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Nagao A, Inagaki Y, Nogami K, Yamasaki N, Iwasaki F, Liu Y, Murakami Y, Ito T, Takedani H. Artificial intelligence-assisted ultrasound imaging in hemophilia: research, development, and evaluation of hemarthrosis and synovitis detection. Res Pract Thromb Haemost 2024; 8:102439. [PMID: 38993620 PMCID: PMC11238186 DOI: 10.1016/j.rpth.2024.102439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/03/2024] [Indexed: 07/13/2024] Open
Abstract
Background Joint bleeding can lead to synovitis and arthropathy in people with hemophilia, reducing quality of life. Although early diagnosis is associated with improved therapeutic outcomes, diagnostic ultrasonography requires specialist experience. Artificial intelligence (AI) algorithms may support ultrasonography diagnoses. Objectives This study will research, develop, and evaluate the diagnostic precision of an AI algorithm for detecting the presence or absence of hemarthrosis and synovitis in people with hemophilia. Methods Elbow, knee, and ankle ultrasound images were obtained from people with hemophilia from January 2010 to March 2022. The images were used to train and test the AI models to estimate the presence/absence of hemarthrosis and synovitis. The primary endpoint was the area under the curve for the diagnostic precision to diagnose hemarthrosis and synovitis. Other endpoints were the rate of accuracy, precision, sensitivity, and specificity. Results Out of 5649 images collected, 3435 were used for analysis. The area under the curve for hemarthrosis detection for the elbow, knee, and ankle joints was ≥0.87 and for synovitis, it was ≥0.90. The accuracy and precision for hemarthrosis detection were ≥0.74 and ≥0.67, respectively, and those for synovitis were ≥0.83 and ≥0.74, respectively. Analysis across people with hemophilia aged 10 to 60 years showed consistent results. Conclusion AI models have the potential to aid diagnosis and enable earlier therapeutic interventions, helping people with hemophilia achieve healthy and active lives. Although AI models show potential in diagnosis, evidence is unclear on required control for abnormal findings. Long-term observation is crucial for assessing impact on joint health.
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Affiliation(s)
- Azusa Nagao
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan
| | - Yusuke Inagaki
- Department of Rehabilitation Medicine, Nara Medical University, Nara, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Nara, Japan
| | - Naoya Yamasaki
- Department of Transfusion Medicine, Hiroshima University, Hiroshima, Japan
| | - Fuminori Iwasaki
- Division of Hematology and Oncology, Kanagawa Children’s Medical Center, Kanagawa, Japan
| | - Yang Liu
- Clinical Development Division, Chugai Pharmaceutical Co, Ltd, Tokyo, Japan
| | - Yoichi Murakami
- Medical Affairs Division, Chugai Pharmaceutical Co, Ltd, Tokyo, Japan
| | - Takahiro Ito
- Medical Affairs Division, Chugai Pharmaceutical Co, Ltd, Tokyo, Japan
| | - Hideyuki Takedani
- Department of Rehabilitation, National Hospital Organization Tsuruga Medical Center, Fukui, Japan
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van Leeuwen FHP, Lena B, van Bergen EDP, van Klei JJ, Timmer MA, van Vulpen LFD, Fischer K, de Jong PA, Bos C, Foppen W. Quantitative MRI assessment of joint effusion using T2-relaxometry at 3 Tesla: a feasibility and reproducibility study. Skeletal Radiol 2024:10.1007/s00256-024-04652-0. [PMID: 38512365 DOI: 10.1007/s00256-024-04652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/09/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE T2-relaxometry could differentiate between physiological and haemorrhagic joint effusion (≥ 5% blood) in vitro. Are quantitative T2-relaxation time measurements of synovial fluid feasible and reproducible in vivo in clinically bleed-free joints of men with haemophilia? MATERIALS AND METHODS In this cross-sectional study, we measured T2-relaxation times of synovial fluid in clinically bleed-free ankles, knees or elbows of men with severe haemophilia A using a T2-mapping sequence (duration ≤ 7 min) at 3 Tesla MRI. Manual and circular regions of interest (ROI) were drawn in the synovial fluid of each joint by two independent observers to measure T2-relaxation times. Measurement feasibility was expressed as the success rate of the measurements by both observers. The interobserver and intraobserver reproducibility of the measurements were evaluated by the intraclass correlation coefficient of absolute agreement (ICC) and the limits of agreement (LoA) from Bland Altman analysis. RESULTS We evaluated 39 clinically bleed-free joints (11 ankles, 12 knees, 16 elbows) of 39 men (median age, 24 years; range 17-33) with severe haemophilia A. The success rate of the T2-measurements was ≥ 90%. Interobserver reliability was good to excellent (manual ROI: ICC = 0.92, 95% CI 0.76-0.97; circular ROI: ICC = 0.82, 95% CI 0.66-0.91) and interobserver agreement was adequate (manual ROI: LoA = 71 ms; circular ROI: LoA = 146 ms). Intraobserver reliability was good to excellent (manual ROI: ICC = 0.78, 95% CI - 0.06-0.94; circular RO: ICC = 0.99, 95% CI 0.98-0.99) and intraobserver agreement was good (manual ROI: LoA = 63 ms; circular ROI: LoA = 41 ms). CONCLUSION T2-relaxometry of synovial fluid in haemophilia patients is feasible with good interobserver and intraobserver reproducibility.
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Affiliation(s)
- Flora H P van Leeuwen
- Department of Radiology and Nuclear Medicine, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht University, HP: E01.132, P.O. Box 85500, 3584 CX, Utrecht, The Netherlands.
| | - Beatrice Lena
- Department of Radiology and Nuclear Medicine, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht University, HP: E01.132, P.O. Box 85500, 3584 CX, Utrecht, The Netherlands
| | - Eline D P van Bergen
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, HP C01.428, P.O. Box 85500, 3584, CX, Utrecht, The Netherlands
| | - Janoah J van Klei
- Department of Radiology and Nuclear Medicine, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht University, HP: E01.132, P.O. Box 85500, 3584 CX, Utrecht, The Netherlands
| | - Merel A Timmer
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, HP C01.428, P.O. Box 85500, 3584, CX, Utrecht, The Netherlands
| | - Lize F D van Vulpen
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, HP C01.428, P.O. Box 85500, 3584, CX, Utrecht, The Netherlands
| | - Kathelijn Fischer
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, HP C01.428, P.O. Box 85500, 3584, CX, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology and Nuclear Medicine, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht University, HP: E01.132, P.O. Box 85500, 3584 CX, Utrecht, The Netherlands
| | - Clemens Bos
- Department of Radiology and Nuclear Medicine, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht University, HP: E01.132, P.O. Box 85500, 3584 CX, Utrecht, The Netherlands
| | - Wouter Foppen
- Department of Radiology and Nuclear Medicine, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht University, HP: E01.132, P.O. Box 85500, 3584 CX, Utrecht, The Netherlands
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Fang Y, Sun R, Chang J, Zhang C. Diagnostic Value of the HEAD-US-C Scale for the Knees of Severe Hemophilia A Patients. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:347-353. [PMID: 37916658 DOI: 10.1002/jum.16367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/01/2023] [Accepted: 10/15/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES This study aimed to assess the reliability of the Hemophilia Early Arthropathy Detection with Ultrasound in China (HEAD-US-C) scale for the knees of severe hemophilia A (SHA) patients and to determine its diagnostic accuracy for assessments of knee-joint lesions in comparison with magnetic resonance imaging (MRI). METHODS We collected data from 32 knee joints of 21 patients diagnosed with SHA. The knees were evaluated based on the HEAD-US-C scale and the results were compared with the International Prevention Study Group (IPSG) scale. The HEAD-US-C scale was applied independently by two trained ultrasonographers blinded to the MRI results. The IPSG scale was applied independently by two radiologists blinded to the clinical data and ultrasound (US) results. RESULTS The IPSG and HEAD-US-C scales exhibited good to excellent inter-rater reliability. Additionally, there was good to excellent agreement between the US and MRI results for the detection of knee lesions in SHA patients. The sensitivities of US for joint effusion, synovial hyperplasia, cartilage loss, and bone-surface irregularities in the knees of patients were 92.59, 100, 95.45, and 87.50%, respectively. The HEAD-US-C scale was positively correlated with the IPSG scale. CONCLUSIONS US is important for evaluating knee lesions in patients with SHA and may potentially replace MRI.
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Affiliation(s)
- Yunmei Fang
- Department of Ultrasound, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rui Sun
- Department of Ultrasound, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jingxuan Chang
- Department of Ultrasound, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Cuiming Zhang
- Department of Ultrasound, The Second Hospital of Shanxi Medical University, Taiyuan, China
- Department of Ultrasound, Huizhou Third People's Hospital, Guangzhou Medical University, Guangzhou, China
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Brakel BA, Sussman MS, Majeed H, Teitel J, Man C, Rayner T, Weiss R, Moineddin R, Blanchette V, Doria AS. T2 mapping magnetic resonance imaging of cartilage in hemophilia. Res Pract Thromb Haemost 2023; 7:102182. [PMID: 37767061 PMCID: PMC10520564 DOI: 10.1016/j.rpth.2023.102182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 09/29/2023] Open
Abstract
Background In hemophilia, recurrent hemarthrosis may lead to irreversible arthropathy. T2 mapping MRI may reflect cartilage changes at an earlier reversible stage of arthropathy as opposed to structural MRI. Objectives To evaluate interval changes of T2 mapping compared with the International Prophylaxis Study Group (IPSG) structural MRI scores of ankle cartilage in boys with hemophilia receiving prophylaxis. Methods Eight boys with hemophilia A (median age, 13; range, 9-17 years), 7 age- and sex-matched healthy boys (controls, median age, 15; range, 7-16 years). A multiecho spin-echo T2-weighted MRI sequence at 3.0T was used to obtain T2 maps of cartilage of boys with hemophilia and controls. Structural joint status was evaluated using the IPSG MRI score. Results T2 relaxation times of ankle cartilage increased significantly over time in both persons with hemophilia and controls (P = .002 and P = .00009, respectively). Changes in T2 relaxation time strongly correlated with changes in IPSG cartilage scores (rs = 0.93 to rs = 0.78 [P = .0007 to P = .023]), but not with changes in age (P = .304 to P = .840). Responsiveness of T2 relaxation times were higher than that of IPSG cartilage scores, with standardized response means >1.4 for T2 mapping in all regions-of-interest compared with 0.84 for IPSG cartilage scores. Baseline T2 relaxation time strongly correlated with timepoint 2 IPSG cartilage score (rs = 0.93 to rs = 0.82 [P = .001 to P = .012]) and T2 relaxation time (rs = 0.98 to rs = 0.88 [P = .00003 to P = .004]) changes in most regions-of-interest. Conclusion T2 mapping shows sensitivity to biochemical changes in cartilage prior to detectable damage using conventional MRI, offering potential for early detection of bleed-related cartilage damage in boys with hemophilia.
