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Additionally, treatment should ideally be administered intensively (enhanced on\u2010demand treatment) until the resolution of symptoms. Joint aspiration plays an important role in acute and profuse haemarthroses as the presence of blood in the joint leads to chondrocyte apoptosis and chronic synovitis, which will eventually result in joint degeneration (haemophilic arthropathy). Ultrasonography (US) is an appropriate diagnostic technique to assess the evolution of acute haemarthrosis in haemophilia, although magnetic resonance imaging remains the gold standard as far as imaging techniques are concerned. Some patients experience subclinical haemarthroses, which eventually tend to result in some degree of arthropathy, especially in the ankles. Nowadays, the most effective way of protecting these patients is primary prophylaxis, which in practice changes severe haemophilia into moderate haemophilia, preventing or at least minimizing the occurrence of haemarthrosis. If primary prophylaxis is, for whatever reason not an option, secondary prophylaxis and enhanced on demand treatment should be considered. Two alternatives are available for inhibitor patients: (i) control of haemostasis using by\u2010passing agents (rFVIIa or aPCCs) either as enhanced on demand treatment or secondary prophylaxis, as appropriate, following the same basic principles used for non\u2010inhibitor patients and (ii) immune tolerance induction (ITI) to eradicate the inhibitor.<\/jats:p>","DOI":"10.1111\/j.1365-2516.2011.02615.x","type":"journal-article","created":{"date-parts":[[2011,8,8]],"date-time":"2011-08-08T10:11:45Z","timestamp":1312798305000},"page":"1-23","source":"Crossref","is-referenced-by-count":113,"title":["Joint protection in haemophilia"],"prefix":"10.1111","volume":"17","author":[{"given":"E. 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