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Lundin B, Baghaei F, Holmström M, Petrini P, Müller G, Månsson S, Ljung R. Haemophilia A and B - evaluation of the Swedish prophylactic regimen by magnetic resonance imaging. Haemophilia 2023; 29:193-198. [PMID: 36469433 PMCID: PMC10107095 DOI: 10.1111/hae.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Sweden has been a pioneer in the prophylactic treatment of haemophilia. Magnetic resonance imaging (MRI) can detect small changes in joints and can therefore give an indication of a risk of developing arthropathy. AIM To use MRI to evaluate the outcome of the Swedish 'high-dose regimen' and correlate the findings to age, bleeds, joint score and physical activity. METHODS The study group comprised 48 Swedish male patients, mean age 25 years (range 12-33 years), with severe or moderate haemophilia A or B. Data on the Haemophilia Joint Health Score (HJHS) were available and physical activity was evaluated by a self-reported questionnaire. RESULTS MRI score was recorded in 188 joints. Twenty out of 48 patients had a score of ≥1 (range 1-13) in 31 joints of which 3/31 scores were in the knees and 28/31 in the ankles. No correlation was found between the number of recorded bleeds and the MRI score or between HJHS and MRI score. There was no correlation between the physical activity and the number of joint bleeds per se, but a trend (OR 3.0) that those most physically active (19/48; 39.6%), more frequently had an MRI score of ≥1 with an overweight for the right ankle. CONCLUSION The Swedish prophylactic model offers protection against haemophilia joint arthropathy but will still not prevent osteochondral changes in some patients at young age. MRI of the ankles can signal risk of future arthropathy and indicate need to modify the prophylactic regimen.
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Affiliation(s)
- Björn Lundin
- Department of Clinical Sciences Lund (IKVL) - Radiology, Lund University, Lund, Sweden and Dept. of Medical Imaging and Physiology, Skåne University Hospital, Lund/Malmö, Sweden
| | - Fariba Baghaei
- Coagulation Centre, Department of Medicine/Section of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margareta Holmström
- Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pia Petrini
- Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Gunilla Müller
- Institut für Radiologie und Nuklearmedizin, Stadtspital Triemli, Zürich, Switzerland
| | - Sven Månsson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden.,Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Rolf Ljung
- Department of Clinical Sciences Lund (IKVL) - Paediatrics, Lund University, Lund, Sweden
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Fouasson-Chailloux A, Leboeuf F, Maugars Y, Trossaert M, Menu P, Rannou F, Vinatier C, Guicheux J, Gross R, Dauty M. Gait Alteration Due to Haemophilic Arthropathies in Patients with Moderate Haemophilia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127527. [PMID: 35742774 PMCID: PMC9223556 DOI: 10.3390/ijerph19127527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/16/2022] [Accepted: 06/18/2022] [Indexed: 12/10/2022]
Abstract
Some patients with moderate haemophilia (PWMH) report joint damage potentially responsible for gait disorders. Three-dimensional gait analysis (3DGA) is a relevant tool for the identification of complex musculoskeletal impairment. We performed an evaluation with 3DGA of 24 PWMH aged 44.3 ± 16.1 according to their joint status [Haemophilia Joint Health Score (HJHS) < 10 or HJHS ≥ 10] and assessed the correlation with the radiological and clinical parameters. Sixteen had HJHS < 10 (group 1) and eight had HJHS ≥ 10 (group 2). They were compared to 30 healthy subjects of a normative dataset. Both knee and ankle gait variable scores were increased in group 2 compared to the controls (p = 0.02 and p = 0.04, respectively). The PWMH of group 2 had a significant increase in their stance phase, double support duration, and stride width compared to the controls and group 1 (p < 0.01). Very low correlations were found for the ankle gait variable score with the ankle Pettersson sub-score (r2 = 0.250; p = 0.004) and ankle HJHS sub-score (r2 = 0.150; p = 0.04). For the knee, very low correlation was also found between the knee gait variable score and its HJHS sub-score (r2 = 0.290; p < 0.0001). Patients with moderate haemophilia presented a gait alteration in the case of poor lower limb joint status.
