Intra-Articular Bevacizumab for Preventing Recurrent Hemarthrosis in Hemophilia With Chronic Synovitis

Hemophilia is an inherited bleeding disorder characterized by deficiency of clotting factors, leading to increased bleeding tendencies. The most common complications are joint bleeds (hemarthroses), which cause chronic changes in joints and ultimately disability. Recurrent hemarthroses often result from chronic synovitis in target joints of patients with hemophilia, a process driven by Vascular Endothelial Growth Factor (VEGF) mediated pathological angiogenesis. Intra-articular administration of Bevacizumab, a VEGF neutralizing monoclonal antibody, may block this process and reduce the frequency of recurrent joint bleeds. This study evaluates the efficacy and safety of intra-articular Bevacizumab for preventing recurrent hemarthrosis in patients with hemophilia and chronic synovitis.

Inclusion Criteria: * Confirmed diagnosis of Hemophilia A. * Presence of one or more target joints (knee, elbow, ankle) with chronic synovitis and a history of \>2 hemarthrosis episodes in the past 6 months. * Target joint World Federation of Hemophilia (WFH) joint score of 2-3. * Adequate hematological, renal, and liver function (as specified by protocol lab values). * Ability and willingness to provide informed consent and comply with the study protocol. Exclusion Criteria: * HIV positive diagnosis. * Severely damaged joints or anatomical limitations preventing safe injection. * Contraindications to MRI. * Uncontrolled hypertension. * Recent major surgery/trauma (\