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Bakeer N, Saied W, Gavrilovski A, Bailey C. Haemophilic arthropathy: Diagnosis, management, and aging patient considerations. Haemophilia 2024; 30 Suppl 3:120-127. [PMID: 38578694 DOI: 10.1111/hae.15004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/07/2024]
Abstract
Gene therapy and universal use of safer, more effective, and personalised prophylactic regimens (factor, and nonfactor) are expected to prevent joint bleeding and promote joint health in persons with haemophilia (PwH). Growing evidence suggests that subclinical bleeding, with active and inactive synovial proliferation, continues and haemophilic arthropathy remains a major morbidity in PwH despite early institution of joint prophylaxis. Joint health assessment is evolving with physical examination scores complementing imaging scores. Point-of-care ultrasound is emerging as a safe, cost-effective, and readily available tool for acute determination of musculoskeletal abnormalities, serial evaluation of joints for sonographic markers of haemophilic arthropathy, and in providing objective insight into the efficacy of new therapies. In acute haemarthrosis, arthrocentesis expedites recovery and prevent the vicious cycle of bleed-synovitis-rebleed. When synovial proliferation develops, a multidisciplinary team approach is critical with haematology, orthopaedics, and physiotherapy involvement. Synovectomy is considered for patients with chronic synovitis that fail conservative management. Non-surgical and minimally invasive procedures should always be offered and considered first. Careful patient selection, screening and early intervention increase the success of these interventions in reducing bleeding, pain, and improving joint function and quality of life. Chemical synovectomy is practical in developing countries, but radioactive synovectomy appears to be more effective. When surgical synovectomy is considered, arthroscopic/minimally invasive approach should be attempted first. In advanced haemophilic arthropathy, joint replacement and arthrodesis can be considered. While excited about the future of haemophilia management, navigating musculoskeletal challenges in the aging haemophilia population is equally important.
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Affiliation(s)
- Nihal Bakeer
- Indiana Haemophilia and Thrombosis Centre, Indianapolis, Indiana, USA
- Children's Hospital of Philadelphia, Pennsylvania, USA
| | - Walid Saied
- Department of Paediatric Orthopaedic Surgery, Children's Hospital "Bechir HAMZA", Medical School of Tunis, University Tunis-El Manar, Tunis, Tunisia
| | - Antonio Gavrilovski
- University Clinic for Orthopaedic Surgery-TOARILUC, Clinical Centre Mother Theresa Skopje, Skopje, North Macedonia
| | - Cindy Bailey
- Orthopaedic Haemophilia Treatment Centre at Orthopaedic Institute for Children Los Angeles, Los Angeles, California, USA
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2
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Kloosterman FR, Zwagemaker AF, Bay-Jensen AC, Cnossen MH, Kruip MJHA, Leebeek FWG, Hemke R, Maas M, Fijnvandraat K, Gouw SC, Coppens M. Poor correlation between biomarkers and MRI-detected joint damage in a cross-sectional study of persons with nonsevere hemophilia A (DYNAMO study). J Thromb Haemost 2023; 21:1813-1823. [PMID: 37019364 DOI: 10.1016/j.jtha.2023.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/05/2023] [Accepted: 03/14/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Persons with nonsevere hemophilia A (NSHA) experience less frequent joint bleeding than persons with severe hemophilia A, but may still develop joint damage. Biomarkers of cartilage and synovial remodeling can reflect ongoing pathologic processes that may precede or coincide with damage on joint imaging. If so, biomarkers may be an important diagnostic tool for joint damage in NSHA. OBJECTIVE To assess the correlation between biomarkers and MRI-detected joint damage in persons with NSHA. METHODS In a cross-sectional study, men with NSHA (factor VIII [FVIII], 2-35 IU/dL) were included. Participants underwent magnetic resonance imaging of elbows, knees, and ankles and blood and urine sampling for biomarker analysis on a single visit. The following biomarker(s) were analyzed in urine: CTX-II or serum: cartilage oligomeric matrix protein, chondroitin sulfate 846, vascular cell adhesion molecule 1, osteopontin (OPN), neo-epitope of MMP -mediated degradation of type II collagen, N-terminal propeptide of type II collagen, collagen type IV M, and propetide of type IV collagen. Spearman's rank correlations were calculated between these biomarkers and the total International Prophylaxis Study group (IPSG) score, soft-tissue subscore, and osteochondral subscore. RESULTS In total, 48 persons with NSHA were included. Median age was 43 years (range, 24-55 years) and median FVIII was 10 IU/dL (IQR, 4-16 IU/dL). The median IPSG score was 4 (IQR, 2-9). Median IPSG soft-tissue subscores were 3 (IQR, 2-4) and osteochondral subscores were 0 (IQR, 0-4). No strong correlations were found between the studied biomarkers, total IPSG score, subsequent soft-tissue, and osteochondral subscores. CONCLUSIONS In this study, selected biomarkers indicative of different aspects of hemophilic arthropathy showed no consistent correlation with IPSG scores. This suggests that systemically measured biomarkers are currently not suitable for identifying milder joint damage in NSHA, as observed on magnetic resonance imaging.