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Affiliation(s)
- Alban Fouasson-Chailloux
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, 44042 Nantes, France; (Y.M.); (P.M.); (C.V.); (J.G.); (M.D.)
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- Institut Régional de Médecine du Sport, 44093 Nantes, France
- Correspondence:
| | - Fabien Leboeuf
- Movement-Interactions-Performance (MIP), EA 4334, CHU Nantes, Nantes Université, 44000 Nantes, France; (F.L.); (R.G.)
- School of Health & Society, The University of Salford, Salford M6 6PU, UK
| | - Yves Maugars
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, 44042 Nantes, France; (Y.M.); (P.M.); (C.V.); (J.G.); (M.D.)
- Service de Rhumatologie, CHU Nantes, Nantes Université, 44000 Nantes, France
| | - Marc Trossaert
- Centre Régional de Traitement de l’Hémophilie, CHU Nantes, Nantes Université, 44000 Nantes, France;
| | - Pierre Menu
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, 44042 Nantes, France; (Y.M.); (P.M.); (C.V.); (J.G.); (M.D.)
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- Institut Régional de Médecine du Sport, 44093 Nantes, France
| | - François Rannou
- Service de Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires-Paris Centre, Groupe Hospitalier Cochin, Assistance Publique—Hôpitaux de Paris, 75014 Paris, France;
| | - Claire Vinatier
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, 44042 Nantes, France; (Y.M.); (P.M.); (C.V.); (J.G.); (M.D.)
- UFR Odontologie, CHU Nantes, Nantes Université, 44042 Nantes, France
| | - Jérome Guicheux
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, 44042 Nantes, France; (Y.M.); (P.M.); (C.V.); (J.G.); (M.D.)
- UFR Odontologie, CHU Nantes, Nantes Université, 44042 Nantes, France
- CHU Nantes, PHU4 OTONN, 44093 Nantes, France
| | - Raphael Gross
- Movement-Interactions-Performance (MIP), EA 4334, CHU Nantes, Nantes Université, 44000 Nantes, France; (F.L.); (R.G.)
| | - Marc Dauty
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes Université, ONIRIS, 44042 Nantes, France; (Y.M.); (P.M.); (C.V.); (J.G.); (M.D.)
- Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France
- Institut Régional de Médecine du Sport, 44093 Nantes, France
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Artificial Intelligence Algorithm-Based Magnetic Resonance Imaging to Evaluate the Effect of Radiation Synovectomy for Hemophilic Arthropathy. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5694163. [PMID: 35360269 PMCID: PMC8957465 DOI: 10.1155/2022/5694163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/17/2022]
Abstract
This study aimed to discuss magnetic resonance imaging (MRI) based on artificial intelligence (AI) algorithm to evaluate the effect of radiation synovectomy for hemophilic arthropathy (HA). MRI based on the Canny algorithm was applied and compared with conventional MRI to evaluate its application effects according to the PSNR and SSIM. Sixty patients diagnosed with HA were selected as the research subjects. According to the detection method, the patients were divided into group A (pathological detection after radiation synovectomy), group B (conventional MRI detection), and group C (MRI detection based on the Canny algorithm). The application value of MRI based on the Canny algorithm was judged by comparing the differences between the two detection methods and pathological results. The results displayed that the reconstruction effect of the Canny algorithm was remarkably better than that of the traditional algorithm regarding the peak signal-to-noise ratio (PSNR) and structural similarity (SSIM), which showed a clearer synovial contour. The results of the IPSG score of joint effusion and hemorrhage showed that there was a difference in the detection rate of joints between conventional MRI and pathological results on the score of 1 and 2 (P < 0.05); and there was no significant difference between the MRI and pathological results based on the Canny algorithm (P > 0.05). The results of the IPSG score of synovial hyperplasia showed that the detection rate of conventional MRI was different from pathological results on the score of 1 and 2 (P < 0.05); and there was no significant difference between the MRI and pathological results based on the Canny algorithm (P > 0.05). The results of the IPSG score of hemosiderin deposition showed that the detection rate of conventional MRI was different from the pathological results on the score of 1 and 2 (P < 0.05); and there was no significant difference between the MRI and pathological results based on the Canny algorithm (P > 0.05). The synovial volume of patients after surgery was reduced compared with that before surgery. One-factor variance was used to analyze the clinical hemorrhage frequency before and after surgery, and the results showed that the differences were statistically significant (P < 0.05). Therefore, MRI on account of AI algorithm made it easier to detect synovial contour, which was helpful to evaluate the efficacy of polygenic risk scores (PRS) surgery in HA patients. MRI based on the Canny algorithm had less differences between the score of hemophilic arthropathy and pathological results, which could replace conventional MRI examination and have clinical application value.
