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Ucero-Lozano R, Donoso-Úbeda E, Cuesta-Barriuso R, Pérez-Llanes R. Immersive VR movement visualization in patients with hemophilic knee arthropathy: randomized, multicenter, single-blind clinical trial. Disabil Rehabil 2024:1-8. [PMID: 39244653 DOI: 10.1080/09638288.2024.2401138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 08/30/2024] [Accepted: 08/31/2024] [Indexed: 09/10/2024]
Abstract
PURPOSE To evaluate the efficacy of an immersive movement visualization intervention in patients with hemophilia and hemophilic knee arthropathy. MATERIALS AND METHODS Randomized, single-blind clinical study. Twenty-eight patients with hemophilia were recruited. Patients were randomized to an experimental group (four weeks of immersive movement visualization) and a control group (no intervention). The intensity of pain, pressure pain threshold in the knee, tibialis anterior muscle, lower back level, conditioned pain modulation, range of knee motion, and lower limb functionality were evaluated. RESULTS There were statistically significant differences in the intergroup effect on knee pain intensity (F = 23.71; p < 0.001) and lower limb functionality (F = 7.11; p = 0.003). 42.86% of the patients in the experimental group exhibited changes greater than the minimum detectable change (MDC) in functionality. 39.29% of the patients subject to the intervention experienced changes greater than the MDC in the knee pressure pain threshold. CONCLUSIONS Immersive motion visualization can improve the intensity of joint pain and functionality in patients with hemophilic knee arthropathy. Functionality, pressure pain threshold, and pain intensity improved in those patients who conducted immersive movement visualization.Implications for rehabilitationImmersive visualization of movement significantly improves intensity of joint pain, functionality, pressure pain threshold, joint health, and conditioned pain modulation in patients with hemophilic knee arthropathy.The fact that it is a therapy without potential aversive stimuli makes it a possible access pathway for patients with high levels of kinesiophobia and/or catastrophism.This low-cost, home-based technology allows its use in patients far from hemophilia reference centers or with difficult access to physiotherapy treatments.The immersive visualization of movement influences the democratization of treatment, in accordance with the WHO's Sustainable Development Goal 3 (health and well-being for all).
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Affiliation(s)
- Roberto Ucero-Lozano
- Department of Physiotherapy, European University of Madrid, Madrid, Spain
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain
| | - Elena Donoso-Úbeda
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain
- Department of Physiotherapy, Catholic University San Antonio-UCAM Murcia, Murcia, Spain
| | - Rubén Cuesta-Barriuso
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Oviedo, Spain
| | - Raúl Pérez-Llanes
- InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), Oviedo, Spain
- Department of Physiotherapy, University of Murcia, Murcia, Spain
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2
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Ghosn Y, Alam R, El Annan T, Haddad G, Khdhir M, Farhat L, Hafez R, Moukaddam H, Khoury N, Khouzami R. Para-articular and intra-articular soft tissue lesions: Radiologic-pathologic correlation. Eur J Radiol 2024; 181:111718. [PMID: 39357286 DOI: 10.1016/j.ejrad.2024.111718] [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: 06/25/2023] [Revised: 08/27/2024] [Accepted: 09/01/2024] [Indexed: 10/04/2024]
Abstract
Articular masses comprise various disease entities including benign or malignant proliferative processes and other non-neoplastic processes such as infection, deposition diseases, vascular malformations, and other lesions. Many diseases that lead to intra-articular or para-articular masses have distinct imaging features, particularly on MRI. Radiologists can localize masses to the joint space by knowing the articular anatomy and can reach a suggested diagnosis by looking at precise imaging findings. In this review article, we first define the concept of articular space (intraarticular, para-articular) and the normal joint anatomy and histology. We provide a general and comprehensive approach for evaluation of articular lesions on MRI. We then describe specific imaging and histologic features of typical benign and malignant soft tissue articular neoplasms and some non-neoplastic mimickers; and provide a radio-pathologic correlation of the different described entities.
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Affiliation(s)
- Youssef Ghosn
- Department of Diagnostic Radiology, American University of Beirut, Lebanon.
| | | | - Tamara El Annan
- Department of Diagnostic Radiology, American University of Beirut, Lebanon.
| | | | - Mihran Khdhir
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, USA
| | - Lama Farhat
- Department of Pathology, American University of Beirut, Lebanon.
| | - Rayan Hafez
- Department of Pathology, American University of Beirut, Lebanon.
| | - Hicham Moukaddam
- Department of Diagnostic Radiology, American University of Beirut, Lebanon.
| | - Nabil Khoury
- Department of Diagnostic Radiology, American University of Beirut, Lebanon.
| | - Riad Khouzami
- Department of Diagnostic Radiology, American University of Beirut, Lebanon.
