1
|
Arvanitakis A, Jepsen C, Andersson NG, Baghaei F, Astermark J. Primary prophylaxis implementation and long-term joint outcomes in Swedish haemophilia A patients. Haemophilia 2024; 30:671-677. [PMID: 38575549 DOI: 10.1111/hae.15013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Primary prophylaxis is the gold standard in severe haemophilia A (SHA) but time to escalate the prophylaxis regimen varies. AIM Assess prophylaxis implementation and long-term joint health outcomes in SHA with primary prophylaxis. METHODS Adult male patients born after 1980, with SHA on primary prophylaxis, started before the age of 3 years and second joint bleed, and no history of FVIII inhibitors, were enrolled. Repeated joint-health examinations were performed with HJHS or HEAD-US; VERITAS-PRO assessed adherence. RESULTS Thirty patients were enrolled with, at inclusion, median age 33.5 years, annualized bleed rate and joint bleed rate 0, and FVIII consumption 4232 IU/kg/year, respectively. The median age was 1.2 years, at prophylaxis start once weekly with a median FVIII dose of 47.7 IU/kg, and 1.7 years, by the time escalation to a final regimen had occurred, with a median infusion frequency of thrice weekly and FVIII dose 41.7 IU/kg, respectively. Older age correlated with later transition to escalated prophylaxis (p < .001). Longer time to escalated prophylaxis correlated to more bleeds (p < .001). Median HJHS increased slowly, reaching 4 at 35-40 years. HJHS at 15-20 years correlated with higher HJHS afterwards. Median total HEAD-US score was 1 and correlated with HJHS (p < .001). Median VERITAS-PRO score was 36, indicating good treatment adherence. CONCLUSION Primary prophylaxis is effective but does not completely prevent the gradual development of arthropathy in SHA. Joint assessments with HJHS should start at an early age, as they correlate with arthropathy in later life. Prophylaxis escalation should proceed expeditiously to prevent bleeds.
Collapse
Affiliation(s)
- Alexandros Arvanitakis
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Caroline Jepsen
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine, Coagulation Centre, Gothenburg, Sweden
| | - Nadine G Andersson
- Department for Paediatric Haematology and Oncology, Children's Hospital, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences, Paediatrics, Lund University, Malmö, Sweden
| | - Fariba Baghaei
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine, Coagulation Centre, Gothenburg, Sweden
| | - Jan Astermark
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
2
|
Yılmaz E, Kaya Z, Satış H, Yazol M, Kirkiz S, Koçak Ü. The role of rheumatologist in the assessment of hemophilic arthropathy using head-us in patients with hemophilia. Int J Rheum Dis 2024; 27:e15138. [PMID: 38576103 DOI: 10.1111/1756-185x.15138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/29/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Emine Yılmaz
- Department of Pediatric Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Zühre Kaya
- Department of Pediatric Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hasan Satış
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Merve Yazol
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Serap Kirkiz
- Department of Pediatric Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ülker Koçak
- Department of Pediatric Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
3
|
van Leeuwen FHP, Foppen W, de Jong PA, van Dijk WE, Blokzijl J, Fischer K, Timmer MA. Ultrasound in addition to clinical assessment of acute musculoskeletal complaints in bleeding disorders: impact on patient management. Res Pract Thromb Haemost 2024; 8:102372. [PMID: 38590365 PMCID: PMC10999475 DOI: 10.1016/j.rpth.2024.102372] [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: 01/07/2024] [Revised: 02/25/2024] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
Background Ultrasound is increasingly used for musculoskeletal assessment in hemophilia care. Objectives To evaluate the impact of point-of-care ultrasound added to clinical assessment for diagnosis and treatment of acute musculoskeletal episodes in a heterogeneous cohort of children and adults with hemophilia and von Willebrand disease (VWD). Methods This prospective cross-sectional study consecutively included children and adults with hemophilia or VWD who visited the outpatient clinic with acute musculoskeletal complaints between March 2020 and May 2023. For all episodes, initial diagnosis and treatment determined by clinical assessment were recorded on a case report form. Subsequently, a physiotherapist (M.A.T. and J.B.) with knowledge of the clinical diagnosis performed point-of-care ultrasound. After ultrasound, updated diagnosis and treatment were recorded. Diagnosis and treatment before and after ultrasound were compared, and proportions of change with 95% CIs were determined. Results We evaluated 77 episodes in 67 patients (median age, 24 years; IQR, 13-42 years). Before ultrasound, 37 joint bleeds, 13 muscle bleeds, and 27 other diagnoses were diagnosed. After ultrasound, 33 joint bleeds, 11 muscle bleeds, and 33 other diagnoses were confirmed. The diagnosis changed in 28 of 77 episodes (36%; 95% CI, 26%-48%). Nine joint bleeds and 2 muscle bleeds were missed by clinical assessment. Ultrasound findings changed treatment strategy in 30 of 77 episodes (39%; 95% CI, 28%-51%). Conclusion Ultrasound in addition to clinical assessment of acute musculoskeletal complaints in people with hemophilia and VWD has an impact on diagnosis (36%) and treatment (39%), which supports the use of ultrasound in acute musculoskeletal complaints in hemophilia and VWD.