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Roussel NA, Chantrain VA, Foubert A, Lambert C, Hermans C, Meeus M, Guillaume S, Lecouvet F, Krüger S, Hilberg T, Lobet S. Gaining more insight into ankle pain in haemophilia: A study exploring pain, structural and functional evaluation of the ankle joint. Haemophilia 2022; 28:480-490. [PMID: 35294993 DOI: 10.1111/hae.14544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Ankle arthropathy is highly prevalent among people with haemophilia (PwH), even with prophylaxis, and leads to pain and disability. Mechanisms and consequences of painful symptoms related to ankle arthropathy have not been extensively studied. METHODS A consecutive sample of 30 adult PwH was included (60 ankles). Ankle structure was assessed with magnetic resonance imaging (IPSG-MRI) and ultrasound (HEAD-US). The HJHS 2.1 assessed function of ankles and knees. Physical functioning was assessed with the Timed Up and Go test, the 2-Minute Walking Test and activity limitations with the HAL questionnaire. Health-related quality of life was evaluated using the EQ-5D-5L questionnaire. Overall pain severity was examined using the Brief Pain Inventory questionnaire and ankle pain intensity with a visual analogue scale. Pressure pain thresholds with an algometer assessed pain sensitivity. Spearman correlations were used to calculate interrelations between joint structure, function and pain. RESULTS Twenty-five PwH (83%) reported ≥1 painful joint, with 67% reporting the ankle as most painful joint. MRI-confirmed abnormalities were seen in 76% of talocrural and 55% of subtalar joints. HEAD-US abnormalities were seen in 93% of the ankles. A large variation was seen in pain sensitivity at the ankle. While moderate to high correlations were observed between ankle structure and HJHS, no meaningful correlations were found between MRI-scores and pain intensity or sensitivity. CONCLUSIONS Structural joint damage is present in many ankles but is not related to pain in PwH. Further studies should consider somatosensory nervous system dysfunction in PwH as contributing factor to painful ankle arthropathy.
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Affiliation(s)
- Nathalie Anne Roussel
- Faculty of Medicine and Health Sciences (MOVANT), University of Antwerp, Antwerp, Belgium
| | - Valérie-Anne Chantrain
- Faculty of Medicine and Health Sciences (MOVANT), University of Antwerp, Antwerp, Belgium.,Pain in Motion International Research Group, www.paininmotion.be
| | - Anthe Foubert
- Faculty of Medicine and Health Sciences (MOVANT), University of Antwerp, Antwerp, Belgium.,Pain in Motion International Research Group, www.paininmotion.be
| | - Catherine Lambert
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Cedric Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Mira Meeus
- Faculty of Medicine and Health Sciences (MOVANT), University of Antwerp, Antwerp, Belgium.,Pain in Motion International Research Group, www.paininmotion.be.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Sylvain Guillaume
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Frédéric Lecouvet
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Steffen Krüger
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Thomas Hilberg
- Department of Sports Medicine, University of Wuppertal, Wuppertal, Germany
| | - Sebastien Lobet
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Louvain, Belgium.,Secteur de kinésithérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Wu Y, Lu J, Zhou Y, Li K, Liu Y, Liu S, Li Z, Zhao Y, Poon MC, Xiao J. Long-term joint outcomes of regular low-dose prophylaxis in Chinese children with severe haemophilia A. Haemophilia 2021; 27:237-244. [PMID: 33550696 DOI: 10.1111/hae.14256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/13/2020] [Accepted: 12/20/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To explore the long-term joint outcomes of low-dose prophylaxis in Chinese children with severe haemophilia A and to analyse their related factors. METHODS We retrospectively analysed follow-up data from 21 severe haemophilia A children on regular low-dose prophylaxis for 6-10 years. We used International Prophylaxis Study Group magnetic resonance imaging score (IPSG MRI score), Hemophilia Joint Health Score (HJHS), number of target joints, and Hemophilia-Specific Quality of Life Index (Haemo-QoL) to evaluate joint outcomes. Factors associated with these outcomes were evaluated by statistical analysis. RESULTS (1) The children were 1.75 to 17 years age at