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Shane AM, Reeves CL, Nguyen GB, Ferrise TD, Calaj PM. Soft Tissue Pathology. Clin Podiatr Med Surg 2023; 40:381-395. [PMID: 37236677 DOI: 10.1016/j.cpm.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A wide spectrum of pathologies can lead to soft tissue abnormalities within the ankle joint. Many of these disorders can develop into irreversible joint degeneration if left untreated. Arthroscopy is frequently used to treat these soft tissue conditions such as instability, synovitis, impingement, arthrofibrosis, and other inflammatory disorders in the rearfoot and ankle. In general, the etiology of these ankle soft tissue disorders can be classified as traumatic, inflammatory, and congenital/neoplastic. Overall, the goal of diagnosing and treating soft tissue pathologies of the ankle is to restore anatomic and physiologic motion, reduce pain, optimize functional return to activity, and decrease the chance of recurrence while minimizing complications.
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Affiliation(s)
- Amber M Shane
- Department of Podiatric Surgery Advent Health System, Advent Health East Orlando Podiatric Surgery Residency, Upperline Health, 250 North Alafaya Trail Suite 1115, Orlando, FL 32828, USA; Department of Podiatric Surgery, Advent Health East Orlando Podiatric Surgery Residency, 250 North Alafaya Trail Suite 1115, Orlando, FL 32828, USA.
| | - Christopher L Reeves
- Department of Podiatric Surgery, Advent Health East Orlando Podiatric Surgery Residency, 250 North Alafaya Trail Suite 1115, Orlando, FL 32828, USA; Rothman Institute, Foot and Ankle Surgery, Advent Health East Orlando Hospital, 7727 Lake Underhill Road, Orlando, FL 32822, USA
| | - Garrett B Nguyen
- Department of Podiatric Surgery, Advent Health East Orlando Podiatric Surgery Residency, 250 North Alafaya Trail Suite 1115, Orlando, FL 32828, USA
| | - Thomas D Ferrise
- Department of Podiatric Surgery, Advent Health East Orlando Podiatric Surgery Residency, 250 North Alafaya Trail Suite 1115, Orlando, FL 32828, USA
| | - Phillip M Calaj
- Department of Podiatric Surgery, Advent Health East Orlando Podiatric Surgery Residency, 250 North Alafaya Trail Suite 1115, Orlando, FL 32828, USA
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Chantrain VA, Guillaume S, Foubert A, Meeus M, Lobet S, Lambert C, Lecouvet F, Hermans C, Roussel NA. Discordance between joint pain and imagery severity in the ankle joint and contributors of lower limb activity limitations in adults with haemophilia: A cross-sectional study. Haemophilia 2023; 29:648-657. [PMID: 36696283 DOI: 10.1111/hae.14749] [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: 10/28/2022] [Revised: 12/19/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION People with haemophilia (PwH) suffer from knee and ankle joint pain, but the association with structural damage remains underexplored. They report activity limitations but it is unclear which factors contribute to lower limb activity limitations (LL-AL). AIMS This study aimed (i) to analyse the association between ankle joint pain and structure and (ii) explore the contribution of haemophilia-related, individual and psychological factors to LL-AL in PwH. METHODS This study included 104 moderate/severe PwH. Ankle pain intensity was assessed with a numeric rating scale and pain sensitivity with algometry (pressure pain threshold (PPTA )). Ankle structure was assessed with MRI (IPSG-MRI) and ultrasound (HEAD-US), joint health with the Haemophilia Joint Health Score (HJHS). The HAL-LOWCOM subscore evaluated LL-AL. A Spearman correlation analysed the correlation between ankle pain and structure. The contribution of haemophilia-related factors (joint health, overall pain (Brief Pain Inventory-Pain Severity (BPI-PS)), functional status (2-Minute-Walking-Distance, Timed Up and Go); individual factors (age, BMI) and psychological factors (fear and avoidance beliefs over physical activity (FABQ-PA) and work (FABQ-Work), anxiety and depression) to LL-AL was explored using a regression analysis. RESULTS Only low correlations were found between ankle pain intensity and structure (IPSG-MRI, HEAD-US). PPTA was unrelated to structure. Altogether, HJHS, overall pain (BPI-PS), FABQ-Work and age explained 69% of HAL-LOWCOM variance, with 65% explained by the combination of HJHS and BPI-PS. CONCLUSION No meaningful associations were found between ankle pain and structural damage, suggesting that other factors may contribute to PwH's ankle pain. In contrast, mainly haemophilia-related factors explained LL-AL variance.