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Affiliation(s)
- Benjamin A. Brakel
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Marshall S. Sussman
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Haris Majeed
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Jerry Teitel
- Division of Hematology/Oncology, St Michael’s Hospital, Toronto, ON, Canada
| | - Carina Man
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Tammy Rayner
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ruth Weiss
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Division of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Victor Blanchette
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea S. Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Mancuso ME, Holstein K, O'Donnell JS, Lobet S, Klamroth R. Synovitis and joint health in patients with haemophilia: Statements from a European e-Delphi consensus study. Haemophilia 2023; 29:619-628. [PMID: 36622258 DOI: 10.1111/hae.14734] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/01/2022] [Accepted: 12/14/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Synovitis, a common feature in haemophilia, is triggered by the presence of blood in joints, and represents the first step towards the development of chronic arthropathy. Synovitis may be detected early by means of ultrasound or magnetic resonance imaging scan; clinical joint scores are less sensitive in this setting. Regular long-term prophylaxis with clotting factor concentrates, as primary prophylaxis and tailored to individual needs, has high efficacy in preventing synovitis. In general, higher factor levels lower bleeding risk, but no direct correlation between factor levels and synovitis incidence has been demonstrated. AIM This study aimed to develop an expert consensus relating to the definition, pathophysiology, diagnosis, prevention, follow-up and treatment of synovitis, recognising its relevance for joint health and taking into account existing knowledge gaps. METHODS A Delphi consensus study was designed and performed. An expert group prepared 22 statements based on existing literature; a wider expert panel subsequently voted on these. RESULTS Retention of panellists was high. Four statements required amending and consensus on all statements was achieved after three rounds of voting. CONCLUSION This e-Delphi consensus study addressed the importance of synovitis in joint health of people with haemophilia and highlighted knowledge gaps in this field. Studies on the natural course of synovitis are lacking and the biological mechanisms underlying this process are not yet fully elucidated. While basic and clinical research proceeds in this field, expert consensus can help guide clinicians in their routine clinical practice, and Delphi methodology is often used to produce best-practice guidelines.
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Affiliation(s)
- Maria Elisa Mancuso
- IRCCS Humanitas Research Hospital, Centre for Thrombosis and Haemorrhagic Diseases, Rozzano, Milan, Italy
| | - Katharina Holstein
- Department of Haematology and Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - James S O'Donnell
- National Coagulation Centre, St. James's Hospital, Dublin, Ireland.,Irish Centre for Vascular Biology, School of Pharmacy and Biomedical Sciences, RCSI, Dublin, Ireland
| | - Sébastien Lobet
- Hematology department, Saint-Luc University Clinics, Avenue Hippocrate 10, Brussels, Belgium.,Neuromusculoskeletal Lab (NMSK), Institute for Experimental and Clinical, Catholic University of Louvain, Avenue Hippocrate, Woluwe-Saint-Lambert, Belgium.,Physical Medicine and Rehabilitation Service, Saint-Luc University Clinics, Avenue Hippocrate 10, Brussels, Belgium
| | - Robert Klamroth
- Vivantes Hospital, Friedrichshain, Berlin, Germany.,Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
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- IRCCS Humanitas Research Hospital, Centre for Thrombosis and Haemorrhagic Diseases, Rozzano, Milan, Italy
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Duan W, Su X, Yu Z, Jiang M, Zhao L, Giannoudis PV, Guo JJ. No Benefit to Platelet-rich Plasma Over Placebo Injections in Terms of Pain or Function in Patients with Hemophilic Knee Arthritis: A Randomized Trial. Clin Orthop Relat Res 2022; 480:2361-2370. [PMID: 35638918 PMCID: PMC10538914 DOI: 10.1097/corr.0000000000002264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/11/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hemophilic knee arthritis is one of the most common presenting symptoms of hemophilia, and its management continues to be challenging to practitioners. Preliminary research has suggested that platelet-rich plasma (PRP) may have short-term efficacy in the treatment of hemophilic knee arthritis, but evidence for this treatment is limited. QUESTIONS/PURPOSES What is the effectiveness of PRP compared with placebo in (1) reducing pain and improving knee joint function (as measured by WOMAC, VAS, and Hemophilia Joint Health Score [HJHS]) and (2) improving quality of life (as measured by SF-36 scores) in patients with hemophilic knee arthritis through 24 months of follow-up? METHODS This was a prospective, parallel-group, double-blinded, single-center, placebo-controlled randomized clinical trial that included participants from a tertiary care center starting January 1, 2019, with follow-up completed on November 30, 2021. Participants were older than 18 years and had hemophilic knee arthritis confirmed by MRI, and they were randomly allocated to interventions in a 1:1 ratio. The investigators were not informed of the randomization sequence generated by the computer. Patient groups were comparable with respect to age, gender, BMI, hemophilia type, and disease severity at baseline. Physicians delivered three sessions (one per week) of a standard intraarticular injection of PRP (n = 95) or placebo (n = 95). The rate of successful blinding was balanced across the groups, which was assessed by asking participants which injection they thought they had received. The primary outcome was the WOMAC score (range 0 to 96; higher scores indicate more pain and worse function; minimum clinically important difference, 6.4 points) over 24 months. Among the 190 patients assigned to PRP or saline injections (mean age 31 ± 7 years), 100% (190) of patients were men). There was no between-group difference in the proportion of patients who completed the trial; 97% (92 of 95) of patients in the PRP group and 94% (89 of 95) of patients in the placebo group completed the trial. The most common adverse events were injection site discomfort 8% (8 of 95) in the PRP group and 4% (4 of 95) in the placebo group. An intention-to-treat analysis was planned, but there was no crossover between groups. All patients were included in the analyses. With 95 patients in each group, the study was powered a priori at 90% to detect a difference in WOMAC score of 6.4 points, which was considered a clinically important difference. RESULTS There were no clinically important differences in the mean WOMAC, VAS pain, HJHS, SF-36, and MRI scores between groups at any timepoint. Intraarticular PRP did not ameliorate function, symptoms, and quality of life in patients with hemophilic knee arthritis. At 24 months of follow-up, the mean difference between the PRP and placebo groups in the WOMAC score was -1 (95% CI -5 to 2; p = 0.42). The mean difference in the VAS pain score was -0.3 (95% CI -0.8 to 0.2; p = 0.19), in the HJHS was -0.6 (95% CI -1.4 to 0.1; p = 0.10), in the SF-36 physical component summary was 0 (95% CI -2 to 3; p = 0.87), and in the SF-36 mental component summary was -1 (95% CI -3 to 2; p = 0.64). The mean differences in the MRI scores of soft tissue and osteochondral subscore were 0.1 (95% CI -0.3 to 0.5; p = 0.59) and -0.3 (95% CI -0.7 to 0.1; p = 0.19), respectively. CONCLUSION Among patients with hemophilic knee arthritis, three intraarticular PRP injections, compared with placebo injections, did not improve hemophilic knee symptoms, function, and quality of life over 24 months. The results of this study do not support the use of PRP injections in patients who have hemophilic knee arthritis. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Weifeng Duan
- Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Xinlin Su
- Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Ziqiang Yu
- Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of the People’s Republic of China, Suzhou, People’s Republic of China
| | - Miao Jiang
- Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of the People’s Republic of China, Suzhou, People’s Republic of China
| | - Lingying Zhao
- Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health of the People’s Republic of China, Suzhou, People’s Republic of China
| | - Peter V. Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Leeds, UK
- National Institute for Health Research, Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - Jiong Jiong Guo
- Department of Orthopedics and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
- Department of Hematology, National Clinical Research Center for Hematologic Disease, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
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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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Padrez K, Shyy W, Gandhi K, Anaya N, Knight R. Identification of Spontaneous Shoulder Hemarthrosis with Point-of-Care Ultrasound in the Emergency Department. Clin Pract Cases Emerg Med 2022; 6:177-179. [PMID: 35701356 PMCID: PMC9197738 DOI: 10.5811/cpcem.2021.7.53408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
Case presentation A 32-year-old man with a history of hemophilia A presented to the emergency department with right shoulder pain, swelling, and decreased range of motion. Discussion Emergency physicians can use ultrasound to quickly and accurately identify hemarthrosis at the bedside.
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Affiliation(s)
- Kevin Padrez
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - William Shyy
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Kavita Gandhi
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Nancy Anaya
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - R. Knight
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
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Verma DK, Kumari P, Kanagaraj S. Engineering Aspects of Incidence, Prevalence, and Management of Osteoarthritis: A Review. Ann Biomed Eng 2022; 50:237-252. [DOI: 10.1007/s10439-022-02913-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/01/2022] [Indexed: 12/14/2022]
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Di Minno MND, Napolitano M, Giuffrida AC, Baldacci E, Carulli C, Boccalandro E, Bruno C, Forneris E, Ricca I, Passeri W, Martinelli M, Rivolta GF, Solimeno LP, Martinoli C, Rocino A, Pasta G. Diagnosis and treatment of chronic synovitis in patients with haemophilia: consensus statements from the Italian Association of Haemophilia Centres. Br J Haematol 2021; 196:871-883. [PMID: 34923621 PMCID: PMC9299781 DOI: 10.1111/bjh.17919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/28/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023]
Abstract
Although synovitis is recognized as a marker of joint disease activity, its periodic assessment is not included in routine clinical surveillance of patients with haemophilia (PwH). In order to evaluate the current knowledge and to identify controversial issues, a preliminary literature search by the Musculoskeletal Committee of the Italian Association of Haemophilia Centres (AICE) has been conducted. Statements have been established and sent to the Italian AICE members to collect their level of agreement or disagreement by a Delphi process. Thirty‐seven consensus recommendations have been drafted. We found a general agreement on the indication to consider the presence of synovitis as a marker of joint disease activity in PwH. Accordingly, there was agreement on the indication to search for synovitis both in patients reporting joint pain and in asymptomatic ones, recognizing ultrasound as the most practical imaging technique to perform periodic joint screening. Interestingly, after detection of synovitis, there was agreement on the indication to modify the therapeutic approach, suggesting prophylaxis in patients treated on demand and tailoring treatment in patients already under prophylaxis. Whereas the need of an early consultation with a physiotherapist is recommended for PwH affected by chronic synovitis, the exact timing for an orthopaedic surgeon consultation is currently unknown.