prophylaxis initiation. Median prophylactic factor VIII dose was 22.9 IU/kg per week. (2) At the end of follow-up: (a) The total IPSG MRI scores were 2-24 with 90.5% children exhibiting moderate to severe joint involvement (score 7-24); (b) The HJHS ranged 2-27, with 0-10 for 46.7% children and >10 for 53.3% children. There was a positive correlation between the MRI score and HJHS (p < .05); (c) Compared to their on-demand treatment period before prophylaxis, target joints numbers decreased, and no child needed auxiliary devices to walk; (d) Joint outcomes were positively correlated with the age at initiation of low-dose prophylaxis (p < .05) and negatively correlated with the treatment dose. CONCLUSION Long-term low-dose prophylaxis had positive effect on joint outcomes compared with on-demand treatment. However, a certain degree of joint damage remained in all children indicating the need for improving the current strategy of low-dose prophylaxis.
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Affiliation(s)
- Yuefang Wu
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Pediatrics, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jingjing Lu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yin Zhou
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kuixing Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ying Liu
- Department of Physical Medical Rehabilitation, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shufen Liu
- Department of Physical Medical Rehabilitation, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhuo Li
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongqiang Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Man-Chiu Poon
- Department of Medicine, Pediatrics and Oncology, University of Calgary Cumming School of Medicine, Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Foothills Hospital, Calgary, Alberta, Canada
| | - Juan Xiao
- Department of Pediatrics, Peking Union Medical College Hospital, Chinese Academe of Medical Sciences and Peking Union Medical College, Beijing, China
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Pasta G, Annunziata S, Polizzi A, Caliogna L, Jannelli E, Minen A, Mosconi M, Benazzo F, Di Minno MND. The Progression of Hemophilic Arthropathy: The Role of Biomarkers. Int J Mol Sci 2020; 21:E7292. [PMID: 33023246 PMCID: PMC7583947 DOI: 10.3390/ijms21197292] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hemophilia A and B are X-linked congenital bleeding disorders characterized by recurrent hemarthroses leading to specific changes in the synovium and cartilage, which finally result in the destruction of the joint: this process is called hemophilic arthropathy (HA). This review highlights the most prominent molecular biomarkers found in the literature to discuss their potential use in the clinical practice to monitor bleeding, to assess the progression of the HA and the effectiveness of treatments. METHODS A review of the literature was performed on PubMed and Embase, from 3 to 7 August 2020. Study selection and data extraction were achieved independently by two authors and the following inclusion criteria were determined a priori: English language, available full text and articles published in peer-reviewed journal. In addition, further articles were identified by checking the bibliography of relevant articles and searching for the studies cited in all the articles examined. RESULTS Eligible studies obtained at the end of the search and screen process were seventy-three (73). CONCLUSIONS Despite the surge of interest in the clinical use of biomarkers, current literature underlines the lack of their standardization and their potential use in the clinical practice preserving the role of physical examination and imaging in early diagnosis.
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Affiliation(s)
- Gianluigi Pasta
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Salvatore Annunziata
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Alberto Polizzi
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Laura Caliogna
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Eugenio Jannelli
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Alessandro Minen
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Mario Mosconi
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
| | - Francesco Benazzo
- Department of Orthopaedics and Traumatology, Fondazione Policlinico IRCCS San Matteo, University of Pavia, 27100 Pavia, Italy; (G.P.); (A.P.); (L.C.); (E.J.); (A.M.); (M.M.); (F.B.)