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Affiliation(s)
- Fabienne R Kloosterman
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Amsterdam, the Netherlands
| | - Anne-Fleur Zwagemaker
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Amsterdam, the Netherlands
| | - Anne C Bay-Jensen
- Immunoscience, Nordic Bioscience, Biomarkers and Research, Herlev, Denmark
| | - Marjon H Cnossen
- Department of Pediatric Hematology and Oncology, Erasmus MC Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marieke J H A Kruip
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Karin Fijnvandraat
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Amsterdam, the Netherlands; Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands
| | - Samantha C Gouw
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Pediatric Hematology, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Michiel Coppens
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, the Netherlands.
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Ray A, Colville JG, Hartley R, Rowbotham E. The musculoskeletal manifestations of haemophilia: a review of the imaging findings. Clin Radiol 2022; 77:730-737. [PMID: 35985846 DOI: 10.1016/j.crad.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/29/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
Haemophilia is a common hereditary cause of bleeding diathesis and the musculoskeletal system is frequently affected. Repeated episodes of haemarthrosis initiate a cascade towards haemophilic arthropathy, a disabling and deforming joint disease with both degenerative and inflammatory features, which include articular cartilage loss, bone erosions, and synovitis. Haemophilic pseudotumour and intra-muscular haematoma make up the remainder of the musculoskeletal manifestations of this systemic condition. Radiological assessment is vital in the assessment and follow-up of these haemophilic complications and MRI is the reference standard. This article summarises the radiological findings relevant to the diagnosis and monitoring of this complex patient group.
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Affiliation(s)
- A Ray
- Department of Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK.
| | - J G Colville
- Department of Radiology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| | - R Hartley
- Department of Radiology, The James Cook University Hospital, South Tees NHS Trust, Middlesbrough TS43BW, UK
| | - E Rowbotham
- Department of Radiology, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Chapel Town Road, Leeds LS7 4SA, UK
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4
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Zwagemaker A, Kloosterman FR, Hemke R, Gouw SC, Coppens M, Romano LGR, Kruip MJHA, Cnossen MH, Leebeek FWG, Hutten BA, Maas M, Fijnvandraat K. Joint status of patients with nonsevere hemophilia A. J Thromb Haemost 2022; 20:1126-1137. [PMID: 35171522 PMCID: PMC9314729 DOI: 10.1111/jth.15676] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/01/2022] [Accepted: 02/11/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Joint bleeding in hemophilia may eventually lead to joint damage. In nonsevere hemophilia, joint bleeds occur infrequently. Currently, knowledge on the joint status of patients with nonsevere hemophilia using objective imaging is limited. OBJECTIVE To investigate the joint status in patients with nonsevere hemophilia A. METHODS This cross-sectional study included patients with nonsevere hemophilia A aged 24-55 years. Joint status was assessed by magnetic resonance imaging (MRI) of the elbows, knees, and ankles and International Prophylaxis Study Group (IPSG) scores were calculated. Lifetime joint bleeding history was collected from medical files. The contribution of factors to joint outcome was explored using multivariable linear regression analysis. RESULTS In total, 51 patients were included, of whom 19 (37%) had moderate and 32 (63%) had mild hemophilia. Patients had a median age of 43 years (interquartile range [IQR] 32-50), a median factor VIII activity of 10 IU/dl (IQR 4-16) and a median annual joint bleeding rate (AJBR) of 0.0 (IQR 0.0-0.2). Soft-tissue changes (IPSG subscore > 0) in the elbows, knees, and ankles were present in 19%, 71%, and 71% of patients, respectively. Osteochondral changes (IPSG subscore > 0) in the elbows, knees, and ankles were present in 0%, 20%, and 35% of patients, respectively. In 14% of bleed-free joints, hemosiderin depositions were observed. Age and AJBRs were most strongly associated with the IPSG score. CONCLUSION This study demonstrates that a substantial proportion of adults with nonsevere hemophilia has joint changes on MRI despite low joint bleeding rates.