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Affiliation(s)
| | - Mariasanta Napolitano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | | | - Erminia Baldacci
- Hematology, University Hospital Policlinico Umberto I, Rome, Italy
| | - Christian Carulli
- Department of Health Sciences, Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Elena Boccalandro
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, IRCCS Cà Granda Foundation, Maggiore Hospital Policlinic, Milan, Italy
| | - Clarissa Bruno
- Haemophilia Center and Thrombosis, Policlinico, Bari, Italy
| | - Eleonora Forneris
- Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Irene Ricca
- Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Walter Passeri
- Rehabilitation Service, "Domus Salutis" Casa di Cura, "Teresa Camplani" Foundation, Brescia, Italy
| | - Marco Martinelli
- Rehabilitation Service, "Domus Salutis" Casa di Cura, "Teresa Camplani" Foundation, Brescia, Italy
| | - Gianna Franca Rivolta
- Regional Reference Centre for Inherited Bleeding Disorders, University Hospital of Parma, Parma, Italy
| | - Luigi Piero Solimeno
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Center, IRCCS Cà Granda Foundation, Maggiore Hospital Policlinic, Traumatology and Orthopaedic Unit, Milan, Italy
| | - Carlo Martinoli
- Department of Health Science (DISSAL), University of Genoa, Unit of Radiology and IRCCS San Martino Hospital, Genoa, Italy
| | - Angiola Rocino
- Haemophilia and Thrombosis Centre, Haematology, Ospedale del Mare, ASL Napoli 1 Centro, Naples, Italy
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11
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A semiquantitative color Doppler ultrasound scoring system for evaluation of synovitis in joints of patients with blood-induced arthropathy. Insights Imaging 2021; 12:132. [PMID: 34564747 PMCID: PMC8464640 DOI: 10.1186/s13244-021-01043-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
Background Intra-articular bleeds in patients with inherited bleeding disorders lead to active synovitis which may progress to a chronic state over time. We explored the diagnostic value of color Doppler ultrasound in detecting synovitis in boys with bleeding disorders. Results Sixty boys with hemophilia and 3 boys with type 3 von Willebrand disease aged 5 to 18 years (median 12.3 years) were imaged by gray-scale and color Doppler ultrasound (US) in three centers (Beijing, China [n = 22], Guangzhou, China [n = 12] and Toronto, Canada [n = 29])) in this observational study. Images were independently reviewed by two radiologists blinded to clinical data using a subjective semi-quantitative scoring system and objective measurements of synovial thickness and vascularity. Inter-reader reliability for using subjective versus objective color Doppler US methods for assessing synovial vascularity was excellent for the subjective method and moderate/lower range of substantial for the objective method. Agreement between degree of vascularity on color Doppler and extent of synovial hypertrophy on gray-scale US was overall poor for Canada data and moderate for China data. Correlations between degree of vascularity on color Doppler and synovial hypertrophy on gray-scale US, and clinical constructs (total and itemized HJHS scores and total Pettersson X-ray scores) for assessment of blood-induced arthropathy were all poor. Conclusion Color Doppler US is a valuable scoring method for evaluating reactive synovitis in joints of subjects with inherited bleeding disorders and holds potential for assessing post-bleed reactive synovitis once further information on its association with timing of the joint bleed becomes available in the literature. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-021-01043-0.
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12
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Prasetyo M, Mongan AE, Chozie NA, Prihartono J, Setiawan SI. Hemosiderin deposition evaluation in hemophilic ankle joints: association between US finding and gradient-recalled echo MR imaging sequence. Insights Imaging 2021; 12:107. [PMID: 34318359 PMCID: PMC8316516 DOI: 10.1186/s13244-021-01050-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background Repeated bleeding in hemophilic arthropathy (HA) may result in severe degenerative changes and joint destruction. The gradient-recalled echo (GRE) sequence MR is proved to be the best method to detect hemosiderin deposition. However, MR is not widely available in developing countries, including Indonesia. Some studies have proposed ultrasonography (US) as an alternative tool in evaluating hemophilic joint. However, there is still some disagreement on the ability of US to detect hemosiderin deposition. Objective To evaluate the association between US and GRE-sequence MR imaging in detecting hemosiderin deposition in hemophilic ankle joint. Material and methods A total of 102 sites from 17 ankle joints of 11 boys with severe hemophilia A underwent US examination using a high-frequency linear array transducer. GRE-sequence MR examination was performed in sagittal view consistent with the sites scanned by US. Both examinations were performed on the same day, but MR interpretation was performed blindly at different times. The association between US and GRE-sequences in detecting hemosiderin deposition was analyzed using McNemar’s test. Results Statistical analysis showed a significant association (p value < 0.001) between US and GRE MR in detecting hemosiderin deposition, but the association is weak (R = 0.26). Sensitivity and specificity of US for detecting hemosiderin deposition were 46.84% (95%CI: 35.51–58.40) and 95.65% (95%CI: 78.05–99.89), respectively, with positive predictive value 97.37% (95%CI: 84.29–99.61), negative predictive value 34.38% (95%CI: 29.50–39.60) and accuracy 57.84% (95%CI: 47.66–67.56). Conclusion There was a weak association between US and GRE-sequences in detecting hemosiderin deposition of hemophilic ankle joint.
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Affiliation(s)
- Marcel Prasetyo
- Department of Radiology, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jl. Diponegoro No.71, Jakarta Pusat, DKI Jakarta, 10430, Indonesia.
| | - Ariel Elisa Mongan
- Department of Radiology, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jl. Diponegoro No.71, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Novie Amelia Chozie
- Department of Pediatric, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Joedo Prihartono
- Departement of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Stefanus Imanuel Setiawan
- Department of Radiology, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jl. Diponegoro No.71, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
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13
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Prasetyo M, Moniqa R, Tulaar A, Prihartono J, Setiawan SI. Correlation between Hemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) score and Hemophilia Joint Health Score (HJHS) in patients with hemophilic arthropathy. PLoS One 2021; 16:e0248952. [PMID: 33826621 PMCID: PMC8026024 DOI: 10.1371/journal.pone.0248952] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Hemophilic arthropathy, a condition manifested as joint destruction due to spontaneous joint bleeding, is one complication of hemophiliac patients. Early detection and intervention may improve the outcome, in which ultrasonography can be an ideal modality with the introduction of HEAD-US (Hemophilia Early Arthropathy Detection with Ultrasound) protocol. Studies have shown US benefit in hemophiliac patients, including its potential as an alternative for the Hemophiliac Joint Health Score (HJHS) system. However, many of the studies were conducted in countries with better management of hemophilia using prophylaxis treatment. It is unclear whether HEAD-US has a correlation with HJHS in countries using episodic treatment only, like in Indonesia. PURPOSE This study aimed to explore the correlation between HEAD-US and HJHS in hemophiliac patients with joint problems in Indonesia. MATERIALS AND METHODS A cross-sectional correlation study between HEAD-US and HJHS was performed with primary data collected from 120 hemophilic patients. US examination was performed on elbow, knee and ankle joints using the HEAD-US scoring method by a musculoskeletal radiologist. HJHS examination was conducted by a trained physiotherapist and a medical rehabilitation specialist. All examiner is member of multidisciplinary Hemophiliac Management Team in Cipto Mangunkusumo General Hospital in Jakarta, Indonesia. RESULTS The mean age of the participant was 9.3 (5-14) years old. The median score of HEAD-US was 8 (1-28) with most of the joint abnormalities found on the ankles. The median score of HJHS was 3 (0-35), with most joint abnormalities found on the knees. There was a moderate correlation between HEAD-US and HJHS score (p < 0.05, r = 0.65). CONCLUSION HEAD-US shows a moderate correlation to HJHS in hemophiliac patients who received episodic treatment. HEAD-US can provide additional value in the anatomical evaluation of the joint and could be complementary to HJHS in assessing the joint status in hemophilic patient.
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Affiliation(s)
- Marcel Prasetyo
- Department of Radiology, Faculty of Medicine Universitas Indonesia–Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Ratna Moniqa
- Department of Radiology, Faculty of Medicine Universitas Indonesia–Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Angela Tulaar
- Department of Medical Rehabilitation, Faculty of Medicine Universitas Indonesia–Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Joedo Prihartono
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Stefanus Imanuel Setiawan
- Department of Radiology, Faculty of Medicine Universitas Indonesia–Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
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14
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van Bergen EDP, van Vulpen LFD, Schutgens REG, Mastbergen SC, Lafeber FPJG. Biochemical marker research in hemophilic arthropathy: A systematic review. Blood Rev 2020; 47:100781. [PMID: 33277057 DOI: 10.1016/j.blre.2020.100781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/10/2020] [Accepted: 11/11/2020] [Indexed: 12/14/2022]
Abstract
Hemophilic arthropathy (HA) causes major morbidity. Breakthrough therapies reduce the bleeding frequency tremendously, but well-defined joint outcome assessments with a focus on early changes and subclinical damage are lacking. Biomarkers reflecting joint tissue turnover/inflammation might be useful to predict invalidating arthropathy. This systematic review summarized and categorized publications on blood/urinary biomarkers in HA to provide leads for implementation. A PubMed/EMBASE search was performed on September 9, 2019. All publications were assessed and allocated to one or several BIPED-categories, based on the utility of biomarkers. Of the initial 1307 publications found, 27 were eligible for inclusion. The majority (81%, n = 32/42) was cross-sectional in design, including relatively small numbers of patients (median 44, interquartile range 35-78). Fourteen percent (n = 6/42) investigated dynamic changes around a bleeding or treatment. Only two studies investigated the prognostic value of biomarkers. Most promising biomarkers were serum Coll2-1, COL-18N, COMP, C1,2C, C2M, CS846, MIF, plasma sVCAM-1 and urinary CTX-II. Comparing performances and pooling data was not possible due to heterogeneity. Currently, biomarker research in HA is still in an explorative stage and not yet sufficient for translation into daily practice. Clearly, larger homogeneous longitudinal studies in well-defined populations should be performed for further development.
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Affiliation(s)
- E D P van Bergen
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands.
| | - L F D van Vulpen
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - R E G Schutgens
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - S C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands.
| | - F P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands.
