prophylaxis, recurrent joint
bleeding with progression to chronic
synovitis and haemophilic
arthropathy is still a daily concern for the multidisciplinary health care teams managing patients with severe
haemophilia or
haemophilia complicated by inhibitor development. Advanced stages of
arthropathy could be prevented by regular assessment of musculoskeletal status and thus early detection of symptoms, daily
rehabilitation exercises at home, and implementation of appropriate physiotherapy and medical training. Patient's education and psychological counselling are crucial. New tools such as magnetic resonance imaging are promising for the monitoring of these patients and might promote early detection of
arthropathy and thus appropriate preventive measures to avoid further joint deterioration can be implemented. Medical
synovectomy such as radionucleide synoviorthesis is a simple and non-invasive procedure that often delays the need for surgery which despite considerable improvement in techniques and postoperative rehabilitation remains a high-risk strategy in patients with severe
haemophilia, especially those with inhibitors. In these high risk patients, availability of specific
clotting factors such as activated
prothrombin complex concentrate (
FEIBA, Baxter, Vienna, Austria) and more recently,
recombinant factor VIIa (
rFVIIa,
NovoSeven, Bagsvaerd, Denmark) has allowed to perform effective and safe orthopaedic procedures. The on-going EUREKA study will undoubtedly provide additional information about the optimal use of
rFVIIa in this context.