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Tijskens D, Lobet S, Eerdekens M, Peerlinck K, Hermans C, Van Damme A, Staes F, Deschamps K. Paediatric patients with blood-induced ankle joint arthritis demonstrate physiological foot joint mechanics and energetics during walking. Haemophilia 2020; 26:907-915. [PMID: 32770628 DOI: 10.1111/hae.14128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/18/2020] [Accepted: 07/24/2020] [Indexed: 11/29/2022]
Abstract
AIM To compare foot joint kinetics and energetics in male paediatric boys with and without blood-induced ankle joint destruction to these of matched control groups. METHODS A cross-sectional study was conducted in which 3D gait analysis data were collected from thirty-five male children (6-21 years) with severe or moderate haemophilia and twenty-six typically developing boys. Structural integrity of the tarsal foot joints of all haemophilic patients was assessed using the IPSG-MRI scale. All participants walked barefoot while adopting a physiological gait pattern. Three subgroups were created based on the IPSG-MRI scores: a group with no joint involvement (HealthyHaemo), with uni- or bilaterally involvement (PathoHaemo) and with only unilaterally involvement (Haemo_Unilateral_Patho). RESULTS The PathoHaemo group presented a significant lower Lisfranc peak dorsiflexion angular velocity (34.7°/s vs 71.4°/s, P = .000, Cohen d = 1.31) and a significantly higher Lisfranc peak plantarflexion angular velocity (-130.5°/s vs -51.8°/s, P = .000, Cohen d = 0.98) compared to the control group. The Haemo_Unilateral_Patho side had a significant higher Chopart peak dorsiflexion angular velocity compared to the Haemo_Unilateral_Healthy side (41.7°/s vs 31.9°/s, P = .002, Cohen d = 1.16). CONCLUSION No evidence for mild and severe gait deviations could be demonstrated. Internal moments, used as a surrogate measure of joint loading, quantified by the multi-segment foot model were found to be similar within the three subanalyses. We suggest that the ongoing musculoskeletal development in children compensates for structural damage to the ankle joint.
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Affiliation(s)
- Dorien Tijskens
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KULeuven, Heverlee, Belgium
| | - Sébastien Lobet
- Service D'hématologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.,Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Maarten Eerdekens
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KULeuven, Heverlee, Belgium
| | - Kathelijne Peerlinck
- Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Cédric Hermans
- Service D'hématologie, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - An Van Damme
- Service D'hématologie Pédiatrique, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Filip Staes
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KULeuven, Heverlee, Belgium
| | - Kevin Deschamps
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KULeuven, Brugge, Belgium.,Division of Podiatry, Institut D'enseignement Supérieur Parnasse Deux-Alice, Sint-Lambrechts-Woluwe, Belgium.,Department of Podiatry, Artevelde University College, Ghent, Belgium
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8
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Lobet S, Peerlinck K, Hermans C, Van Damme A, Staes F, Deschamps K. Acquired multi-segment foot kinematics in haemophilic children, adolescents and young adults with or without haemophilic ankle arthropathy. Haemophilia 2020; 26:701-710. [PMID: 32588506 DOI: 10.1111/hae.14076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND AIM The ankle joint remains vulnerable in children with haemophilia and is the primary joint affected. The purpose of this study was to dynamically characterize the segmental foot and ankle kinematics of male children, adolescents and young adults with or without ankle arthropathy. METHODS The barefoot multi-segment foot kinematics of 70 ankles from 35 haemophilia subjects between 6 and 20 years old were captured with the Rizzoli Multi-Segment Foot Model. Joint damage of the tibiotalar and subtalar joints was scored using the IPSG-MRI score. The feet of patients with or without evidence of ankle arthropathy were compared with those of matched typically developing boys via a nonpaired comparison. The differences between the affected and nonaffected sides of patients with unilateral ankle arthropathy were assessed using a paired comparison. RESULTS Subjects without arthropathy demonstrated a nonsignificant trend towards a higher frontal plane range of motion (RoM) at the midfoot upon loading response and a lower sagittal plane RoM at the midfoot during midstance. No differences were observed between the affected side group and their matched control group. The affected side of unilaterally affected subjects exhibited a nonsignificant tendency towards a higher frontal plane RoM at the ankle joint upon loading response and terminal stance compared to the healthy side. CONCLUSION Most patients maintained physiological rocker function of the ankle and had no (mal)adaptive motion patterns in the more distal joints of the foot. Therefore, established structural lesions may remain subclinical with respect to moderate functional activities like walking.