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Affiliation(s)
- Valérie-Anne Chantrain
- Research Group (MOVANT), Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group.,Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium.,Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Sylvain Guillaume
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Anthe Foubert
- Research Group (MOVANT), Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group.,Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Mira Meeus
- Research Group (MOVANT), Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.,Pain in Motion, International Research Group.,Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Sébastien Lobet
- Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium.,Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCLouvain), Brussels, Belgium.,Secteur de kinésithérapie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Catherine Lambert
- Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Frédéric Lecouvet
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Cedric Hermans
- Haemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Nathalie Anne Roussel
- Research Group (MOVANT), Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
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Ray A, Colville JG, Hartley R, Rowbotham E. The musculoskeletal manifestations of haemophilia: a review of the imaging findings. Clin Radiol 2022; 77:730-737. [PMID: 35985846 DOI: 10.1016/j.crad.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/29/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
Haemophilia is a common hereditary cause of bleeding diathesis and the musculoskeletal system is frequently affected. Repeated episodes of haemarthrosis initiate a cascade towards haemophilic arthropathy, a disabling and deforming joint disease with both degenerative and inflammatory features, which include articular cartilage loss, bone erosions, and synovitis. Haemophilic pseudotumour and intra-muscular haematoma make up the remainder of the musculoskeletal manifestations of this systemic condition. Radiological assessment is vital in the assessment and follow-up of these haemophilic complications and MRI is the reference standard. This article summarises the radiological findings relevant to the diagnosis and monitoring of this complex patient group.
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Affiliation(s)
- A Ray
- Department of Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK.
| | - J G Colville
- Department of Radiology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| | - R Hartley
- Department of Radiology, The James Cook University Hospital, South Tees NHS Trust, Middlesbrough TS43BW, UK
| | - E Rowbotham
- Department of Radiology, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Chapel Town Road, Leeds LS7 4SA, UK
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Lee HW, Park CH, Bae DK, Song SJ. How much preoperative flexion contracture is a predictor for residual flexion contracture after total knee arthroplasty in hemophilic arthropathy and rheumatoid arthritis? Knee Surg Relat Res 2022; 34:20. [PMID: 35395934 PMCID: PMC8994339 DOI: 10.1186/s43019-022-00146-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background Although total knee arthroplasty (TKA) in hemophilic arthropathy (HA) or rheumatoid arthritis (RA) can improve functional ability, the postoperative range of motion (ROM) and prosthesis durability are reduced compared with those in osteoarthritic patients. Aim We aimed to compare (1) the pre- and postoperative flexion contracture after TKA in HA and RA, (2) the threshold of preoperative flexion contracture as a predictor of residual contracture > 15° after TKA, and (3) the survival rate. Methods Data from a consecutive cohort comprising 48 TKAs in HA and 92 TKAs in RA were retrospectively reviewed. The degree of flexion contracture was analyzed. Through receiver operating characteristics analysis, we aimed to determine the cutoff value of preoperative flexion contracture that increases the risk of residual contracture > 15° after TKA and compare the cutoff value in HA and RA. The survival rate was evaluated based on life table analysis and the Kaplan–Meier method. Results The degree of preoperative flexion contracture was not significantly different. The degree of postoperative residual flexion contracture was 5.6° in the HA group and 1.4° in the RA group, respectively (p < 0.001). The cutoff value of preoperative flexion contracture for residual contracture of > 15° at last-follow up was 25.0° in the HA group and 32.5° in the RA group. The 5- and 12-year survival rates were 96% and 87% in the HA and 99% and 95% in the RA group, respectively (n.s.). Conclusions The postoperative residual flexion contracture was greater and the cutoff value of preoperative flexion contracture for residual contracture was smaller in the HA group than the RA group. Appropriate intra- and postoperative care to avoid postoperative residual contracture is required in HA patients. Level of evidence III.
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Affiliation(s)
- Hyun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-702, Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-702, Korea.
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7
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Cantarelli Rodrigues T, Serfaty A. MRI Assessment of Benign Tumor And Tumor-Like Synovial Diseases. Semin Roentgenol 2022; 57:191-200. [DOI: 10.1053/j.ro.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/11/2022]
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8
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Visweshwar N, Zhang Y, Joseph H, Jaglal M, Ayala I. Chronic pain in patients with hemophilia: is it preventable? Blood Coagul Fibrinolysis 2020; 31:346-352. [PMID: 32815911 DOI: 10.1097/mbc.0000000000000939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
: Current management of chronic pain in patients with hemophilia (PWH) focuses on pain relief with analgesics and symptom control. The clinical practice of managing chronic pain in PWH varies considerably across hemophilia treatment centers. Here, we aim to study the appropriate intervention of hemophilic arthropathy for prevention and treatment of chronic pain in PWH. Medline, Embase, Cochrane databases were searched for randomized controlled trials, and the European Hemophilia Therapy Standardization Board, The World Federation of Hemophilia, Nordic Hemophilia Guidelines, American Society of the International Pain Physicians and the Medical and Scientific Advisory Council guidelines were studied through November 2019 for chronic pain in PWH for a narrative review. We found no standardized approach for the prevention and management of chronic pain in PWH. Evidence suggests that prophylactic factor concentrate therapy, programmed exercise and educational intervention may help PWH manage their chronic pain.