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15
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Majeed H, Ahmed H, Sussman MS, Macgowan C, Rayner T, Weiss R, Feldman BM, Doria AS. Understanding Early Hemophilic Arthropathy in Children and Adolescents Through MRI T 2 Mapping. J Magn Reson Imaging 2020; 53:827-837. [PMID: 33135834 DOI: 10.1002/jmri.27406] [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: 06/16/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Persons with hemophilia experience hemarthrosis, which can lead to cartilage degeneration, causing physical impairment. MRI T2 mapping has the potential to be used as a tool to evaluate early arthropathic changes and cartilage degeneration in patients with hemophilia. PURPOSE To assess the value of MRI-T2 mapping as a tool for investigating the cartilage status of children and adolescents with hemophilic arthropathy. STUDY TYPE Prospective, cross-sectional. SUBJECTS Twenty-eight boys with hemophilia (aged 5-17 years) and 23 healthy boys (aged 7-17 years). FIELD STRENGTH/SEQUENCES A multiecho spin-echo T2 -weighted gradient echo sequence was used on a 3.0T magnet. ASSESSMENT MRI-T2 maps of ankle (tibia-talus) (n = 19) or knee (femur-tibia) (n = 9) cartilage were assessed in hemophilia and healthy groups. An anatomically-based MRI score was also assigned to each ankle/knee. STATISTICAL TESTS Pearson's correlation coefficient (r), linear regression, intraclass correlation coefficient (ICC), and analysis of variance (ANOVA) test. RESULTS Negative associations between age and ankle/knee cartilage T2 relaxation times were found in hemophilia (r = -0.72 [P = 0.03] to -0.55 [P = 0.01]) and healthy (r = -0.84 [P < 0.001] to -0.55 [P = 0.20]) groups. There were nonsignificant associations between ankle cartilage T2 relaxation times and MRI scores (r = -0.15 [P = 0.54] to 0.31 [P = 0.19]). DATA CONCLUSION Results of this clinical investigation emphasize the potential importance of MRI-T2 maps as a tool to understand the functional status of cartilage in children and adolescents with hemophilic arthropathy, while holding promise for the detection of early cartilage degeneration prior to macroscopic characterization by conventional MRI. MRI-T2 mapping may provide novel information that is not reflected in the anatomically-based MRI scoring system. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Haris Majeed
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Humayun Ahmed
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Marshall S Sussman
- Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Christopher Macgowan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tammy Rayner
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ruth Weiss
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, Institute of Health Policy, Management & Evaluation, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrea S Doria
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
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16
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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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17
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Serological biomarkers in hemophilic arthropathy: Can they be used to monitor bleeding and ongoing progression of blood-induced joint disease in patients with hemophilia? Blood Rev 2020; 41:100642. [DOI: 10.1016/j.blre.2019.100642] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/16/2019] [Accepted: 11/12/2019] [Indexed: 12/20/2022]
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18
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Kandagaddala M, Sundaramoorthy M, Keshava SN, Gibikote S, Mahata KM, Kavitha ML, Poonnoose P, Srivastava A. A new and simplified comprehensive ultrasound protocol of haemophilic joints: the Universal Simplified Ultrasound (US-US) protocol. Clin Radiol 2019; 74:897.e9-897.e16. [PMID: 31474302 DOI: 10.1016/j.crad.2019.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/24/2019] [Indexed: 11/17/2022]
Abstract
AIM To present a new protocol to optimise ultrasound (US) assessment of haemophilic arthropathy. MATERIALS AND METHODS Ultrasound of haemophilic arthropathy joints was performed using three different ultrasound protocols, namely, the Toronto-Vellore Comprehensive Ultrasound (TVC-US) protocol, the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US), and the newly developed Universal Simplified Ultrasound (US-US) protocol. Synovial hypertrophy, haemosiderin deposition, effusion, erosion, and cartilage loss were evaluated in 20 joints. The reliability and diagnostic efficiency of these protocols was compared using magnetic resonance imaging (MRI). RESULTS The correlation between the TVC-US and US-US protocols for synovial hypertrophy was excellent: kappa significance (KS) was 1, but was substantial (KS=0.65) with the HEAD-US protocol. For effusion, both the TVC-US and the HEAD-US protocols had substantial correlation with the US-US protocol (KS=0.7 and 0.6 respectively). The correlation for erosion and cartilage loss was excellent between the TVC-US and the US-US with MRI (KS=1), but poor (KS=0) with the HEAD-US protocol. The US-US protocol also had good interobserver agreement (KS=1). CONCLUSION The accuracy of the US-US protocol is comparable to the TVC-US protocol and MRI and is superior to the HEAD-US protocol in the assessment of haemophilic arthropathy.
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Affiliation(s)
| | | | - S N Keshava
- Radiology, Christian Medical College, Vellore, India.
| | - S Gibikote
- Radiology, Christian Medical College, Vellore, India
| | - K M Mahata
- Radiology, Christian Medical College, Vellore, India
| | - M L Kavitha
- Haematology, Christian Medical College, Vellore, India
| | - P Poonnoose
- Orthopaedics, Christian Medical College, Vellore, India
| | - A Srivastava
- Haematology, Christian Medical College, Vellore, India
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19
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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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20
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Volland LM, Zhou JY, Barnes RFW, Kruse-Jarres R, Steiner B, Quon DV, Bailey C, Hughes TH, Moore RE, Chang EY, von Drygalski A. Development and Reliability of the Joint Tissue Activity and Damage Examination for Quantitation of Structural Abnormalities by Musculoskeletal Ultrasound in Hemophilic Joints. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1569-1581. [PMID: 30371941 DOI: 10.1002/jum.14846] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/24/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Musculoskeletal ultrasound (US) is used increasingly to examine hemophilic arthropathy. However, quantitative algorithms to document findings are lacking. We developed and sought to validate a protocol quantifying hemophilic joint abnormalities. METHODS Thirty-one patients with hemophilia were examined serially for 2 years with musculoskeletal US (≈600 joint examinations and ≈6000 images). Based on the spectrum of pathologies, a quantitative algorithm, named Joint Tissue Activity and Damage Examination (JADE), was developed for soft tissue and osteochondral measurements, including power Doppler, using nominal group techniques. To study intra- and inter-rater reliability, 8 musculoskeletal US-experienced hemophilia providers performed anatomic landmark recognition and tissue measurements on 86 images with arthropathic changes, with repetition 1 month later. Twenty-three musculoskeletal US-inexperienced providers performed similar assessments. Inter-operator reliability was established by 6 musculoskeletal US-experienced hemophilia providers, each acquiring images and JADE assessments of 3 hemophilic arthropathic joints. A radiologist and musculoskeletal sonographer functioned as adjudicators. The statistical analysis was performed with the intraclass correlation coefficient (ICC), Fleiss κ, and Cohen κ where appropriate. RESULTS The musculoskeletal US-experienced providers showed excellent intra-and inter-rater reliability for tissue measurements (ICCs, 0.94-0.96). Agreement was good to excellent for landmark recognition (Fleiss κ, 0.87-0.94). Inter-operator reliability was excellent for measurements and landmark recognition (ICC, 0.90; Fleiss κ, 1.0). Agreement with adjudicators was mostly good to excellent. Musculoskeletal US-inexperienced providers showed excellent inter-rater reliability for measurements (ICC, 0.96) and moderate agreement for landmark recognition (Fleiss κ, 0.58). CONCLUSIONS The JADE protocol appears feasible for quantifying hemophilic intra-articular abnormalities. Musculoskeletal US-trained hemophilia providers showed high intra-rater, inter-rater, and inter-operator reliability, supporting JADE as a protocol for clinical management and research.
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Affiliation(s)
- Lena M Volland
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Jenny Y Zhou
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Richard F W Barnes
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
| | - Rebecca Kruse-Jarres
- Washington Center for Bleeding Disorders at Bloodworks Northwest, Seattle, Washington, USA
| | - Bruno Steiner
- Washington Center for Bleeding Disorders at Bloodworks Northwest, Seattle, Washington, USA
| | - Doris V Quon
- Orthopedic Hemophilia Treatment Center, Orthopedic Institute for Children, Los Angeles, California, USA
| | - Cindy Bailey
- Orthopedic Hemophilia Treatment Center, Orthopedic Institute for Children, Los Angeles, California, USA
| | - Tudor H Hughes
- Department of Radiology, University of California, San Diego, California, USA
| | - Randy E Moore
- General Musculoskeletal Imaging, Inc, Cincinnati, Ohio, USA
| | - Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Annette von Drygalski
- Department of Medicine, Division of Hematology/Oncology, University of California, San Diego, California, USA
- Department of Molecular Medicine, Scripps Research Institute, La Jolla, California, USA
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21
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García-Massó X, Ye-Lin Y, Garcia-Casado J, Querol F, Gonzalez LM. Assessment of haemophilic arthropathy through balance analysis: a promising tool. Comput Methods Biomech Biomed Engin 2019; 22:418-425. [PMID: 30714398 DOI: 10.1080/10255842.2018.1561877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The purpose of this study was to develop a tool able to distinguish between subjects who have haemophilic arthropathy in lower limbs and those who do not by analyzing the centre of pressure displacement. The second objective was to assess the possible different responses of haemophiliacs and healthy subjects by creating a classifier that could distinguish between both groups. Fifty-four haemophilic patients (28 with and 26 without arthropathy) and 23 healthy subjects took part voluntarily in the study. A force plate was used to measure postural stability. A total of 276 centre of pressure displacement parameters were calculated under different conditions: unipedal/bipedal balance with eyes open/closed. These parameters were used to design a Quadratic Discriminant Analysis classifier. The arthropathy versus non-arthropathy classifier had an overall accuracy of 97.5% when only 10 features were used in its design. Similarly, the haemophiliac versus non-haemophiliac classifier had an overall accuracy of 97.2% when only 7 features were used. In conclusion, an objective haemophilic arthropathy in lower limbs evaluation system was developed by analyzing centre of pressure displacement signals. The haemophiliac vs. non-haemophiliac classifier designed was also able to corroborate the existing differences in postural control between haemophilic patients (with and without arthropathy) and healthy subjects.