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Affiliation(s)
- Anne‐Fleur Zwagemaker
- Pediatric HematologyAmsterdam UMCUniversity of AmsterdamEmma Children’s HospitalAmsterdamThe Netherlands
| | - Fabienne R. Kloosterman
- Pediatric HematologyAmsterdam UMCUniversity of AmsterdamEmma Children’s HospitalAmsterdamThe Netherlands
| | - Robert Hemke
- Department of Radiology and Nuclear MedicineAmsterdam University Medical CentersUniversity of AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Samantha C. Gouw
- Pediatric HematologyAmsterdam UMCUniversity of AmsterdamEmma Children’s HospitalAmsterdamThe Netherlands
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Michiel Coppens
- Department of Vascular MedicineAmsterdam University Medical CentersAmsterdamthe Netherlands
| | - Lorenzo G. R. Romano
- Department of HematologyErasmus MCErasmus University Medical CenterRotterdamThe Netherlands
| | - Marieke J. H. A. Kruip
- Department of HematologyErasmus MCErasmus University Medical CenterRotterdamThe Netherlands
| | - Marjon H. Cnossen
- Department of Pediatric HematologyErasmus MC Sophia Children’s HospitalErasmus University Medical CenterRotterdamThe Netherlands
| | - Frank W. G. Leebeek
- Department of HematologyErasmus MCErasmus University Medical CenterRotterdamThe Netherlands
| | - Barbara A. Hutten
- Department of Epidemiology and Data ScienceAmsterdam Cardiovascular SciencesAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear MedicineAmsterdam University Medical CentersUniversity of AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Karin Fijnvandraat
- Pediatric HematologyAmsterdam UMCUniversity of AmsterdamEmma Children’s HospitalAmsterdamThe Netherlands
- Department of Molecular Cellular HemostasisSanquin Research and Landsteiner LaboratoryAmsterdamThe Netherlands
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5
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Kloosterman FR, Abdi A, Gouw SC, Hart DP, Fijnvandraat K. The factor VIII treatment history of non-severe hemophilia A-Response from original authors Abdi et al. J Thromb Haemost 2021; 19:2642-2644. [PMID: 34558782 DOI: 10.1111/jth.15474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Fabienne R Kloosterman
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Amal Abdi
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Samantha C Gouw
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Daniel P Hart
- Barts and the London School of Medicine and Dentistry, The Royal London Haemophilia Centre, QMUL, London, UK
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands
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Bakeer N, Dover S, Babyn P, Feldman BM, von Drygalski A, Doria AS, Ignas DM, Abad A, Bailey C, Beggs I, Chang EY, Dunn A, Funk S, Gibikote S, Goddard N, Hilliard P, Keshava SN, Kruse-Jarres R, Li Y, Lobet S, Manco-Johnson M, Martinoli C, O'Donnell JS, Papakonstantinou O, Pergantou H, Poonnoose P, Querol F, Srivastava A, Steiner B, Strike K, Timmer M, Tyrrell PN, Vidarsson L, Blanchette VS. Musculoskeletal ultrasound in hemophilia: Results and recommendations from a global survey and consensus meeting. Res Pract Thromb Haemost 2021; 5:e12531. [PMID: 34268464 PMCID: PMC8271584 DOI: 10.1002/rth2.12531] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/18/2021] [Accepted: 04/24/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction For persons with hemophilia, optimization of joint outcomes is an important unmet need. The aim of this initiative was to determine use of ultrasound in evaluating arthropathy in persons with hemophilia, and to move toward consensus among hemophilia care providers regarding the preferred