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Affiliation(s)
| | - Yumeng Zhang
- Department Internal Medicine, University of South Florida
| | | | | | - Irmel Ayala
- Hemophilia Treatment Center, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
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Puetz J. Nano-evidence for joint microbleeds in hemophilia patients. J Thromb Haemost 2018; 16:1914-1917. [PMID: 30007042 DOI: 10.1111/jth.14242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/06/2018] [Indexed: 11/26/2022]
Abstract
The concept of joint microbleeding in hemophilia patients was first proposed over 10 years ago. This was based on unexpected abnormalities found in medical imaging studies of asymptomatic joints. Since then, there have been no published studies confirming the presence of joint microbleeds. This critique will review the evidence for and against joint microbleeding in hemophilia patients and the potential implications.
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Affiliation(s)
- J Puetz
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, MO, USA
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10
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Vyzantiadis TA, Charizopoulou M, Adamidou F, Karras S, Goulis D, Karagiannis A, Garipidou V, Vakalopoulou S, Anagnostis P. The effect of monthly ibandronate on bone mineral density and bone turnover markers in patients with haemophilia A and B and increased risk for fracture. Thromb Haemost 2017; 110:257-63. [DOI: 10.1160/th13-01-0030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/30/2013] [Indexed: 12/23/2022]
Abstract
SummaryHaemophilia A and B have been associated with increased prevalence of low bone mineral density (BMD). However, no study has so far evaluated the effects of anti-osteoporotic therapy on BMD in haemophilia. The primary endpoint of this prospective study was to estimate the effect of 12-month therapy of oral ibandronate 150 mg/ month on BMD in patients with haemophilia A and B. Secondary endpoint was its effect on turnover markers (BTM) of bone resorption [serum C-terminal telopeptide of type 1 collagen (sCTX), tartrate-resistant acid phosphatase band 5b] and bone formation (osteocalcin and bone-specific alkaline phosphatase. Ten adult patients with T-score < −2.5 SD or Z-score < −2 and/or increased risk of fracture according to FRAX model were included. All received 1,000 mg/day calcium carbonate with 800 IU/d cholecalciferol. Males with haemophilia A (n=7) or B (n=3) (mean age 43.5 ± 13.5 years) were studied. Ibandronate resulted in an increase in lumbar BMD (from 0.886 ± 0.169 to 0.927 ± 0.176 g/cm2, 4.7%, p=0.004). No change in BMD of total hip (from 0.717 ± 0.128 to 0.729 ± 0.153 g/cm2, p=0.963) or femoral neck (0.741 ± 0.135 to 0.761 ± 0.146 g/cm2, p=0.952) was noticed. Ibandronate led to a decrease in sCTX (from 0.520 ± 0.243 to 0.347 ± 0.230 ng/ml, −29.9%, p=0.042). No change was observed in other BTM. Ibandronate was generally well-tolerated. In conclusion, ibandronate significantly improved BMD in lumbar spine and reduced bone resorption in adults with haemophilia at increased risk of fracture. Its effect on hip BMD and bone formation markers was not significant.
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11
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Anagnostis P, Vakalopoulou S, Christoulas D, Paschou SA, Papatheodorou A, Garipidou V, Kokkoris P, Terpos E. The role of sclerostin/dickkopf-1 and receptor activator of nuclear factor kB ligand/osteoprotegerin signalling pathways in the development of osteoporosis in patients with haemophilia A and B: A cross-sectional study. Haemophilia 2017; 24:316-322. [PMID: 29194852 DOI: 10.1111/hae.13384] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 12/19/2022]
Abstract
AIM Haemophilia A and B are associated with reduced bone mineral density (BMD). The aim of this study was to assess circulating sclerostin and dickkopf-1 (Dkk-1), (inhibitors of osteoblastic differentiation), as well as the receptor activator of nuclear factor kB ligand (RANKL)/osteoprotegerin (OPG) system (the major regulator of osteoclastogenesis), in patients with haemophilia (PWH), their possible correlations with clinical risk factors and the effect of ibandronate on these markers. METHODS Eighty-nine male PWH (mean age 45.9 ± 15.3 years) and 30 age-matched healthy male controls participated. BMD was assessed by DXA. Sclerostin, Dkk-1, RANKL and OPG were measured in serum of patients, controls, as well as in ten patients receiving oral ibandronate (150 mg/mo), at baseline and after 12 months. RESULTS Patients with haemophilia had lower circulating sclerostin (median ± IQR: 47.4 ± 26.93 vs 250 ± 250 pmol/L, P < .001), Dkk-1 (21.24 ± 17.18 vs 26.16 ± 15.32pg/mL, P = .04) and higher levels of RANKL (0.23 ± 0.03 vs 0.04 ± 0.03 pmol/L, P = .001), RANKL/OPG ratio (0.063 ± 0.25 vs 0.005 ± 0.11, P = .001) compared with controls. Patients with low BMD had higher OPG concentrations compared to those with normal BMD. Sclerostin and RANKL/OPG correlated positively with BMD. Patients with severe haemophilia had lower sclerostin concentrations compared with those with mild or moderate disease. The degree of arthropathy negatively correlated with sclerostin and Dkk-1 levels. PWH who received ibandronate showed a decrease in serum Dkk-1 without any significant effect on sclerostin and RANKL/OPG. CONCLUSIONS Patients with haemophilia present increased osteoclastic activity coupled with compensatory increased osteoblastic activity. Ibandronate did not affect RANKL/OPG ratio, but it decreased Dkk-1.