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Affiliation(s)
- Xavier García-Massó
- a Departamento de Didáctica de la Expresión Musical Plástica y Corporal , Universidad de Valencia , Valencia , España
| | - Yiyao Ye-Lin
- b Centro de Investigación e Innovación en Bioingeniería (CI2B) , Universitat Politècnica de València , Valencia , España
| | - Javier Garcia-Casado
- b Centro de Investigación e Innovación en Bioingeniería (CI2B) , Universitat Politècnica de València , Valencia , España
| | - Felipe Querol
- c Departamento de Fisioterapia , Universidad de Valencia , Valencia , España.,d Unidad de Trombosis y Hemostasia Hospital Universitario La FE , Valencia , España
| | - Luis-Millan Gonzalez
- e Departamento de Educación Física y Deportiva , Universidad de Valencia , Valencia , España
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22
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Roh YY, Choi YH, Park M, Hahn JH, Kim SH, Shin YJ, Hahn SM, Lee HY, Park JM, Hong JP, Lyu CJ, Han JW. Joint Health Status in Hemophilia Patients Using Hemophilia Joint Health Score and Pettersson Score. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2018. [DOI: 10.15264/cpho.2018.25.2.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yun Young Roh
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Young Ha Choi
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Mina Park
- Department of Nursing, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Jung Hwa Hahn
- Department of Nursing, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Sun Hee Kim
- Department of Nursing, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Yoon Jung Shin
- Department of Nursing, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Seung Min Hahn
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Hee Young Lee
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Jung Min Park
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Jun Pyo Hong
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Chuhl Joo Lyu
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Jung Woo Han
- Department of Pediatric Hematology-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
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23
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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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24
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Li J, Guo XJ, Ding XL, Lyu BM, Xiao J, Sun QL, Li DS, Zhang WF, Zhou JC, Li CP, Yang RC. [Clinical application and optimization of HEAD-US quantitative ultrasound assessment scale for hemophilic arthropathy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2018; 39:132-136. [PMID: 29562448 PMCID: PMC7342577 DOI: 10.3760/cma.j.issn.0253-2727.2018.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Indexed: 01/05/2023]
Abstract
Objective: To assess the feasibility of HEAD-US scale in the clinical application of hemophilic arthropathy (HA) and propose an optimized ultrasound scoring system. Methods: From July 2015 to August 2017, 1 035 joints ultrasonographic examinations were performed in 91 patients. Melchiorre, HEAD-US (Hemophilic Early Arthropathy Detection with UltraSound) and HEAD-US-C (HEAD-US in China) scale scores were used respectively to analyze the results. The correlations between three ultrasound scales and Hemophilia Joint Health Scores (HJHS) were evaluated. The sensitivity differences of the above Ultrasonic scoring systems in evaluation of HA were compared. Results: All the 91 patients were male, with median age of 16 (4-55) years old, including 86 cases of hemophilia A and 5 cases hemophilia B. The median (P25, P75) of Melchiorre, HEAD-US and HEAD-US-C scores of 1 035 joints were 2(0,6), 1(0,5) and 2(0,6), respectively, and the correlation coefficients compared with HJHS was 0.747, 0.762 and 0.765 respectively, with statistical significance (P<0.001). The positive rates of Melchiorre, HEAD-US-C and HEAD-US scale score were 63.0% (95%CI 59.7%-65.9%), 59.5% (95%CI 56.5%-62.4%) and 56.6% (95%CI 53.6%-59.6%) respectively, and the difference was statistically significant (P<0.001). Even for 336 cases of asymptomatic joints, the positive rates of Melchiorre, HEAD-US-C and HEAD-US scale score were 25.0% (95%CI 20.6%-29.6%), 17.0% (95%CI 12.6%-21.1%) and 11.9% (95%CI 8.4%-15.7%) respectively, and the difference was statistically significant (P<0.001). There were significant changes (P<0.05) in the ultrasonographic score of HA before and after onset of hemorrhage in 107 joints of 40 patients. The difference in variation amplitude of HEAD-US-C scores and HEAD-US scores before and after joint bleeding was statistically significant (P<0.001). Conclusion: Compared with Melchiorre, there were similar good correlations between HEAD-US, HEAD-US-C and HJHS. HEAD-US ultrasound scoring system is quick, convenient and simple to use. The optimized HEAD-US-C scale score is more sensitive than HEAD-US, especially for patients with HA who have subclinical state, which make up for insufficiency of sensitivity in HEAD-US scoring system.
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Affiliation(s)
- J Li
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
| | | | | | | | | | | | | | | | | | | | - R C Yang
- Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China
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25
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Brunel T, Lobet S, Deschamps K, Hermans C, Peerlinck K, Vandesande J, Pialat JB. Reliability and clinical features associated with the IPSG MRI tibiotalar and subtalar joint scores in children, adolescents and young adults with haemophilia. Haemophilia 2017; 24:141-148. [DOI: 10.1111/hae.13368] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/29/2022]
Affiliation(s)
- T. Brunel
- Department of Radiology; Hôpital de la Croix-rousse; Hospices Civils de Lyon; Lyon France
| | - S. Lobet
- Secteur des Sciences de la Santé; Institut de Recherche Expérimentale et Clinique; Neuromusculoskeletal Lab (NMSK); Université Catholique de Louvain; Brussels Belgium
- Cliniques Universitaires Saint-Luc; Service d'hématologie; Brussels Belgium
- Cliniques Universitaires Saint-Luc; Service de médecine physique et réadaptation; Brussels Belgium
| | - K. Deschamps
- Department of Rehabilitation Sciences; Musculoskeletal Rehabilitation Research Group; KU Leuven; Leuven Belgium
- Laboratory for Clinical Motion Analysis; University Hospital Pellenberg; UZ Leuven; Leuve Belgium
- Department of Podiatry; Parnasse-ISEI; Brussels Belgium
- Department of Podiatry; Artevelde University College Ghent; Ghent Belgium
| | - C. Hermans
- Cliniques Universitaires Saint-Luc; Service d'hématologie; Brussels Belgium
| | - K. Peerlinck
- Department of Cardiovascular sciences; KULeuven; Leuven Belgium
- Haemophilia Center; University Hospitals Leuven; Leuven Belgium
| | - J. Vandesande
- Haemophilia Center; University Hospitals Leuven; Leuven Belgium
| | - J.-B. Pialat
- Department of Radiology; Centre Hospitalier Lyon-Sud; Hospices Civils de Lyon; Pierre-Bénite France
- Université Claude Bernard Lyon 1; Université de Lyon; Lyon France
- INSERM; UMR 1033 LYOS; Lyon France
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26
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Chung SW, Seo YJ, You CW, Chun TJ, Jung KJ, Kim JH. A Combined Ultrasonographic and Conventional Radiographic Assessment of Hemophilic Arthropathy. Indian J Hematol Blood Transfus 2017; 33:380-388. [PMID: 28824241 DOI: 10.1007/s12288-016-0717-4] [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: 08/19/2015] [Accepted: 08/10/2016] [Indexed: 11/24/2022] Open
Abstract
Hemophilic arthropathy (HA) can be diagnosed by a number of imaging studies. However, it is difficult with conventional radiography to find soft tissue structures around joints, and ultrasonography has limited effectiveness in evaluating internal bony structures. We attempt to determine whether a combination of ultrasonography for soft tissue around joints and conventional radiography for bony structures can be used as a cost-effective imaging tool for evaluating HA and whether it reflects the functional status of hemophilic patients. Thirty-six males (median age 16.5 years; severe 34, mild 2) with hemophilia were recruited. We evaluated the severity of HA using combined imaging score that consisted of modified Petterson X-ray score (mPXS) and the modified ultrasonographic score (mUS). Joint impairment was clinically assesses using the World Federation of Hemophilia-Physical Examination (WFH-PE) scale and the Hemophilic joint health score (HJHS). We assessed the Hemophilia activities list (HAL) for the functional level. We performed a comparative analysis between the combined imaging score and the joint impairment scores as well as the functional scores. The mean mUS was 4.97 ± 3.99 points, and the mean mPXS was 2.85 ± 2.91 points; the combined imaging score was 7.83 ± 6.31 points. The combined imaging score was significantly correlated with the HJHS (p = 0.006) and WFH-PE scores (p = 0.019) as well as the HAL score (p = 0.002). A combination of conventional radiological and ultrasongraphic study might ultimately impact the optimal evaluation of joint impairment and functional status in hemophilic patients.
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Affiliation(s)
- So-Won Chung
- Department of Physical Medicine and Rehabilitation, Hemophilia Treatment Center of Eulji University Hospital, Eulji University School of Medicine, #95, Dunsanse-Ro, Seo-Gu, Daejeon, 302-799 Republic of Korea
| | - Young-Jae Seo
- Department of Physical Medicine and Rehabilitation, Hemophilia Treatment Center of Eulji University Hospital, Eulji University School of Medicine, #95, Dunsanse-Ro, Seo-Gu, Daejeon, 302-799 Republic of Korea
| | - Chur Woo You
- Department of Pediatrics, Hemophilia Treatment Center of Eulji University Hospital, Eulji University School of Medicine, #95, Dunsanse-Ro, Seo-Gu, Daejeon, 302-799 Republic of Korea
| | - Tong-Jin Chun
- Department of Radiology, Hemophilia Treatment Center of Eulji University Hospital, Eulji University School of Medicine, #95, Dunsanse-Ro, Seo-Gu, Daejeon, 302-799 Republic of Korea
| | - Kang-Jae Jung
- Department of Physical Medicine and Rehabilitation, Hemophilia Treatment Center of Eulji University Hospital, Eulji University School of Medicine, #95, Dunsanse-Ro, Seo-Gu, Daejeon, 302-799 Republic of Korea
| | - Jae-Hyung Kim
- Department of Physical Medicine and Rehabilitation, Hemophilia Treatment Center of Eulji University Hospital, Eulji University School of Medicine, #95, Dunsanse-Ro, Seo-Gu, Daejeon, 302-799 Republic of Korea
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27
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Di Minno MND, Pasta G, Airaldi S, Zaottini F, Storino A, Cimino E, Martinoli C. Ultrasound for Early Detection of Joint Disease in Patients with Hemophilic Arthropathy. J Clin Med 2017; 6:E77. [PMID: 28758960 PMCID: PMC5575579 DOI: 10.3390/jcm6080077] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/12/2017] [Accepted: 07/24/2017] [Indexed: 11/16/2022] Open
Abstract
Joint bleeding represents the most commonly reported type of hemorrhage in patients affected by hemophilia. Although the widespread use of prophylaxis has been able to significantly reduce the onset of arthropathy, it has been shown that a non-negligible percentage of patients develop degenerative changes in their joints despite this type of treatment. Thus, periodic monitoring of the joint status in hemophilia patients has been recommended to identify early arthropathic changes and prevent the development or progression of hemophilic arthropathy. Ultrasound (US) has proven able to detect and quantify the most relevant biomarkers of disease activity (i.e., joint effusion and synovial hypertrophy) and degenerative damages (i.e., osteo-chondral changes) by means of scoring scales of increasing disease severity. In the present review, we have detailed major literature evidence about the use of US to assess joint status in hemophilia patients, focusing on signs of disease activity and degenerative damages. In particular, we have discussed recent evidence about "point-of-care" use patients with hemophilia.
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Affiliation(s)
| | - Gianluigi Pasta
- Dipartimento di Ortopedia-Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Sonia Airaldi
- Radiologia III-IRCCS San Martino-IST-DISSAL, Università di Genova, 16132 Genova, Italy.
| | - Federico Zaottini
- Radiologia III-IRCCS San Martino-IST-DISSAL, Università di Genova, 16132 Genova, Italy.
| | - Antonio Storino
- Department of Public Health, Federico II University, 80131 Naples, Italy.
| | - Ernesto Cimino
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Carlo Martinoli
- Radiologia III-IRCCS San Martino-IST-DISSAL, Università di Genova, 16132 Genova, Italy.