ultrasound protocols for global adaptation. Methods A global survey of hemophilia treatment centers was conducted that focused on understanding how and why ultrasound was being used and endeavored to move toward consensus definitions of both point‐of‐care musculoskeletal ultrasound (POC‐MSKUS) and full diagnostic ultrasound, terminology to describe structures being assessed by ultrasound, and how these assessments should be interpreted. Next, an in‐person meeting of an international group of hemophilia health care professionals and patient representatives was held, with the objective of achieving consensus regarding the acquisition and interpretation of POC‐MSKUS and full diagnostic ultrasound for use in the assessment of musculoskeletal (MSK) pathologies in persons with hemophilia. Results The recommendations were that clear definitions of the types of ultrasound examinations should be adopted and that a standardized ultrasound scoring/measurement system should be developed, tested, and implemented. The scoring/measurement system should be tiered to allow for a range of complexity yet maintain the ability for comparison across levels. Conclusion Ultrasound is an evolving technology increasingly used for the assessment of MSK outcomes in persons with hemophilia. As adoption increases globally for clinical care and research, it will become increasingly important to establish clear guidelines for image acquisition, interpretation, and reporting to ensure accuracy, consistency, and comparability across groups.
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Affiliation(s)
- Nihal Bakeer
- Indiana Hemophilia & Thrombosis Center Indianapolis IN USA
| | - Saunya Dover
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada
| | - Paul Babyn
- Department of Medical Imaging University of Saskatchewan and Saskatchewan Health Authority Saskatoon City Hospital SK Canada
| | - Brian M Feldman
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada.,Department of Pediatrics Faculty of Medicine University of Toronto Toronto ON Canada.,Institute of Health Policy, Management and Evaluation The Dalla Lana School of Public Health University of Toronto Toronto ON Canada.,Division of Rheumatology The Hospital for Sick Children Toronto ON Canada
| | | | - Andrea S Doria
- Department of Medical Imaging University of Toronto The Hospital for Sick Children Toronto ON Canada
| | - Danial M Ignas
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada
| | - Audrey Abad
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada
| | - Cindy Bailey
- Los Angeles Orthopaedic Treatment Centre Los Angeles CA USA
| | - Ian Beggs
- Department of Radiology Royal Infirmary of Edinburgh NHS Lothian Edinburgh UK
| | - Eric Y Chang
- University of California San Diego Medical Center San Diego CA USA
| | - Amy Dunn
- Division of Pediatric Hematology, Oncology & Marrow Transplant Department of Pediatrics Nationwide Children's Hospital The Ohio State University College of Medicine Columbus OH USA
| | - Sharon Funk
- Hemophilia and Thrombosis Center University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Sridhar Gibikote
- Division of Clinical Radiology Christian Medical College Vellore India
| | - Nicholas Goddard
- Katherine Dormandy Haemophilia Centre Royal Free Hospital London UK
| | - Pamela Hilliard
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada
| | | | - Rebecca Kruse-Jarres
- University of Washington and Washington Center for Bleeding Disorders Seattle WA USA
| | - Yingjia Li
- Ultrasound Department Manfang Hospital Guangzhou China
| | - Sébastien Lobet
- Haemostasis and Thrombosis Unit Division of Haematology Cliniques Universitaires Saint-Luc Brussels Belgium