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Affiliation(s)
- Sebastien Lobet
- Service d'hématologie, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Bruxelles, Belgium.,Secteur des Sciences de la Santé, Neuromusculoskeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Service de kinésithérapie, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Bruxelles, Belgium
| | - Kathelijne Peerlinck
- Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, KULeuven, Leuven, Belgium
| | - Cedric Hermans
- Service d'hématologie, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Bruxelles, Belgium
| | - An Van Damme
- Service d'hématologie pédiatrique, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Bruxelles, Belgium
| | - Filip Staes
- Department of Rehabilitation Sciences-Musculoskeletal Rehabilitation Research Group, KULeuven, Heverlee, Belgium
| | - Kevin Deschamps
- Department of Rehabilitation Sciences-Musculoskeletal Rehabilitation Research Group, KULeuven, Brugge, Belgium.,Division of Podiatry, Institut d'enseignement Supérieur Parnasse Deux-Alice, Sint-Lambrechts-Woluwe, Belgium
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9
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Tolend M, Majeed H, Soliman M, Daruge P, Bordalo-Rodrigues M, Dertkigil SSJ, Gibikote S, Keshava SN, Stimec J, Dunn A, Li YJ, Blanchette V, Lundin B, Doria AS. Critical appraisal of the International Prophylaxis Study Group magnetic resonance image scale for evaluating haemophilic arthropathy. Haemophilia 2020; 26:565-574. [PMID: 32497355 DOI: 10.1111/hae.14032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 03/24/2020] [Accepted: 04/23/2020] [Indexed: 12/26/2022]
Abstract
A goal of the International Prophylaxis Study Group (IPSG) is to provide an accurate instrument to measure MRI-based disease severity of haemophilic arthropathy at various time points, so that longitudinal changes in disease severity can be identified to support decisions on treatment management. We review and discuss in this paper the evaluative purpose of the IPSG MRI scale in relation to its development and validation processes so far. We also critically appraise the validity, reliability and responsiveness of using the IPSG MRI scale in different clinical and research settings, and whenever applicable, compare these clinimetric properties of the IPSG MRI scale with those of its precursors, the compatible additive and progressive MRI scales.
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Affiliation(s)
- Mirkamal Tolend
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Haris Majeed
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Magdy Soliman
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Paulo Daruge
- Institute of Radiology, Universidade de Sao Paulo (USP), Sao Paulo, SP, Brazil
| | | | | | - Sridhar Gibikote
- Department of Radiology, Christian Medical College, Vellore, India
| | | | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Amy Dunn
- Department of Hematology, Nationwide Children's Hospital, Columbus, OH
| | - Ying-Jia Li
- Department of Radiology, Nanfang Hospital Hospital, Guangzhou, China
| | - Victor Blanchette
- Department of Hematology & Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Björn Lundin
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
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10
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Eerdekens M, Peerlinck K, Staes F, Pialat JB, Hermans C, Lobet S, Deschamps K. Clinical gait features are associated with MRI findings in patients with haemophilic ankle arthropathy. Haemophilia 2020; 26:333-339. [PMID: 31944497 DOI: 10.1111/hae.13925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Haemophilic ankle arthropathy due to repeated joint bleeds often leads to altered gait in adult patients with haemophilia. AIM To investigate the association between clinical gait features and blood-induced ankle joint damage scored using MRI findings in patients with haemophilic ankle arthropathy. METHODS This observational study investigated 48 ankles of 24 patients with severe haemophilia (median age of 33 years). Blood-induced ankle joint damage was scored by an experienced radiologist using the International Prophylaxis Study Group (IPSG-)MRI score which evaluates the presence or absence of effusion, synovial hypertrophy, haemosiderin, surface erosions, subchondral cysts and cartilage degeneration. Using 3D gait analysis, peak ankle joint power generation and absorption (W/kg) were measured for each ankle since these are surrogate measures for joint loading during walking. Associations between MRI findings and these two clinical gait features were calculated using Spearman's ρ correlation with an α-level correction (α = 0.01) for multiple tests. RESULTS We found large negative associations between ankle joint peak power generation and IPSG-MRI score (ρ = -0.631; P = <.001), IPSG-MRI osteochondral subscore (ρ = -0.701; P = <.001), severity of synovial hypertrophy (ρ = -0.507; P = <.001) and haemosiderin (ρ = -0.400; P = .005). Associations were also found for ankle joint peak power absorption and IPSG-MRI score (ρ = -0.425; P = .003) and IPSG-MRI osteochondral subscore (ρ = -0.556; P = <.001). CONCLUSION Severe blood-induced ankle joint damage relates to a lowered tolerance towards ankle joint mechanical loading during walking in patients with haemophilia.