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28
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Bakeer N. A new wave in the evaluation of haemophilic arthropathy. Haemophilia 2017; 23:491-493. [DOI: 10.1111/hae.13199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 01/29/2023]
Affiliation(s)
- N. Bakeer
- Indiana Hemophilia and Thrombosis Center; Indianapolis IN USA
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29
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Soliman M, Daruge P, Dertkigil SSJ, De Avila Fernandes E, Negrao JR, de Aguiar Vilela Mitraud S, Sakuma ETI, Fernandes ARC, Zhang N, Huo A, Li YJ, Zhou F, Rodrigues BM, Mohanta A, Blanchette VS, Doria AS. Imaging of haemophilic arthropathy in growing joints: pitfalls in ultrasound and MRI. Haemophilia 2017; 23:660-672. [PMID: 28574216 DOI: 10.1111/hae.13249] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/28/2022]
Abstract
The purpose of this review was to summarize the current knowledge on the utilization of magnetic resonance imaging (MRI) and ultrasound (US) for assessing arthropathy in children and adolescents with haemophilia and to recognize the limitations of each imaging modality and pitfalls in the diagnosis of soft tissue and osteochondral abnormalities. Awareness of MRI and US limitations and pitfalls in the assessment of joints in persons with haemophilia is essential for accurate diagnosis and optimal management of haemophilic arthropathy.
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Affiliation(s)
- M Soliman
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - P Daruge
- Institute of Radiology, Universidade de Sao Paulo (USP), Sao Paulo, SP, Brazil
| | - S S J Dertkigil
- Department of Radiology, Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
| | - E De Avila Fernandes
- Department of Radiology, Universidade de Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - J R Negrao
- Department of Radiology, Universidade de Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | | | - E T I Sakuma
- Department of Radiology, Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
| | - A R C Fernandes
- Department of Radiology, Universidade de Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - N Zhang
- Department of Radiology, Beijing Children's Hospital, Beijing, China
| | - A Huo
- Department of Radiology, Beijing Children's Hospital, Beijing, China
| | - Y-J Li
- Department of Radiology, Nanfang Hospital, Guangzhou, China
| | - F Zhou
- Department of Radiology, Nanfang Hospital, Guangzhou, China
| | - B M Rodrigues
- Institute of Radiology, Universidade de Sao Paulo (USP), Sao Paulo, SP, Brazil
| | - A Mohanta
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - V S Blanchette
- Department of Hematology & Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - A S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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30
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Ligocki CC, Abadeh A, Wang KC, Adams-Webber T, Blanchette VS, Doria AS. A systematic review of ultrasound imaging as a tool for evaluating haemophilic arthropathy in children and adults. Haemophilia 2017; 23:598-612. [PMID: 28429878 DOI: 10.1111/hae.13163] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2016] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to semi-quantitatively assess the evidence on the value of ultrasound (US) for assessment of haemophilic arthropathy (HA) in children and adults based on the following questions: (1) Does early diagnosis of pathological findings, using available US techniques, impact the functional status of the joint? (2) Do current available US techniques have the ability to accurately detect pathological changes in target joints in haemophilic patients? (3) Does treatment (prophylaxis) improve US evidence of haemophilic arthropathy in children and adults? (4) Is there any association between various US scoring systems and other clinical/radiological constructs? Of the 6880 citations identified searching databases such as MEDLINE, Embase, CENTRAL and Web of Science, 20 articles investigating either the diagnostic accuracy of US and/or US scanning protocols and scoring systems for assessment of HA met the inclusion criteria for the study. Of these, 14 articles evaluating the diagnostic accuracy of US were assessed by two independent reviewers for reporting quality using the Standards for Reporting of Diagnostic Accuracy (STARD) tool and for methodological quality using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Using STARD, 1/14 studies (7%) was scored as of high reporting quality and 8/14 (57%), of moderate quality. Assessment with QUADAS-2 reported 2/14 (14%) studies as having high methodological quality and 6/14 (43%) as having moderate quality. There is fair evidence (Grade B) to recommend US as an accurate technique for early diagnosis of HA, to demonstrate that US scores correlate with clinical/US constructs and to prove an association between US findings and functional status of the joint. However, there is insufficient evidence (Grade I) to conclude that US-detectable findings in HA are sensitive to changes in therapy.
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Affiliation(s)
- C C Ligocki
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - A Abadeh
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - K C Wang
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - T Adams-Webber
- Hospital Library & Archive Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - V S Blanchette
- Department of Hematology & Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - A S Doria
- Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq, Curitiba, Brazil
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31
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Abstract
: There is some controversy over the use of cryotherapy. Low temperatures (Temp) could interfere with coagulation and increase the risk of bleeding. We sought to examine the effect of cryotherapy on joint swelling, temperature, friction, and inflammatory condition after experimental hemarthrosis. The left knee of 23 albino rabbits, 10 in heparin Ice, five in citrate Ice, four in heparin control, and four in citrate control were injected intraarticularly with 1 ml of blood. In total, four animals were considered to be in normal control group. Joint diameter, Temp, and ultrasonography were assessed before the blood injection. One day after the intraarticular blood injection, cryotherapy was applied 4 times per day for 4 consecutive days. Joint diameter and Temp were measured twice a day. After cessation of the protocol, joint diameter and Temp were assessed and sonography performed, animals euthanized, the friction test was performed and the synovial membrane collected, respectively. Joint diameter and Temp were increased after the intraarticular blood injection. Cryotherapy was capable of reducing the swelling and Temp. Ultrasonography findings approved the positive effect of cryotherapy on joint swelling. The proinflammatory tumor necrosis factor (TNF-α) reduced by cryotherapy in both cryotherapy groups but Interleukin 1β was only reduced in heparin group. Interleukin-4 increased in heparin Ice group that was in comparison with TNF-α reduction. Cryotherapy reduced joint swelling and has a positive effect on controlling joint inflammation and Temp.
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32
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Scaddan E, Rowell J, O'Leary S. A preliminary case series evaluating the safety and immediate to short-term clinical benefits of joint mobilization in hemophilic arthritis of the lower limb. J Man Manip Ther 2016; 25:208-214. [PMID: 28912633 DOI: 10.1080/10669817.2016.1256117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Arthritis resulting from recurrent intra-articular bleeding in individuals with hemophilia can be severely debilitating due to joint pain and stiffness with subsequent loss of mobility and function. Very limited studies have investigated the potential benefits of joint mobilization for this condition. This case series is a preliminary investigation of safety, as well as immediate and short-term clinical benefits, associated with gentle knee and ankle joint mobilization in people with hemophilic arthropathy. METHODS A single intervention of joint mobilization was applied to the affected knees and/or ankles of 16 individuals with severe or moderate hemophilia within a public hospital setting. Adverse events, as well as immediate (pain-free passive joint range, Timed Up and Go Test with maximum pain numerical rating scale) and short-term (Lower Extremity Functional Scale) effects of the intervention were evaluated with a repeated measures ANOVA. RESULTS There were no adverse events. An immediate significant increase was observed in pain-free passive ankle joint range of motion (p < 0.05) following the joint mobilization intervention. DISCUSSION The findings of this case series suggest that gentle joint mobilization techniques may be safely considered as part of a multimodal management approach for hemophilic arthropathy.
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Affiliation(s)
- Emma Scaddan
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Australia.,Physiotherapy Department, Curtin University, Perth, Australia.,Queensland Haemophilia Centre, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Australia
| | - John Rowell
- Queensland Haemophilia Centre, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Australia
| | - Shaun O'Leary
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland Health, Brisbane, Australia.,NHMRC CCRE (Spinal Pain, Injury and Health), SHRS, University of Queensland, Brisbane, Australia
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33
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Fischer K, Poonnoose P, Dunn AL, Babyn P, Manco-Johnson MJ, David JA, van der Net J, Feldman B, Berger K, Carcao M, de Kleijn P, Silva M, Hilliard P, Doria A, Srivastava A, Blanchette V. Choosing outcome assessment tools in haemophilia care and research: a multidisciplinary perspective. Haemophilia 2016; 23:11-24. [DOI: 10.1111/hae.13088] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2016] [Indexed: 01/23/2023]
Affiliation(s)
- K. Fischer
- Van Creveldkliniek; University Medical Center Utrecht; Utrecht The Netherlands
| | - P. Poonnoose
- Department of Orthopaedics; Christian Medical College; Vellore Tamil Nadu India
| | - A. L. Dunn
- Division of Hematology and Oncology; Nationwide Children's Hospital and The Ohio State University; Columbus OH USA
| | - P. Babyn
- Department of Medical Imaging; University of Saskatchewan and Saskatoon Health Region Royal University Hospital; Saskatoon SK Canada
| | - M. J. Manco-Johnson
- Section of Hematology/Oncology/Bone Marrow Transplantation; Department of Pediatrics; University of Colorado Anschutz Medical Campus and Children's Hospital; Aurora CO USA
| | - J. A. David
- Department of PMR; Christian Medical College; Vellore Tamil Nadu India
| | - J. van der Net
- Child Health Services; Child Development and Exercise Center; University Medical Center and Children's Hospital; Utrecht The Netherlands
| | - B. Feldman
- Division of Rheumatology; Department of Paediatrics and Child Health Evaluative Sciences; Research Institute; Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - K. Berger
- Division of Haematology/Oncology; University Hospital of Munich; Munich Germany
| | - M. Carcao
- Division of Haematology/Oncology; Department of Paediatrics and Child Health Evaluative Sciences; Research Institute; Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - P. de Kleijn
- Department of Rehabilitation, Nursing Science and Sports, and Van Creveldkliniek; University Medical Center Utrecht; Utrecht The Netherlands
| | - M. Silva
- Department of Orthopaedic Surgery; Orthopaedic Institute for Children; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - P. Hilliard
- Department of Rehabilitation; Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - A. Doria
- Department of Diagnostic Imaging; Research Institute; Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - A. Srivastava
- Department of Haematology; Christian Medical College; Vellore Tamil Nadu India
| | - V. Blanchette
- Division of Haematology/Oncology; Department of Paediatrics and Child Health Evaluative Sciences; Research Institute; Hospital for Sick Children; University of Toronto; Toronto ON Canada
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Christensen KR, Roepstorff K, Petersen M, Wiinberg B, Hansen AK, Kjelgaard-Hansen M, Nielsen LN. Visualization of haemophilic arthropathy in F8−/−rats by ultrasonography and micro-computed tomography. Haemophilia 2016; 23:152-162. [DOI: 10.1111/hae.13080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2016] [Indexed: 12/18/2022]
Affiliation(s)
- K. R. Christensen
- Translational Haemophilia Pharmacology; Novo Nordisk A/S; Maaloev Denmark
- Veterinary Disease Biology; University of Copenhagen; Frederiksberg Denmark
| | - K. Roepstorff
- Histology & Bioimaging; Novo Nordisk A/S; Maaloev Denmark
| | - M. Petersen
- Histology & Bioimaging; Novo Nordisk A/S; Maaloev Denmark
| | - B. Wiinberg
- Translational Haemophilia Pharmacology; Novo Nordisk A/S; Maaloev Denmark
| | - A. K. Hansen
- Veterinary Disease Biology; University of Copenhagen; Frederiksberg Denmark
| | | | - L. N. Nielsen
- Translational Haemophilia Pharmacology; Novo Nordisk A/S; Maaloev Denmark
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Hermans C, Dolan G, Jennings I, Windyga J, Lobet S, Rodríguez-Merchán EC, Di Minno MND, Jiménez-Yuste V, O'Mahony B. Managing Haemophilia for Life: 5th Haemophilia Global Summit. Eur J Haematol 2015; 95 Suppl 78:1-25. [PMID: 26350039 DOI: 10.1111/ejh.12617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The 5th Haemophilia Global Summit was held in Barcelona, Spain, in September 2014. The programme was designed by an independent Scientific Steering Committee of haemophilia experts and explored issues relevant to the practical management of haemophilia, as well as key opportunities and challenges for care in the future. The topics outlined in this supplement were selected by the Scientific Steering Committee for their relevance to improving haemophilia care globally. In this supplement from the meeting, Gerry Dolan explores pharmacokinetics and dynamics in haemophilia, and Gerry Dolan and Ian Jennings jointly address the role of the laboratory in haemophilia care. The potential benefits of low-dose prophylaxis regimens for people with haemophilia in the developing world are reviewed by Jerzy Windyga, and the question of whether 'Future haemophilia research should be undertaken in the developing world' is debated by Jerzy Windyga and Cedric Hermans. Management strategies for ankle arthropathy are discussed by Sébastien Lobet and E. Carlos Rodríguez-Merchán, and the use of ultrasound for the early detection of haemophilic arthropathy is addressed by Matteo Nicola Dario Di Minno and Víctor Jiménez-Yuste. Finally, the role of patients in the future of haemophilia care is reviewed by Brian O'Mahony.
