1. About The Author
Dr Manoj R. kandoi is the founder president of “Institute of Arthritis Care & Prevention”
an NGO involved in the field of patient education regarding arthritis. Besides providing
literature to patient & conducting symposiums, the institute is also engaged in creating
patients “Self Help Group” at every district level. The institute also conducts a certificate
course for healthcare professionals & provide fellowship to experts in the field of
arthritis.
The author has many publications to his credit in various journals. He has also written a
book “ The Basics Of Arthritis” for healthcare professionals.
The author can be contacted at:
Dr manoj R. kandoi
C-202/203 Navare Arcade
Shiv Mandir Road, Opposite Dena Bank
Shiv mandir Road, Opposite Dena bank
Shivaji Chawk, Ambarnath(E) Dist: Thane Pin:421501
State: Maharashtra Ph: (0251)2602404 Country: India
Membership Application forms of the IACR for patients & healthcare professionals
can be obtained from.
Institute of Arthritis Care & Prevention
C/o Ashirwad Hospital
Almas mension, SVP Road, New Colony,
Ambarnath(W) Pin:421501 Dist: Thane
State: Maharashtra Country: India
Ph: (0251) 2681457 Fax: (0251)2680020
Mobile ;9822031683
Email: drkandoi@yahoo.co.in
Preface:
Studies have shown that people who are well informed & participate actively in
their own care experience less pain & make fewer visits to the doctor than do other
people with arthritis. Unfortunately in India & many third world countries we do not
have patient education & arthritis self management programs as well as support groups.
This is an attempt to give a brief account of various arthritis, their prevention & self
management methods which can serve as useful guide to the patients of arthritis.
It would be gratifying if the sufferers of the disease knew most of what is given in the
book.
Acknowledgement
I am thankful to Dr (Mrs) Sangita Kandoi for her immense help in proofreading & for her
invaluable suggestions. The help rendered by Nisha Jaiswal is probably unrivalled.
Thanks also to vidya, praveen, rizwana and parvati for their continous support
throughout the making of the book. The author is grateful to his family for the constant
inspiration they offered. The author alone is responsible for the shortcoming in this piece
of work. He welcomes suggestions for improvement from the readers.

2. Haemophilic Arthritis
Introduction:
Haemephilia include a group of disease affecting males but transmitted by female and
characterized by prolonged coagulation and a life long tendency to excessive bleeding.
Types:
1. Haomophilia A (factor VIII deficiency)
2. Haemophilia B (Christmas disease factor IX deficiency)
3. Von willebrallds disease: There is abnormality of platelet function.
Process of blood caugulation:
Intrinsic pathway Extrinsic pathway
Factor XII Factor IX Tissue factor VII
Factor XI Factor VIII (tissue thromboplastin)
activated on activated on
foregin platelet
Surface surface Factor X
Factor V
PF3
Common pathway Ca
Prothrombin
Thrombin
Fibrinogen Fibrin
Grades of factor VIII deficiency:
Grade I: < 1 % severe bleeding
Grade II: < 5% gross bleeding with minor trauma
Grade III: < 5 -25% severe bleeding after trauma or surgery
Grade IV: < 25 -50% bleeding after major trauma or surgery
Pathophysiology of haemophilic arthropathy:

3. Haemorrhage in the joint (Spontaneous or following trauma)
Blood remain fluid in the joint due to lack of caugulation
Plasma absorbed RBC phagocytosis
Iron deposition in synovial
Tissue and articular cartilage
Chronic inflammation with
Synovial proliferation and
Pannus formation
Rheumatological manifestations:
1. Haemaphilic arthropathy
2. Intramuscular or soft tissue haemorrhege (may cause pseudotumor or
compartment syndrome)
3. Septic arthritis.
a. Haemophilic arthropathy:
 Acute hemarthrosis: It usually starts when child begins to walk
characterized by pain, increased temperature swelling and restricted
motion. Severity and recurrences is dependent on factor levels (if there
are 75% normal, there is a lesser tendency towards haemarrhage).
 Sub acute haemophilic arthropathy: It usually follows repeated
episodes of joint bleeding characterized by features suggestive of
chronic synovitis, It is accompanied with muscle laxity and ligament
laxity. Polyarticular involvement is uncommon.
 Chronic haemophilic arthropathy: The main feature are of joint
deformity, fibrous ankylosis and osteophyte over growth.
Extra skeletal manifestations:
1. Sub cutaneous bleeding with tendency to bruise easily.
2. Mucous membrane and internal bleeding
 Haematuria
 Epistaxis
 Bleeding into brain or spinal cord
 Mouth, gums, lips and tongue bleeding.
Diagnosis:
1. Family history: Especially suggesting a sex linked disorders.
2. Preliminary cougulation testing: Tests include APTT, PT, thrombin clotting
time (TCT) and bleeding time. In haemophilia A & B, APTT is prolonged, if
bleeding time is prolonged one should consider diagnosis of Von willebrands
disease.
3. Specific factor essay: To differentiate between haemophilia A & B.

4. Radiological staging of haemophilic arthritis:
Stage I: Soft tissue swelling
Stage II:
 Soft tissue swelling
 Osteopenia of epiphyses
 Joint space maintained
 Subchondral cysts are present
 Squaring of the patella
 Intercondylar notch femur and trochlear notch of ulna widened
Stage III:
 Disorganization of joint
 ? Ankylosis
 Large subchondral cysts
Management of haemophilia - A:
1. Local haemostatic agents: Such as thrombin or gelfoam if bleeding site is
accessible.
2. Factor VIII replacement:
a. Cryoprecipitate: it is stored frozen
b. Freeze dried factor VIII concentrates -the advantages being ability to store in
domestic refrigerator and higher purity.
3. Non blood products such as synthetic vasopressin may be used in mild to moderate
cases.
4. General care: It includes
a. Prophylactic immunization
b. Correction of anaemia if present
c. To avoid bleeding including drugs such as aspirin.
5. Treatment of acute haemarthritis:
a. Cold application
b. Analgesics
c. Joint immobilization
d. Replacement of coagulation factor
e. Gradual physiotherapy
6. Treatment of chronic arthropathy:
a. Prophylactic factor replacement to prevent recurrences of bleeding.
b. Rest
c. Gradual physiotherapy
d. Intraarticular gluco corticoids to reduce symptoms and recurrent hemathrosis.
e. Synoviectomy for chronic synovitis unresponsive to conservative therapy.
f. For recent contractures: Plaster splinting, dynamic traction, exercises.
g. Postsubluxation of tibia: dynamic traction
h. Painful unstable joints: Orthotic splintage
i. Supracondylar osteotomy for severe FFD knee
j. TA lengthening for TA contractures
k. Total joint replacement in cases with advanced joint destruction.
l. Arthrodesis in severe destructive arthritis

5. m. ORIF for fracture nonunion.
Rheumatologic manifestations of sickle cell anaemia:
1. Bone infarction
2. Septic arthritis
3. Osteomyelitis
4. Hemarthrosis
5. Hyperuricemia and gout
6. Vascular necrosis of bone
7. Hand foot syndrome
8. Muscle necrosis
Arthritis With Leukemia:
Acute monoarticular mimicking acute rheumatic fever may occur, particularly in acute
monocytic leukemia.