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Affiliation(s)
- Maarten Eerdekens
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Heverlee, Belgium.,Clinical Motion Analysis Laboratorium (CMAL), UZ Leuven, Pellenberg, Belgium.,Haemophilia Center, UZ Leuven, Leuven, Belgium
| | - Kathelijne Peerlinck
- Haemophilia Center, UZ Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Filip Staes
- Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Heverlee, Belgium
| | - Jean-Baptiste Pialat
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Cédric Hermans
- Service d'hématologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Sébastien Lobet
- Service d'hématologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal Lab (NMSK), Université Catholique de Louvain, Brussels, Belgium.,Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Kevin Deschamps
- Clinical Motion Analysis Laboratorium (CMAL), UZ Leuven, Pellenberg, Belgium.,Department of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Group, KU Leuven, Brugge, Belgium
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11
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von Drygalski A, Barnes RFW, Jang H, Ma Y, Wong JH, Berman Z, Du J, Chang EY. Advanced magnetic resonance imaging of cartilage components in haemophilic joints reveals that cartilage hemosiderin correlates with joint deterioration. Haemophilia 2019; 25:851-858. [PMID: 31199035 DOI: 10.1111/hae.13802] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Evidence suggests that toxic iron is involved in haemophilic joint destruction. AIM To determine whether joint iron deposition is linked to clinical and imaging outcomes in order to optimize management of haemophilic joint disease. METHODS Adults with haemophilia A or haemophilia B (n = 23, ≥ age 21) of all severities were recruited prospectively to undergo assessment with Hemophilia Joint Health Scores (HJHS), pain scores (visual analogue scale [VAS]) and magnetic resonance imaging (MRI) at 3T using conventional MRI protocols and 4-echo 3D-UTE-Cones sequences for one affected arthropathic joint. MRI was scored blinded by two musculoskeletal radiologists using the International Prophylaxis Study Group (IPSG) MRI scale. Additionally, UTE-T2* values of cartilage were quantified. Correlations between parameters were performed using Spearman rank correlation. Two patients subsequently underwent knee arthroplasty, which permitted linking of histological findings (including Perl's reaction) with MRI results. RESULTS MRI scores did not correlate with pain scores or HJHS. Sixteen joints had sufficient cartilage for UTE-T2* analysis. T2* values for cartilage correlated inversely with HJHS (rs = -0.81, P < 0.001) and MRI scores (rs = -0.52, P = 0.037). This was unexpected since UTE-T2* values decrease with better joint status in patients with osteoarthritis, suggesting that iron was present and responsible for the effects. Histological analysis of cartilage confirmed iron deposition within chondrocytes, associated with low UTE-T2* values. CONCLUSIONS Iron accumulation can occur in cartilage (not only in synovium) and shows a clear association with joint health. Cartilage iron is a novel biomarker which, if quantifiable with innovative joint-specific MRI T2* sequences, may guide treatment optimization.