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Affiliation(s)
| | | | - Ian Jennings
- UK National External Quality Assessment Service, Sheffield, UK
| | - Jerzy Windyga
- Institute of Haematology and Transfusion Medicine, Warsaw, Poland
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Strike KL, Iorio A, Jackson S, Lawson W, Scott L, Squire S, Chan AK. Point of care ultrasonography in haemophilia care: recommendations for training and competency evaluation. Haemophilia 2015. [PMID: 26208178 DOI: 10.1111/hae.12767] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K L Strike
- Hamilton Niagara Regional Hemophilia Program, Hamilton Health Sciences, Hamilton, ON, Canada
| | - A Iorio
- Hamilton Niagara Regional Hemophilia Program, Hamilton Health Sciences, Hamilton, ON, Canada.,Clinical Epidemiology and Biostatistics McMaster University, Hamilton, ON, Canada
| | - S Jackson
- Hemophilia Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada
| | - W Lawson
- McMaster University Mohawk College Institute of Applied Health Sciences, Hamilton, ON, Canada
| | - L Scott
- Hamilton Niagara Regional Hemophilia Program, Hamilton Health Sciences, Hamilton, ON, Canada
| | - S Squire
- Hemophilia Program - Adult Division, St. Paul's Hospital, Vancouver, BC, Canada
| | - A K Chan
- Hamilton Niagara Regional Hemophilia Program, Hamilton Health Sciences, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Timmer MA, Pisters MF, de Kleijn P, de Bie RA, Fischer K, Schutgens RE. Differentiating between signs of intra-articular joint bleeding and chronic arthropathy in haemophilia: a narrative review of the literature. Haemophilia 2015; 21:289-296. [DOI: 10.1111/hae.12667] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2015] [Indexed: 12/20/2022]
Affiliation(s)
- M. A. Timmer
- Van Creveldkliniek; University Medical Center Utrecht; Utrecht the Netherlands
- Physical Therapy Research; Department of Rehabilitation, Nursing Science and Sport; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
| | - M. F. Pisters
- Physical Therapy Research; Department of Rehabilitation, Nursing Science and Sport; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care; Leidsche Rijn Julius Health Care Centers; Utrecht the Netherlands
| | - P. de Kleijn
- Van Creveldkliniek; University Medical Center Utrecht; Utrecht the Netherlands
- Physical Therapy Research; Department of Rehabilitation, Nursing Science and Sport; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
| | - R. A. de Bie
- Physical Therapy Research; Department of Rehabilitation, Nursing Science and Sport; Brain Center Rudolf Magnus; University Medical Center Utrecht; Utrecht the Netherlands
- Department of Epidemiology; CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
| | - K. Fischer
- Van Creveldkliniek; University Medical Center Utrecht; Utrecht the Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; Utrecht the Netherlands
| | - R. E. Schutgens
- Van Creveldkliniek; University Medical Center Utrecht; Utrecht the Netherlands
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38
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Kidder W, Nguyen S, Larios J, Bergstrom J, Ceponis A, von Drygalski A. Point-of-care musculoskeletal ultrasound is critical for the diagnosis of hemarthroses, inflammation and soft tissue abnormalities in adult patients with painful haemophilic arthropathy. Haemophilia 2015; 21:530-7. [PMID: 25623830 DOI: 10.1111/hae.12637] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2014] [Indexed: 01/11/2023]
Abstract
We previously demonstrated in adult patients with haemophilia (PWH) that hemarthrosis is present in only ~1/3rd of acutely painful joints by using point-of-care-musculoskeletal ultrasound (MSKUS). Therefore, other unrecognized tissue abnormalities must contribute to pain. Using high resolution MSKUS, employing grey scale and power Doppler, we sought to retrospectively (i) investigate soft tissue abnormalities in painful haemophilic joints and (ii) to determine to what extent MSKUS findings, functional or radiographic joint scores correlate with biomarkers of inflammation in PWH. Findings were correlated with Hemophilia Joint Health Scores (HJHS), Pettersson scores, high sensitivity C-reactive protein and von Willebrand factor activity and antigen levels. A total of 65 MSKUS examinations for acute and chronic joint pains were performed for 34 adult haemophilia patients, mostly for chronic joint pains (72.3%). The most prominent findings (66.5%) pertained to inflammatory soft tissue changes including synovitis, tendinitis, enthesitis, bursitis and fat pad inflammation. Effusions were present in 55.5% and 46.8% of MSKUS performed for acute and chronic pain, respectively. Of those, 90.0% were bloody during acute and 47.6% during persistent pains. While inflammatory biomarkers correlated well with overall HJHS and total Pettersson scores (P < 0.05), they did not differ between those patients with synovitis and those without. MSKUS is emerging as an important modality to diagnose treatable musculoskeletal abnormalities contributing to pain in haemophilic arthropathy, and therefore seems critical for a personalized approach to haemophilia care. The role of biomarkers in this setting remains less clear and requires further investigation.
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Affiliation(s)
- W Kidder
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - S Nguyen
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, San Diego, CA, USA.,College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - J Larios
- Department of Rehabilitation and Physical Therapy, University of California San Diego, San Diego, CA, USA
| | - J Bergstrom
- Division of Epidemiology, Family and Preventive Medicine, University of California San Diego, San Diego, CA, USA
| | - A Ceponis
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - A von Drygalski
- Division of Hematology/Oncology, Department of Medicine, University of California San Diego, San Diego, CA, USA.,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
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39
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van Vulpen LFD, van Meegeren MER, Roosendaal G, Jansen NWD, van Laar JM, Schutgens REG, Mastbergen SC, Lafeber FPJG. Biochemical markers of joint tissue damage increase shortly after a joint bleed; an explorative human and canine in vivo study. Osteoarthritis Cartilage 2015; 23:63-9. [PMID: 25219667 DOI: 10.1016/j.joca.2014.09.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/26/2014] [Accepted: 09/02/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluation whether biomarkers of joint damage are sensitive to change shortly after a joint bleed in hemophilia patients and in a canine model of blood-induced joint damage. METHODS Blood and urine samples were collected from 10 hemophilia patients after they reported a joint bleed: within 2 days, after 3-5 days, and 12-14 days. Additionally, 90 days after the bleed a blood and urine sample was taken and considered to represent baseline condition. Commercial serum and urine biomarker assays were performed: urinary C-terminal telopeptide of type II collagen (uCTX-II), serum cartilage oligomeric matrix protein (sCOMP), serum cartilage cleavage product C1,2C, and serum chondroitin sulfate 846 (sCS846). The same panel of biomarkers was explored in dogs (n = 7) after induction of a first joint bleed by intra-articular blood injections. Biosamples were collected at baseline, day 2, 1 and 2 weeks later. RESULTS In hemophilia patients, levels of uCTX-II and sCS846 increased 5 days after joint bleeding when compared with baseline (+52%; P = 0.021 and +14%; P = 0.011, respectively). In dogs, uCTX-II increased statistically significant from day 2 to day 7 (from 75% to 155% of baseline; P = 0.018), and sCOMP from baseline to day 2 (+46%; P = 0.028). CONCLUSIONS This study demonstrates that biochemical markers of joint tissue damage increase shortly after a single joint bleed, both in humans with established hemophilic arthropathy (HA) and in an animal model of joint damage upon a first joint bleed. Biomarkers might be useful in monitoring the impact of a joint bleed and in evaluation of treatment of such bleeds.