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Affiliation(s)
- P Anagnostis
- Haemophilia Centre of Northern Greece, 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Vakalopoulou
- Haemophilia Centre of Northern Greece, 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Christoulas
- Department of Haematology, 251 General Air Force Hospital, Athens, Greece
| | - S A Paschou
- Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Papatheodorou
- Department of Haematology, 251 General Air Force Hospital, Athens, Greece
| | - V Garipidou
- Haemophilia Centre of Northern Greece, 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P Kokkoris
- Department of Endocrinology, 251 General Air Force Hospital, Athens, Greece
| | - E Terpos
- Department of Clinical Therapeutics, School of Medicine, Alexandra General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Wang SX, Guan Y, Nie YB, Li HY, Sun BY, Wang XY, Yang RC. [Retrospectively analysis of the difference of bleeding frequency and hemophilic arthropathy between hemophilia A and hemophilia B patients]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:404-409. [PMID: 28565740 PMCID: PMC7354189 DOI: 10.3760/cma.j.issn.0253-2727.2017.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Indexed: 11/26/2022]
Abstract
Objective: To analyze the difference of bleeding frequency, plain radiographic (X-ray) , risk factors in hemophilic arthropathy progression and the Arnold-Hilgartner classification. Methods: A retrospective study was conducted in 211 hemophilia patients hospitalized in our medical center between January 2007 and December 2010, some patients with hemarthrosis were followed up for 5 years. Results: All patients were male, including 150 hemophilia A (HA) and 61 hemophilia B (HB) . The HA patients bled more frequently than HB patients with annualized total bleeding rate 20.5 (0-48) vs 13 (1-40) ; annualized joint bleeding rate 13.5 (0-38) vs 8 (0-33) , especially in moderate hemophilia [26 (1-48) vs 12 (1-36) , P<0.001; 18 (0-36) vs 7.5 (0-26) , P=0.001], but severe hemophilia had no difference in bleeding frequency [33 (1-41) vs 26 (1-40) , P=0.702; 22 (0-36) vs 18 (0-33) , P=0.429]. The condition of the affected joints of 108 HA and 54 HB was evaluated on roentgenography. In HA patients, the Arnold-Hilgartner classification increased with the severity ratings (r=0.063, P=0.004) . However, similar associations were not found in HB patients (r=0.045, P=0.082) . Five years later, 36 HA and 19 HB patients received the same joint X-ray, there were no significant differences in joints radiographic progression between the total HA and HB groups (z=1.941, P=0.052) . However, significant difference between moderate HA and HB was observed (z=0.076, P=0.002) . Multivariate unconditioned Logistic analysis showed that annualized joint bleeding rate [P<0.001, OR=1.166 (95%CI 1.097-1.239) ] and articular structural injuries [P=0.018, OR=2.842 (95% CI 1.196-6.755) ] were independent risk factors for the joints radiographic progression. Conclusion: The study suggests that there was a difference in bleeding phenotype between HA and HB, especially in moderate hemophilia. HB patients showed mild but progressive development over time, compared with HA patients. Annualized joint bleeding rate and articular structural injuries were independent risk factors for the joints radiographic progression.
