Individualised homeopathic medicines may have an important supportive role in the management of PWH, where blood products and factor concentrates are not easily available. Larger, perhaps multicentric trials are warranted.

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Background: Hemarthrosis is a common clinical presentation of patients with severe and moderately severe hemophilia. Severe pain, swelling, and loss of function involving knee, ankle, elbow, and shoulder joints are commonly seen. In India, except for paracetamol and some non-steroidal anti-inflammatory drugs (NSAIDs), opiate analgesics are not easily available even in the mainstay of treatment; i.e., factor concentrates are also not available regularly. Hence, there is an unmet need for exploring alternative management strategies in this condition in India. Objective: To assess the effect of homeopathic medicines on pain and acute hemarthrosis in hemophilia when factor concentrates are not available and paracetamol in adequate doses proves inadequate. Patients: 343 patients with hemophilia (PWH) from Nashik, Mumbai, and Surat presenting with hemarthrosis were prescribed homeopathic medicines in addition to paracetamol and RICE (rest, immobilization, cold application, and elevation). They were assessed using standard techniques. Results: 1,679 episodes of hemarthrosis in major joints were encountered between December 2007 and March 2014, in 343 patients. In 1,580 of the 1,679 hemarthrosis episodes (94.1%), bleeding/inflammation was arrested and pain relieved with homeopathic medication. Additional factor concentrate was required in 99 patients (4.48%). The mean pain score improved from 6.88 ± 2.118 to 1.5 ± 0.34 over 6-24 h following the homeopathic medicines (p < 0.0001). The swellings were also substantially reduced (p < 0.001). The number of joint bleeds per month was reduced significantly under the influence of therapy (p < 0.0001), showing the long-term disease-modifying effect of the treatment. Conclusion: Homeopathic medicines without factor concentrates appeared to reduce bleeding and pain in PWH presenting with hemarthrosis and could have influenced the long-term frequency of bleeding.

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