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Affiliation(s)
- L F D van Vulpen
- Van Creveldkliniek, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands; Department of Rheumatology & Clinical Immunology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
| | - M E R van Meegeren
- Van Creveldkliniek, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands; Department of Rheumatology & Clinical Immunology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
| | - G Roosendaal
- Van Creveldkliniek, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
| | - N W D Jansen
- Van Creveldkliniek, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands; Department of Rheumatology & Clinical Immunology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
| | - J M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
| | - R E G Schutgens
- Van Creveldkliniek, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
| | - S C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
| | - F P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
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Doria AS, Zhang N, Lundin B, Hilliard P, Man C, Weiss R, Detzler G, Blanchette V, Moineddin R, Eckstein F, Sussman MS. Quantitative versus semiquantitative MR imaging of cartilage in blood-induced arthritic ankles: preliminary findings. Pediatr Radiol 2014; 44:576-86. [PMID: 24522564 DOI: 10.1007/s00247-013-2872-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 11/25/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Recent advances in hemophilia prophylaxis have raised the need for accurate noninvasive methods for assessment of early cartilage damage in maturing joints to guide initiation of prophylaxis. Such methods can either be semiquantitative or quantitative. Whereas semiquantitative scores are less time-consuming to be performed than quantitative methods, they are prone to subjective interpretation. OBJECTIVE To test the feasibility of a manual segmentation and a quantitative methodology for cross-sectional evaluation of articular cartilage status in growing ankles of children with blood-induced arthritis, as compared with a semiquantitative scoring system and clinical-radiographic constructs. MATERIALS AND METHODS Twelve boys, 11 with hemophilia (A, n = 9; B, n = 2) and 1 with von Willebrand disease (median age: 13; range: 6-17), underwent physical examination and MRI at 1.5 T. Two radiologists semiquantitatively scored the MRIs for cartilage pathology (surface erosions, cartilage loss) with blinding to clinical information. An experienced operator applied a validated quantitative 3-D MRI method to determine the percentage area of denuded bone (dAB) and the cartilage thickness (ThCtAB) in the joints' MRIs. Quantitative and semiquantitative MRI methods and clinical-radiographic constructs (Hemophilia Joint Health Score [HJHS], Pettersson radiograph scores) were compared. RESULTS Moderate correlations were noted between erosions and dAB (r = 0.62, P = 0.03) in the talus but not in the distal tibia (P > 0.05). Whereas substantial to high correlations (r range: 0.70-0.94, P < 0.05) were observed between erosions, cartilage loss, HJHS and Pettersson scores both at the distal tibia and talus levels, moderate/borderline substantial (r range: 0.55-0.61, P < 0.05) correlations were noted between dAB/ThCtAB and clinical-radiographic constructs. CONCLUSION Whereas the semiquantitative method of assessing cartilage status is closely associated with clinical-radiographic scores in cross-sectional studies of blood-induced arthropathy, quantitative measures provide independent information and are therefore less applicable for that research design.
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Affiliation(s)
- Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada, M5G1X8,
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41
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Cross S, Vaidya S, Fotiadis N. Hemophilic Arthropathy: A Review of Imaging and Staging. Semin Ultrasound CT MR 2013; 34:516-24. [DOI: 10.1053/j.sult.2013.05.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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42
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Auerswald G, Šalek SZ, Benson G, Elezović I, Lambert T, Morfini M, Pasi J, Remor E, Santagostino E, Salaj P, Ljung R. Beyond patient benefit: clinical development in hemophilia. Hematology 2013; 17:1-8. [DOI: 10.1179/102453312x13221316477372] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Günter Auerswald
- Klinikum Bremen-Mitte, Professor Hess Children’s Hospital, Bremen, Germany
| | - Silva Zupančić Šalek
- National Haemophilia and Thrombophilia Centre, Division of Haematology, Department of Internal Medicine, University Hospital Centre Rebro, Zagreb, Croatia
| | - Gary Benson
- Northern Ireland Haemophilia Comprehensive Care Centre, Belfast, Northern Ireland, UK
| | - Ivo Elezović
- Institute of HaematologyClinical Centre of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Thierry Lambert
- Hemophilic Care CenterBicêtre AP-HP Hospital and Faculté de Médecine Paris XI, Paris, France
| | - Massimo Morfini
- Agency for Hemophilia – Reference Center for Inherited Bleeding Disorders of Tuscany, Department of Emergency and Reception, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - John Pasi
- Haemophilia Centre, Barts and the London School of Medicine and Dentistry, London, UK
| | - Eduardo Remor
- Department of Psychobiology and HealthFaculty of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Santagostino
- IRCCS Cà Granda Foundation, Maggiore Hospital Policlinico and University of Milan, Italy
| | - Peter Salaj
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Rolf Ljung
- Lund University, Department of Paediatrics and Malmö Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
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43
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Sierra Aisa C, Lucía Cuesta JF, Rubio Martínez A, Fernández Mosteirín N, Iborra Muñoz A, Abío Calvete M, Guillén Gómez M, Moretó Quintana A, Rubio Félix D. Comparison of ultrasound and magnetic resonance imaging for diagnosis and follow-up of joint lesions in patients with haemophilia. Haemophilia 2013; 20:e51-7. [DOI: 10.1111/hae.12268] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2013] [Indexed: 11/28/2022]
Affiliation(s)
- C. Sierra Aisa
- Hospital Universitario de Cruces; San Vicente de Barakaldo Spain
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44
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Affiliation(s)
- E Berntorp
- Malmö Centre for Thrombosis and Haemostasis, Skåne University Hospital Malmö, Malmö, Sweden
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45
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Colvin B, Dolan G, Martinoli C, O'Mahony B. Pfizer-sponsored satellite symposium at the European Haemophilia Consortium (EHC) congress. Understanding health outcomes: focus on haemophilia. Eur J Haematol 2013:1-9. [PMID: 23570445 DOI: 10.1111/ejh.12093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
At the 25th Annual European Haemophilia Consortium (EHC) Congress held in Prague, Czech Republic, in October 2012, Pfizer sponsored a satellite symposium entitled: 'Understanding Health Outcomes: Focus on Haemophilia'. Co-chaired by Brian O'Mahony (President of the EHC) and Brian Colvin (Director Medical and Scientific Affairs Haemophilia, Pfizer, Europe), the symposium examined the role of outcomes in haemophilia care in an age of evidence-based medicine. The current global economic recession has inevitably directed the spotlight of governments and health economists towards the cost of healthcare. Now is the time to focus on which outcome measures are important to collect in order to validate these costs, and how to standardise collection and reporting measures to support services and patient care. Using the United Kingdom (UK) as a case study, where initiatives in data collection and reporting are being trialled, Gerry Dolan opened the discussion by highlighting the importance of a multidisciplinary approach to ensuring success. Looking at specific measures of haemophilia healthcare, Carlo Martinoli focused on joint scores as a clinical outcome measure that can be systematically collected, and the role of ultrasound in bringing joint assessment into the hands of the haemophilia treater at the 'bedside'. Brian O'Mahony then brought the discussion full circle by highlighting the role of the patient in the multidisciplinary care team and the importance of the patient voice in the assessment and critical examination of health outcomes by payers and government bodies. The meeting closed by summarising the importance of collaboration between patients and their carers; physicians; members of the healthcare team; and budget holders in advancing haemophilia care, to provide the best possible care with optimum long-term outcomes for people with haemophilia.
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Affiliation(s)
- Brian Colvin
- Haemophilia Pfizer Specialty Care, Pfizer Europe, Rome, Italy.
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46
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Abstract
Physical medicine and rehabilitation aim to evaluate, diagnose and treat disability in haemophiliac patients, while preventing injury or deterioration. They also aim to maintain the greatest degree of functional capacity and independence in patients with haemophilia, or to return them to that state. Rehabilitation, together with clotting factor replacement therapy, has revolutionized the management of these patients in developed countries and reduced their morbidity/mortality rates. A knowledge of the musculoskeletal signs and symptoms of haemophilia is essential for providing a treatment which is suitable and customized. Physical medicine and rehabilitation techniques, which are based on physical means, are intended to reduce the impact which these injuries and their consequences or sequelae can have on the quality of life of patients with haemophilia. Under ideal haemostatic control conditions (primary prophylaxis), people with haemophilia could achieve good physical condition which will allow them to enjoy both physical activity and a daily life without limitations. Currently, children undergoing primary prophylaxis are quite close to this ideal situation. For these physical activities to be carried out, the safest possible situations must be sought.
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47
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Ceponis A, Wong-Sefidan I, Glass CS, von Drygalski A. Rapid musculoskeletal ultrasound for painful episodes in adult haemophilia patients. Haemophilia 2013; 19:790-8. [PMID: 23672827 DOI: 10.1111/hae.12175] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2013] [Indexed: 11/29/2022]
Abstract
Little objective information exists about musculoskeletal bleeding patterns in haemophilic arthropathy. Bleeding is assumed to be the cause of painful joints or muscles. Clotting factor treatment is provided empirically, but often does not alleviate pain. We hypothesized that perception of pain aetiology is unreliable, and introduced point-of-care high-resolution musculoskeletal ultrasound (MSKUS) to differentiate intra-articular bleeds vs. joint inflammation, and intra-muscle bleeds vs. other regional pain syndromes. To assess painful musculoskeletal episodes in adult haemophiliacs, we used rapid MSKUS, employing grey scale and power Doppler examination. Forty episodes in 30 adult haemophiliacs were evaluated. Thirty three of the 40 episodes were patient-reported as 'bleeding', five as 'arthritis-type' pain and two as 'undecided'. Of the 33 bleeding reports, only 12 were confirmed by MSKUS; the other episodes revealed other pathology. In contrast, three of five perceived arthritis flares were reclassified as bleeds. Similarly, physician assessment was incorrect in 18 of 40 instances. Swelling and warmth were present in approximately half of confirmed bleeding and non-bleeding episodes, and therefore not useful clinically. Few of the painful episodes were symptom controlled at the time of MSKUS. Management changed based on objective imaging findings in >70% of episodes, which resulted in symptom improvement >60% of the time. Significant discrepancies exist between MSKUS findings and patient/physician-perceived pain classification as bleeding or other musculoskeletal symptoms. Current practice of prescribing clotting factor or conservative measures based on pain perception seems inadequate and suggests that point-of-care imaging should be included into modern haemophilia care.
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Affiliation(s)
- A Ceponis
- Department of Medicine, Division of Rheumatology, University California San Diego, San Diego, CA 92103-8651, USA
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48
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Abstract
Hemarthrosis, the hallmark of severe hemophilia, is the major cause of serious bleeding events, disability and reduced quality of life in patients with factor VIII or factor IX deficiency. Joint bleeding is one of the greatest challenges confronting individuals treating hemophilia, and its economic impact is enormous. This article reviews the current management of hemophilic joint bleeding and discusses the potential impact of novel therapies.
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Affiliation(s)
- Mindy L Simpson
- Department of Pediatrics, Hemophilia and Thrombophilia Center, Rush University Medical Center, Chicago, IL, USA.
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49
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van Galen K, Mauser-Bunschoten E, Leebeek F. Hemophilic arthropathy in patients with von Willebrand disease. Blood Rev 2012; 26:261-6. [DOI: 10.1016/j.blre.2012.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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50
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Abstract
Standardized outcome measures allow us to be more objective when measuring the impact of therapy on persons with haemophilia. Many excellent measures have been developed for haemophilia - especially in the health domains of structure and function, and activities; excellent health status/health-related quality-of-life tools have also been developed for haemophilia. Studies from other disciplines suggest that the use of standardized outcome measures in daily practice leads to improvement in quality of care. Because of their potential complexity, measures must be chosen that are practical for use in clinic. Future research should be focussed on the best ways to implement the use of standardized outcome measures in haemophilia practice.
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Affiliation(s)
- B M Feldman
- Institute of Health Policy Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada.
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