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Affiliation(s)
- S X Wang
- Institute of Hematology & Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
| | | | | | | | | | | | - R C Yang
- Institute of Hematology & Blood Disease Hospital, CAMS & PUMC, Tianjin 300020, China
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Hasan NMA, Alam-Eldean MH, Mousa SS. Stiff elbow in adult: MR imaging findings. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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14
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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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15
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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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Anagnostis P, Vakalopoulou S, Vyzantiadis TA, Charizopoulou M, Karras S, Goulis DG, Karagiannis A, Gerou S, Garipidou V. The clinical utility of bone turnover markers in the evaluation of bone disease in patients with haemophilia A and B. Haemophilia 2013; 20:268-75. [PMID: 24118364 DOI: 10.1111/hae.12271] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2013] [Indexed: 01/01/2023]
Abstract
Haemophilia A and B have been associated with increased prevalence of low bone mineral density (BMD). However, the utility of bone turnover markers (BTM) remains unknown. The aim of this study was to evaluate bone metabolism in men with haemophilia and to investigate associations between BTM and bone disease. Serum N- (NTX-I), C-terminal telopeptide of type I collagen (CTX-I) and tartrate-resistant acid phosphatase band-5b (TRAP-5b), as bone resorption markers, and osteocalcin (OC) and bone-specific alkaline phosphatase (b-ALP), as bone formation markers, were assessed. Seventy men with haemophilia A (n = 59) or B (n = 11) were studied. Patients with low BMD had significantly higher b-ALP concentrations compared with those with normal BMD (12.8 ± 1.60 vs. 9.72 ± 0.58 μg/L, P = 0.009), without any differences in the other BTM. NTX-I and CTX-I concentrations were negatively associated with oestradiol levels and hip BMD and positively with human immunodeficiency virus infection, number of affected joints and arthropathy scores. B-ALP and OC concentrations were negatively associated with hip BMD, severity of haemophilia and fracture history, and positively with the number of affected joints and testosterone concentrations. After multivariate analysis, NTX-I levels remained negatively associated with oestradiol levels, whereas b-ALP concentrations negatively correlated with the level of physical activity and positively with the number of affected joints. Increased bone metabolism exists in men with haemophilia and low BMD. Increased b-ALP levels may identify patients at high risk for fracture. Increased number of target joints, low physical activity and low oestradiol concentrations are independently associated with increased bone metabolism.
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Affiliation(s)
- P Anagnostis
- Haemophilia Centre of Northern Greece, Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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17
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Chan MW, Leckie A, Xavier F, Uleryk E, Tadros S, Blanchette V, Doria AS. A systematic review of MR imaging as a tool for evaluating haemophilic arthropathy in children. Haemophilia 2013; 19:e324-34. [PMID: 23919318 DOI: 10.1111/hae.12248] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2013] [Indexed: 12/26/2022]
Abstract
Our purposes were to determine: (i) whether there is direct evidence that currently available MRI techniques are accurate for early diagnosis of pathological findings in haemophilic arthropathy; (ii) whether there is an MRI scoring system that best correlates with clinical/radiological constructs for evaluation of haemophilic arthropathy; (iii) whether there is an MRI scoring system that best correlates with clinical/radiological constructs for evaluation of haemophilic arthropathy. Articles were screened using MEDLINE (n = 566), EMBASE (n = 201), and the Cochrane Library (n = 1). Two independent reviewers assessed articles for inclusion under the overarching purposes of the review by using the Standards for Reporting of Diagnostic Accuracy (STARD) tool, and the quality of the studies were graded using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. The electronic literature search retrieved 777 references (after duplicates were removed). A total of 32 studies were chosen for inclusion from the results of the search and review of bibliographical references. Using the STARD tool, seven studies were of excellent quality of reporting, and using the QUADAS-2 tool, 10 studies were judged to be of adequate quality. There is 'fair' evidence to recommend MRI as an accurate test for detecting evidence of haemophilic arthropathy and the use of second or third generation MRI scales for assessing haemophilic arthropathy. However, there is no evidence that screening of early intra-articular soft tissue bleed with MRI improves the functional status of joints over time.
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Affiliation(s)
- M W Chan
- Departments of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
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18
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Anagnostis P, Vakalopoulou S, Charizopoulou M, Kazantzidou E, Chrysopoulou T, Moka E, Agapidou A, Zournatzi V, Garipidou V. Is there any association between leptin levels and bone mineral density in haemophiliac men? Arch Med Sci 2013; 9:459-65. [PMID: 23847667 PMCID: PMC3701978 DOI: 10.5114/aoms.2013.35341] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 07/21/2012] [Accepted: 08/01/2012] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Conflicting data exist regarding the role of leptin in bone metabolism. The purpose of the present study was to investigate serum leptin concentrations in male patients with haemophilia A and B, a disease known to be associated with low bone mass. MATERIAL AND METHODS Eighty-one male patients, aged 45.4 ±15 years, were screened. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) in lumbar spine (LS), femoral neck (FN) and total hip (TH). RESULTS Low bone mass was diagnosed in 20 patients (24.7%). Serum leptin concentrations were strongly associated with body weight (r s = 0.457, p = 0.0001) and body mass index (BMI) (r s = 0.491, p = 0.0001). In unadjusted analysis leptin was inversely associated with BMD in LS (r s = -0.255, p = 0.023), but not in FN and TH (r s = -0.205, p = 0.068 and r s = -0.191, p = 0.090, respectively). However, after adjusting for BMI and body weight, leptin was inversely associated with BMD in FN (F 1,76 = 7.727, p = 0.007, β = -0.371, ΔR (2) = 0.089) and TH (F 1,76 = 4.533, p = 0.036, β = -0.290, ΔR (2) = 0.054), but not in LS (F 1,75 = 2.076, p = 0.154, β = -0.202, ΔR (2) = 0.026). No association was found between age, presence of HBV, HCV or HIV infection or alkaline phosphatase and leptin levels. CONCLUSIONS Our study showed a negative association between circulating leptin levels and bone mass in males, independently of body weight and BMI.