| | - Marilyn Manco-Johnson
- Hemophilia & Thrombosis Center Department of Pediatrics University of Colorado Anschutz Medical Center Aurora CO USA
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL) Università di Genova IRCCS Ospedale Policlinico San Martino Genova Italy
| | - James S O'Donnell
- Irish Centre for Vascular Biology Royal College of Surgeons in Ireland Dublin Ireland
| | | | - Helen Pergantou
- Pediatric Hemophilia Centre/Haemostatis and Thrombosis Unit Aghia Sophia Children's Hospital Athens Greece
| | - Pradeep Poonnoose
- Department of Orthopedics Unit 2 Christian Medical College Vellore India
| | - Felipe Querol
- Haemostasis and Thrombosis Unit Hospital LA FE Universidad de Valencia Valencia Spain
| | - Alok Srivastava
- Department of Hematology Christian Medical College Vellore India
| | - Bruno Steiner
- Department of Rehabilitation Medicine Physical Therapy and MSKUS Program Washington Center for Bleeding Disorders University of Washington Seattle WA USA
| | - Karen Strike
- School of Rehabilitation Science Faculty of Health Science Hamilton Niagara Regional Hemophilia Program Hamilton Health Sciences McMaster University Hamilton ON Canada
| | - Merel Timmer
- van Creveldkliniek University Medical Center Utrecht Utrecht The Netherlands
| | - Pascal N Tyrrell
- Department of Medical Imaging Institute of Medical Science Toronto ON Canada.,Department of Statistical Sciences University of Toronto Toronto ON Canada
| | - Logi Vidarsson
- Diagnostic Imaging The Hospital for Sick Children Toronto ON Canada
| | - Victor S Blanchette
- Department of Pediatrics Division of Hematology/Oncology University of Toronto The Hospital for Sick Children Toronto ON Canada
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Jiménez-Yuste V, de la Corte-Rodríguez H, Álvarez-Román MT, Martín-Salces M, Querol F, Bonanad S, Mingot-Castellano ME, Fernández-Mosteirín N, Canaro M, Santamaría A, Núñez R, García-Frade LJ, Martinoli C, Kim HK. Ultrasound evaluation of joint damage and disease activity in adult patients with severe haemophilia A using the HEAD-US system. Haemophilia 2021; 27:479-487. [PMID: 33620134 DOI: 10.1111/hae.14280] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) system and scoring scale has proven to be an accurate and time-efficient imaging method for identifying joint damage in patients with haemophilia. AIM Observational, multicentre, cross-sectional study conducted in 8 centres in Spain that assessed the joint status of adult patients with severe haemophilia A (SHA) using HEAD-US. METHODS Joint status of the elbow, knee and ankle was evaluated in adults with SHA receiving on-demand (OD) treatment, or primary (PP), secondary (SP), tertiary (TP) or intermittent (IP) prophylaxis. RESULTS Of the 95 patients enrolled, 87 received prophylaxis (6.3% PP, 38.9% SP, 43.2% TP and 3.2% IP). Mean age was 35.2 years, and 59% of patients had not undergone image testing in the last year. The HEAD-US score was 0 in all joints in 6.3% of patients. The ankle was the most affected joint, regardless of treatment regimen. Patients receiving OD treatment, TP or IP had the overall worst scores, mainly in the ankles and elbows; a similar but milder profile was observed in patients on SP; and patients on PP had the best score in all joints. CONCLUSION Joint function may be effectively preserved in patients with SHA on PP, but OD treatment or later initiation of prophylaxis does not seem to prevent progression of arthropathy. Disease worsening was observed in patients OD, TP or IP, most often affecting ankles and elbows. Closer ultrasound imaging monitoring may improve management of these patients.