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Affiliation(s)
- Annette von Drygalski
- Department of Medicine, University of California San Diego, San Diego, California.,Department of Molecular Medicine, The Scripps Research Institute, La Jolla, California
| | - Richard F W Barnes
- Department of Medicine, University of California San Diego, San Diego, California
| | - Hyungseok Jang
- Department of Radiology, University of California San Diego, San Diego, California
| | - Yajun Ma
- Department of Radiology, University of California San Diego, San Diego, California
| | - Jonathan H Wong
- Department of Radiology, University of California San Diego, San Diego, California
| | - Zachary Berman
- Department of Radiology, University of California San Diego, San Diego, California
| | - Jiang Du
- Department of Radiology, University of California San Diego, San Diego, California
| | - Eric Y Chang
- Department of Radiology, University of California San Diego, San Diego, California.,Radiology Service, VA San Diego Healthcare System, San Diego, California
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12
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Fouasson-Chailloux A, Maugars Y, Vinatier C, Trossaert M, Menu P, Rannou F, Guicheux J, Dauty M. Clinical relevance of 3D gait analysis in patients with haemophilia. Haemophilia 2018; 24:703-710. [DOI: 10.1111/hae.13563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 02/06/2023]
Affiliation(s)
- A. Fouasson-Chailloux
- CHU Nantes; Physical Medicine and Rehabilitation Center; Nantes France
- Inserm; UMR 1229; RMeS, Regenerative Medicine and Skeleton; Université de Nantes; ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
| | - Y. Maugars
- Inserm; UMR 1229; RMeS, Regenerative Medicine and Skeleton; Université de Nantes; ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
- CHU Nantes; Nantes France
- Rheumatologic Department; CHU Nantes; Nantes France
| | - C. Vinatier
- Inserm; UMR 1229; RMeS, Regenerative Medicine and Skeleton; Université de Nantes; ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
| | - M. Trossaert
- CHU Nantes Centre Régional de traitement de l'hémophilie; Nantes France
| | - P. Menu
- CHU Nantes; Physical Medicine and Rehabilitation Center; Nantes France
- Inserm; UMR 1229; RMeS, Regenerative Medicine and Skeleton; Université de Nantes; ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
| | - F. Rannou
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis; Hôpitaux Universitaires-Paris Centre; Groupe Hospitalier Cochin; Assistance Publique-Hôpitaux de Paris; Paris France
| | - J. Guicheux
- Inserm; UMR 1229; RMeS, Regenerative Medicine and Skeleton; Université de Nantes; ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
- CHU Nantes; Nantes France
| | - M. Dauty
- CHU Nantes; Physical Medicine and Rehabilitation Center; Nantes France
- Inserm; UMR 1229; RMeS, Regenerative Medicine and Skeleton; Université de Nantes; ONIRIS; Nantes France
- UFR Odontologie; Université de Nantes; Nantes France
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13
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Deschamps K, Staes F, Eerdekens M, Peerlinck K, Hermans C, Vandesande J, Lobet S. Postural control during a transition task in haemophilic children, adolescents and young adults with haemophilic ankle arthropathy. Haemophilia 2018; 24:667-674. [DOI: 10.1111/hae.13484] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2018] [Indexed: 11/27/2022]
Affiliation(s)
- K. Deschamps
- Department of Rehabilitation Sciences; Musculoskeletal Rehabilitation Research Group; KULeuven; Leuven (Heverlee) Belgium
- Division of Podiatry; Institut D'Enseignement; Supérieur Parnasse Deux-Alice; Sint-Lambrechts-Woluwe Belgium
- Department of Podiatry; Artevelde University College; Ghent Belgium
- Department of Physical Medicine; University Hospitals Leuven; Pellenberg Belgium
| | - F. Staes
- Department of Rehabilitation Sciences; Musculoskeletal Rehabilitation Research Group; KULeuven; Leuven (Heverlee) Belgium
| | - M. Eerdekens
- Department of Physical Medicine; University Hospitals Leuven; Pellenberg Belgium
| | - K. Peerlinck
- Department of Cardiovascular Sciences; Centre for Molecular and Vascular Biology; KULeuven; Leuven Belgium
| | - C. Hermans
- Service d'hématologie; Cliniques Universitaires Saint-Luc; Bruxelles Belgium
| | - J. Vandesande
- Department of Cardiovascular Sciences; Centre for Molecular and Vascular Biology; KULeuven; Leuven Belgium
| | - S. Lobet
- Service d'hématologie; Cliniques Universitaires Saint-Luc; Bruxelles Belgium
- Secteur des Sciences de la Santé; Institut de Recherche Expérimentale et Clinique; Neuromusculoskeletal Lab (NMSK); Université catholique de Louvain; Brussels Belgium
- Service de médecine physique et réadaptation; Cliniques universitaires Saint-Luc; Brussels Belgium
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