From the Guidelines
Hemarthrosis from severe arthritis should be managed with a multi-faceted approach, prioritizing joint rest, pain management, and inflammation reduction, while also addressing the underlying arthritis with disease-modifying antirheumatic drugs (DMARDs) like methotrexate, as recommended by the 2017 EULAR guidelines 1.
Key Considerations
- The management of hemarthrosis involves reducing bleeding and swelling through the RICE protocol (rest, ice, compression, and elevation) and pain management with acetaminophen or cautious use of NSAIDs like ibuprofen, considering the potential increased bleeding risk.
- Joint aspiration (arthrocentesis) may be necessary to remove blood from the joint and reduce pain, and corticosteroid injections can be used to reduce inflammation in cases of recurrent hemarthrosis.
- The 2017 EULAR guidelines recommend starting patients at risk of persistent arthritis on DMARDs as early as possible, ideally within 3 months, with methotrexate considered the anchor drug unless contraindicated 1.
Underlying Arthritis Management
- The goal of DMARD treatment is to achieve clinical remission, with regular monitoring of disease activity, adverse events, and comorbidities guiding treatment decisions 1.
- Non-pharmacological interventions, such as dynamic exercises and occupational therapy, should be considered as adjuncts to drug treatment in patients with early arthritis, as recommended by the 2017 EULAR guidelines 1.
Prioritizing Morbidity, Mortality, and Quality of Life
- The management of hemarthrosis and underlying arthritis should prioritize reducing morbidity, mortality, and improving quality of life, with a focus on achieving clinical remission and minimizing treatment-related adverse events.
- The 2017 EULAR guidelines provide a comprehensive approach to managing early arthritis, emphasizing the importance of early referral to a rheumatologist, clinical examination, and consideration of risk factors for persistent and erosive disease 1.
From the Research
Hemarthrosis from Severe Arthritis
- Hemarthrosis, or bloody effusion, can occur in the knee joint due to injury, leading to the early onset of osteoarthritis 2
- The presence of blood in the joint can precipitate deleterious interactions with cartilage and synovium, accelerating degenerative changes in the joint 2
- There is no consensus on the optimal management of traumatic knee joint injury with hemarthrosis, but joint aspiration may be a rationale to minimize harmful effects of blood 2
Treatment of Osteoarthritis
- Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are common pharmacologic treatments for osteoarthritis, with NSAIDs being more effective for improving knee and hip pain, but having similar efficacy for improving functional status 3
- The use of NSAIDs with methotrexate appears to be safe in the management of rheumatoid arthritis, provided appropriate monitoring is performed 4
- Anti-inflammatory doses of aspirin should be avoided due to potential adverse effects on liver and renal function 4
- Acetaminophen is less effective than NSAIDs for pain reduction, but has a similar safety profile 3