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Methods of haemophilia care delivery: regular prophylaxis versus episodic treatment

Haemophilic arthropathy due to repeated joint bleeds is the major cause of morbidity in haemophiliacs. In patients with severe haemophilia (factor VIII or IX levels <0.01 IU/ml or 1% of normal), bleeding episodes occur approximately 3&35 times a year, whereas in those with moderate or mild forms of the disease bleeds are much less frequent and the clinical course is milder [l , 21. Although the pathophysiology of haemophilic arthropathy is not known in any detail, there are strong indications that fewer than 10 joint bleeds may suffice to cause changes and the subsequent development of clinical symptoms [3]. Therefore one major challenge in haemophilia care is to prevent joint bleeds.