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Affiliation(s)
| | - Sofia Vakalopoulou
- Division of Haematology, 2 Propaedeutic Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Maria Charizopoulou
- Department of Psychology, School of Philosophy, Aristotle University of Thessaloniki, Greece
| | | | | | - Eleni Moka
- Division of Haematology, 2 Propaedeutic Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Alexandra Agapidou
- Division of Haematology, 2 Propaedeutic Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | - Vassiliki Zournatzi
- 2 Department of Obstetrics and Gynaecology, Aristotle University, Hippokration General Hospital, Thessaloniki, Greece
| | - Vasilia Garipidou
- Division of Haematology, 2 Propaedeutic Department of Internal Medicine, Aristotle University, Hippokration Hospital, Thessaloniki, Greece
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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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Di Minno MND, Iervolino S, Soscia E, Tosetto A, Coppola A, Schiavulli M, Marrone E, Ruosi C, Salvatore M, Di Minno G. Magnetic resonance imaging and ultrasound evaluation of “healthy” joints in young subjects with severe haemophilia A. Haemophilia 2013; 19:e167-73. [DOI: 10.1111/hae.12107] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2013] [Indexed: 11/29/2022]
Affiliation(s)
- M. N. D. Di Minno
- Regional Reference Centre for Coagulation Disorders; Federico II University; Naples; Italy
| | - S. Iervolino
- Rheumatology Unit; Federico II University; Naples; Italy
| | - E. Soscia
- Department of Bio-morphological and Functional Sciences; Federico II University; Naples; Italy
| | - A. Tosetto
- Department of Hematology; S. Bortolo Hospital; Vicenza; Italy
| | - A. Coppola
- Regional Reference Centre for Coagulation Disorders; Federico II University; Naples; Italy
| | - M. Schiavulli
- Paediatric Regional Reference Centre for Coagulation Disorders; Santobono-Pausilipon Hospital; Naples; Italy
| | - E. Marrone
- Regional Reference Centre for Coagulation Disorders; Federico II University; Naples; Italy
| | - C. Ruosi
- Department of Orthopedic Surgery; Federico II University; Naples; Italy
| | - M. Salvatore
- Department of Bio-morphological and Functional Sciences; Federico II University; Naples; Italy
| | - G. Di Minno
- Regional Reference Centre for Coagulation Disorders; Federico II University; Naples; Italy
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Anagnostis P, Vakalopoulou S, Slavakis A, Charizopoulou M, Kazantzidou E, Chrysopoulou T, Vyzantiadis TA, Moka E, Agapidou A, Garipidou V. Reduced bone mineral density in patients with haemophilia A and B in Northern Greece. Thromb Haemost 2012; 107:545-51. [PMID: 22318743 DOI: 10.1160/th11-08-05563] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 12/16/2011] [Indexed: 11/05/2022]
Abstract
Haemophilia A and B has been associated with increased prevalence of low bone mass (67-86%). The aim of this study was to estimate the prevalence of bone disease in haemophiliacs and its association with potential risk factors. Adult patients with haemophilia A and B followed-up in the Haemophilia Centre of Northern Greece were included. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) in lumbar spine (LS), femoral neck (FN), total hip (TH) and great trochanter (GT). One-hundred four male patients (aged 45.8 ± 15.1 years) and 50 controls (aged 44.9 ± 12.8 years) were screened. Low BMD was diagnosed in 28 patients (26.9%) and 10 controls (20%) (p=0.0001). Patients had lower BMD in TH (p=0.007), FN (p=0.029) and GT (p=0.008) than controls, without differences in LS. BMD was positively associated with the severity of haemophilia, history of herpes virus C or human immunodeficiency virus and level of physical activity, and negatively with the level of arthropathy. In multiple-regression analysis, only the level of physical activity and 25-hydroxyvitamin D [25(OH)D] significantly predicted BMD. Half of the patients had vitamin D deficiency. In conclusion, our study showed increased prevalence of low BMD in haemophiliacs. The levels of physical activity and 25(OH)D independently predicted low BMD.