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Affiliation(s)
- Víctor Jiménez-Yuste
- Department of Haematology, Hospital Universitario La Paz, Autonoma University, Madrid, Spain
| | | | | | | | - Felipe Querol
- University of Valencia and Haemostasis and Thrombosis Unit, Department of Haematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit. Department of Haematology, Hospital Universitari i Politècnic La Fe, University of Valencia, Valencia, Spain
| | - María Eva Mingot-Castellano
- Department of Haematology, Hospital Regional Universitario de Málaga, Malaga, Spain.,Department of Haematology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Mariana Canaro
- Department of Haemostasis and Thrombosis, Hospital Universitario Son Espases, Mallorca, Spain
| | - Amparo Santamaría
- Department of Thrombosis and Haemostasis, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ramiro Núñez
- Department of Haematology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Carlo Martinoli
- Dipartimento di Scienze della Salute Department of Health Sciences (DISSAL) and IRCCS Ospedale Policlinico San Martino, Genova, University of Genoa, Genoa, Italy
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8
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Bakeer N, Shapiro AD. Merging into the mainstream: the evolution of the role of point-of-care musculoskeletal ultrasound in hemophilia. F1000Res 2019; 8. [PMID: 31431824 PMCID: PMC6619375 DOI: 10.12688/f1000research.16039.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2019] [Indexed: 01/19/2023] Open
Abstract
Bleeding with resultant hemophilic arthropathy constitutes the largest cause of morbidity in patients with hemophilia. It results from repeated bleeding episodes in the joint and is characterized by synovial hypertrophy and cartilage and bony destruction. Hemophilic arthropathy assessment is a continually evolving process and is particularly challenging in children and young adults in whom joint disease may be missed or underestimated as obtaining serial "baseline" magnetic resonance imaging scans of multiple clinically asymptomatic or nearly asymptomatic joints may be unjustifiable and cost-ineffective. Musculoskeletal ultrasound-particularly, point-of-care musculoskeletal ultrasound-has emerged as a promising imaging modality for the early detection and management of hemophilic arthropathy, and for the evaluation of hemarthrosis and painful musculoskeletal episodes in patients with hemophilia. This review summarizes currently available data on the emerging role of this new imaging modality, its limitations, and gaps in knowledge. The review also raises unanswered questions, highlights the need for consolidated research efforts, and delineates future directions expected to advance this technology and optimize its use in this patient population.
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Affiliation(s)
- Nihal Bakeer
- Indiana Hemophilia and Thrombosis Center, 8326 Naab Road, Indianapolis, IN, 46260, USA
| | - Amy D Shapiro
- Indiana Hemophilia and Thrombosis Center, 8326 Naab Road, Indianapolis, IN, 46260, USA
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9
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Jiménez-Yuste V, Álvarez-Román MT, Martín-Salces M, De la Corte-Rodríguez H, Altisent C, Parra R, Núñez R, Pérez R, García-Candel F, Bonanad S, Querol F, Alonso N, Fernández-Mosteirín N, López-Ansoar E, García-Frade LJ, Bermejo N, Pérez-González N, Gutiérrez-Pimentel MJ, Martinoli C, Fernández-Arias I, Kim HK. Joint status in Spanish haemophilia B patients assessed using the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) score. Haemophilia 2018; 25:144-153. [DOI: 10.1111/hae.13628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/05/2018] [Accepted: 10/10/2018] [Indexed: 01/05/2023]
Affiliation(s)
| | | | | | | | | | - Rafael Parra
- Hospital Universitario Vall d’Hebron; Barcelona Spain
| | - Ramiro Núñez
- Hospital Universitario Virgen del Rocio; Seville Spain
| | - Rosario Pérez
- Hospital Universitario Virgen del Rocio; Seville Spain
| | | | | | - Felipe Querol
- Hospital Universitario y Politécnico La Fe; Valencia Spain
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10
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De la Corte-Rodriguez H, Rodriguez-Merchan EC, Jimenez-Yuste V. Point-of-care Ultrasonography in Orthopedic Management of Hemophilia: Multiple Uses of an Effective Tool. HSS J 2018; 14:307-313. [PMID: 30258338 PMCID: PMC6148577 DOI: 10.1007/s11420-018-9604-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/25/2018] [Indexed: 02/07/2023]
Abstract
Even in our current era of hemophilia prophylaxis, articular complications can arise and there is a growing need for strategies in the prevention, diagnosis, and treatment of hemophilic arthropathy, a significant contributor to disability in patients with hemophilia. One useful tool, point-of-care ultrasonography (POC-US), offers diverse diagnostic and therapeutic possibilities. This article reviews the literature on the uses of POC-US in hemophilia, including early diagnosis of joint damage, differential diagnosis of articular pain, follow-up of joint injury, and guidance for both arthrocentesis and intra-articular injection. Studies show that for patients with hemophilia, POC-US enhances diagnostic accuracy and targeted treatments. Further research is required into the most efficient use of POC-US and the training needed to develop clinicians' skills. The attributes of POC-US should be understood more fully to enable its widespread application.
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Affiliation(s)
| | - E. Carlos Rodriguez-Merchan
- Department of Orthopaedic Surgery, La Paz University Hospital–IdiPaz, Paseo de la Castellana 261, 28046 Madrid, Spain
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