Joint pain in people with hemophilia depends on joint status

Recurrent joint bleedings in people with hemophilia (PWH) often progress into the full clinical picture of hemophilic arthropathy, accompanied by chronic pain. Although chronic pain is commonly present in PWH, investigations assessing pain thresholds have not been performed yet. Thus, the aim of this study was to obtain objective and subjective measures of joint pain in PWH and to relate these to the severity of joint pathology. Thirty-six patients (aged 43 ± 11 years) with hemophilia A and B (31 severe A, 1 B; 3 moderate A, 1 B) and 40 healthy control subjects (aged 42 ± 14 years) participated in this study. Mechanical pain thresholds were obtained as objective parameters using an algometer, while subjective pain intensity and quality were assessed using numeric analogue scales. Quality of life was estimated using the Short-Form Health Survey (SF-36) questionnaire. Overall, we found reduced mechanical pain thresholds as obtained from the knee (PWH - left 38.1 [28.7/57.7], right 29.5 [20.9/49.3]; control - left 67.4 [56.8/112.6], right 60.9 [42.6/97.2]), and elbow (PWH - left 23.4 [15.3/33.4], right 23.5 [20.1/35.1]; control - left 56.7 [32.6/86.6], right 53.0 [30.7/87.7] in N; median [25th/75th percentile]) joints in PWH. Interestingly, this increased pain sensitivity was related to the severity of clinical joint pathology. In addition, PWH reported their pain in a more descriptive and not affective manner and scored similar to controls in the mental domain of the SF-36, thereby indicating good coping strategies despite the chronic nature of their complaints. In conclusion, pain sensitivity at the site of the affected joints is increased and closely related to joint pathology in people with hemophilia.