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| Hemophilic arthropathy (HA) [1] [2] [54] [55] | Osteoarthritis (OA) [56] [57] [58] | Rheumatoid arthritis (RA) [59] [60] [61] [62] [63] |
| Shared features with HA | - | Cartilage degeneration and osteophyte formation | Synovitis, cartilage degradation, and bone resorption |
| Presentation | Painful acute onset Joint swelling and damage | Gradual joint swelling and enlargement | Gradual painful joint swelling and damage |
| Pathophysiology | Bleeding directly from synovial lining into the joint | Mix of risk factors, including age, sex, injury, wear and tear, obesity, genetics Biochemical processes involving synovium, cartilage, and bone | Genetic basis Chronic autoimmune disorder May also include systemic and extra-articular manifestations |
| Major processes | Hemarthrosis-induced, widespread synovial inflammation Acute inflammatory mediators and iron-induced oxygen metabolites cause chondrocyte apoptosis and hemosiderin deposition Iron increases pro-inflammatory cytokines that increase pannus in synovium Widespread cartilage destruction and bone changes | Synovial inflammation, mostly in regions adjacent to cartilage and bone damage Activated synovium releases cytokines that accelerate destruction of adjacent cartilage | Autoimmune-mediated synovitis causes pannus (through angiogenesis), and leads to bone destruction Enzymes from synoviocytes and chondrocytes destroy cartilage |
| Age of onset | First joint bleed usually occurs in infants (age < 2 years) in most severe cases (varies with severity and quality of prophylaxis) | Present in 50% of people > 65 years of age with chronic knee pain | Present in 3% - 4% of people 65 - 74 years of age, with prevalence of onset decreasing with age |
| Degree of damage at equivalent age | Greater than with OA or RA | Less than with HA | Less than with HA |
| Severity depends on: | Number of hemarthroses Cumulative biomechanical stresses Access to medical care, factor infusion concentrate and physical therapy | Age Time since onset Risk factors (see above) | Age at diagnosis Access to disease-modifying drugs Smoking status Disease duration Joint erosions |