Priority 10 from the Bleeding Disorder PSP

UNCERTAINTY: In people with haemophilia, what is the best way to tell the difference between pain from acute bleeds, non-bleeding muscle/ligament injury and long term joint damage? (JLA PSP Priority 10)
Overall ranking	10
JLA question ID	0078/10
Explanatory note	Joint bleeding is the main characteristic of haemophilia. When a joint bleeds it is very painful as well as becoming swollen and difficult to move. When a joint has had many bleeds, arthritis develops and this can cause disabling joint pain, stiffness and reduced mobility. Overuse of an arthritic joint or injury may cause inflammation of the joint, together with pain and limited movement; symptoms that are similar to that of a joint bleed. To offer appropriate treatment and, in turn, regain optimal functional ability, accurate diagnosis of bleeding and non-bleeding episodes is essential. Currently, the diagnosis of joint bleeding and non-bleeding episodes is made empirically by patients who treat themselves at home. However, the overlap in clinical symptoms between acute bleeds, non-bleeding muscle/ligament injury and long term joint damage joint arthritis make it challenging to differentiate between the conditions.
Evidence	No RCT or systematic review identfied
Health Research Classification System category	Blood

Extra information provided by this PSP
Original uncertainty examples	Differentiating between a bleed and a musculoskeletal injury - how can access to a specialist physiotherapist help patient awareness ~ What symptoms differentiate acute joint bleeding and exacerbation of haemophilia arthropathy? ~ How to differentiate between bleeds, arthritic pain and normal aches/pains and muscle pain etc
Submitted by	Not available

PSP information
PSP unique ID	0078
PSP name	Bleeding Disorders
Total number of uncertainties identified by this PSP.	66 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	7 July 2018