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Jaganathan S, Gamanagatti S, Goyal A. Musculoskeletal Manifestations of Hemophilia: Imaging Features. Curr Probl Diagn Radiol 2011; 40:191-7. [DOI: 10.1067/j.cpradiol.2010.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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23
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ABDEL-MESSIH IY, MOHAMED HABASHY DM, MOFTAH SG, EL-ALFY M. Persistent factor VIII inhibitors and orthopaedic complications in children with severe haemophilia A. Haemophilia 2011; 17:490-3. [DOI: 10.1111/j.1365-2516.2010.02447.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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LOBET S, HERMANS C, PASTA G, DETREMBLEUR C. Body structure versus body function in haemophilia: the case of haemophilic ankle arthropathy. Haemophilia 2011; 17:508-15. [DOI: 10.1111/j.1365-2516.2010.02433.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Maclachlan J, Gough-Palmer A, Hargunani R, Farrant J, Holloway B. Haemophilia imaging: a review. Skeletal Radiol 2009; 38:949-57. [PMID: 18807029 DOI: 10.1007/s00256-008-0586-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 08/16/2008] [Accepted: 08/18/2008] [Indexed: 02/02/2023]
Abstract
Haemophilia disorders are characterised by a blood coagulation anomaly leading to prolonged and excessive bleeding. Imaging provides an essential role in the investigation of both the musculoskeletal and the non-musculoskeletal complications of haemophilia. Our institution is home to a large tertiary referral centre for haemophilia treatment. Using our broad experience, we present a multi-modality pictorial review of the musculoskeletal manifestations of haemophilia, including haemophilic arthropathy, intra-muscular haemorrhage and haemophilic pseudotumour. The main imaging features of haemophilic arthropathy are described, including synovial hypertrophy, haemosiderin deposition, sub-chondral cyst formation and loss of joint space.
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Abstract
Of the methods used to evaluate haemophilic arthropathy, clinical joint score can only detect advanced and not minor changes, which usually occur in younger patients. In addition, the currently used clinical scores are poorly correlated with the MRI and X-rays scales. In an attempt to address these shortcomings, a modification of Stockholm clinical scale was designed in which elements of clinical information were included. This new scale was applied in 165 joints of 40 patients with haemophilia A and B and the results were statistically analyzed for its capacity to detect early joints alterations. Furthermore, the adjusted score was compared with Pettersson's radiological score and Denver's MRI score, which can detect early signs of arthropathy. The adjusted scale (a) revealed the earliest abnormalities of haemophilic arthropathy and its correlation with the Pettersson and Denver scores is better than those of Stockholm's scale, (b) provided prediction of the Denver score and (c) was simple and safe to be performed and it could easily be repeated.
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Santos MK, Polezi MB, Engel EE, Pastorello MT, Simão MN, Elias Junior J, Nogueira-Barbosa MH. Apresentações incomuns no diagnóstico por imagem do pseudotumor intraósseo do hemofílico. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000300008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Este estudo tem como objetivo descrever apresentações incomuns do pseudotumor do hemofílico no diagnóstico por imagem. MATERIAIS E MÉTODOS: Estudo retrospectivo com avaliação de cinco pseudotumores ósseos do hemofílico em dois pacientes. Os achados de imagem em dois pacientes hemofílicos tipo A foram avaliados em consenso por dois radiologistas musculoesqueléticos. Foram estudados exames de radiografia simples, tomografia computadorizada e ressonância magnética. RESULTADOS: Em uma das lesões analisadas a fase pós-contraste intravenoso da tomografia computadorizada mostrou áreas de reforço heterogêneo e de aspecto sólido no interior da lesão da coxa direita. Este aspecto foi confirmado no exame anatomopatológico da lesão em questão. Outro achado raro foi a identificação de dois pseudotumores intraósseos no úmero, separados por segmento de osso normal. E, por fim, também um pseudotumor do fêmur com extensão para partes moles e transarticular, com conseqüente acometimento da tíbia e patela. CONCLUSÃO: Os achados de diagnóstico por imagem acima descritos não são comumente relatados para os pseudotumores ósseos do hemofílico. É importante que o radiologista tenha conhecimento dessas apresentações mais raras.
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Constantine S, Buckley J, Heysen J. Imaging of the haemorrhagic complications of the haemophilias. J Med Imaging Radiat Oncol 2009; 53:13-21. [DOI: 10.1111/j.1754-9485.2009.02032.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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DORIA AS, LUNDIN B, MILLER S, KILCOYNE R, DUNN A, THOMAS S, RIVARD G, MOINEDDIN R, BABYN P. Reliability and construct validity of the compatible MRI scoring system for evaluation of elbows in haemophilic children. Haemophilia 2008; 14:303-14. [DOI: 10.1111/j.1365-2516.2007.01602.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Aubry S, Chateil JF. [Pediatric radiology]. JOURNAL DE RADIOLOGIE 2006; 87:899-905. [PMID: 16888580 DOI: 10.1016/s0221-0363(06)74106-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- S Aubry
- Service de Radiologie A, CHU de Besançon, France
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