Hemophilia: skeletal manifestations


Any chronic disease that keeps a child bedridden a lot during their growth phase (leukemia, juvenile chronic arthritis, hemophilia, etc.) may give them mildly dysplastic bones that look like one of the neuromuscular diseases, such as paraplegia.

Early findings of hemophilia include joint effusion and hemarthrosis, followed by articular
and periarticular changes (including synovial hypertrophy and hemosiderin deposition). In later stages, there is epiphyseal overgrowth and osteopenia (due to hyperemia), early closureof physeal plate, destructive changes like loss of cartilage, subchondral cyst formation, and bone erosions. 

Features that favor hemophilic arthropathy on radiograph include epiphyseal overgrowth and osteopenia, widened intercondylar notch, soft-tissue swelling, flattening of the condylar
surface, squaring of the patella, and other destructive changes.

The radiographic mimic of hemophilic arthropathy is juvenile rheumatoid arthritis.