Collapse
Affiliation(s)
- Flora Hendrica Pieternella van Leeuwen
- Department of Radiology and Nuclear Medicine, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wouter Foppen
- Department of Radiology and Nuclear Medicine, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Pim A. de Jong
- Department of Radiology and Nuclear Medicine, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wobke E.M. van Dijk
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Johan Blokzijl
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Kathelijn Fischer
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Merel A. Timmer
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
4
|
van Bergen EDP, van Leeuwen FHP, Foppen W, Timmer MA, Schutgens REG, Mastbergen SC, Lafeber FPJG, de Jong PA, Fischer K, van Vulpen LFD. Subclinical synovial proliferation in patients with severe haemophilia A: The value of ultrasound screening and biochemical markers. Haemophilia 2023; 29:1580-1588. [PMID: 37694775 DOI: 10.1111/hae.14861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
AIM Subclinical bleeding and inflammation play a role in progression of haemophilic arthropathy. Synovial proliferation is predictive of joint bleeding and its early detection may guide treatment changes and prevent arthropathy progression. This study evaluated the prevalence of active and inactive subclinical synovial proliferation and investigated potential biochemical blood/urine markers to identify patients with active subclinical synovial proliferation. METHODS This cross-sectional study included patients with severe haemophilia A born 1970-2006 who were evaluated during routine clinic visits. Patients with (a history of) inhibitors or recent joint bleeding were excluded. Elbows, knees and ankles were examined for subclinical synovial proliferation by ultrasound and physical examination. Active synovial proliferation was distinguished from inactive synovial proliferation using predefined criteria. Blood/urine biochemical markers (serum osteopontin, sVCAM-1, Coll2-1, COMP, CS846, TIMP, and urinary CTX-II) were compared individually and as combined indexes between patients with and without active synovial proliferation. RESULTS This cohort consisted of 79 patients with a median age of 31 years (range 16.5-50.8 years) with 62/79 (78%) of the patients using continuous prophylaxis. The annualized joint bleeding rate over the last 5 years was .6 (.2-1.1). Active (17/79, 22%) and inactive subclinical synovial proliferation (17/79, 22%) were both prevalent in this cohort. Biochemical markers were not correlated with active subclinical synovial proliferation. CONCLUSION Subclinical synovial proliferation, both active and inactive, was prevalent in patients with severe haemophilia A with access to prophylaxis and would be overlooked without routinely performed ultrasounds. Biochemical markers were unable to identify patients with active subclinical synovial proliferation.
Collapse
Affiliation(s)
- Eline D P van Bergen
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Flora H P van Leeuwen
- Department of Radiology & Nuclear Imaging, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Wouter Foppen
- Department of Radiology & Nuclear Imaging, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Merel A Timmer
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Roger E G Schutgens
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology & Nuclear Imaging, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Kathelijn Fischer
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Lize F D van Vulpen
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| |
Collapse
|
5
|
Bladen M, Harbidge H, Drechsler W, Duport G, Mahaffey R, van der Net J, Pérez-Alenda S, Sayers F, Strike K, Timmer M, Stephensen D. Identifying performance-based outcome measures of physical function in people with haemophilia (IPOP). Haemophilia 2023; 29:1611-1620. [PMID: 37840142 DOI: 10.1111/hae.14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Recent recommendations of core outcome sets for haemophilia highlight the need for including measures of performance-based physical health and physical function sustainability. To date, there is no consensus on what outcomes might be of value to clinicians and patients. AIM To identify instruments of performance-based physical function to monitor musculoskeletal health in people with haemophilia that are practical in the clinical setting. METHODS Utilising components from the Activities and Participation Category of the WHO International Classification of Functioning (WHO-ICF), a consensus-based, decision analysis approach was used to: identify activities people with haemophilia have most difficulty performing; identify quantitative performance-based measures of identified activities via a scoping review; and obtain views on acceptability of the tests utilising a DELPHI approach. RESULTS Eleven activities were identified: maintaining a standing position, walking long distances, walking up and down stairs, walking on different surfaces, running, hopping, jumping, squatting, kneeling, undertaking a complex lower limb task, undertaking a complex upper limb task. Following a 2-round DELPHI survey of international physiotherapists, the 6-min walk test, timed up and down stairs, 30-s sit to stand, single leg stance, tandem stance, single hop for distance (children only) and timed up and go (adults only) reached consensus. CONCLUSION This study is the first step in defining a core set of performance-based instruments to monitor physical health and sustainability of physical function outcomes in people with haemophilia. Establishing the psychometric properties of the instruments and whether they are meaningful to people with haemophilia is essential.
Collapse
Affiliation(s)
- Melanie Bladen
- Haemophilia Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Hannah Harbidge
- Haemophilia Centre, East Kent Hospitals University NHS Trust, Canterbury, UK
| | - Wendy Drechsler
- Haemophilia Centre, East Kent Hospitals University NHS Trust, Canterbury, UK
| | | | - Ryan Mahaffey
- St Mary's University, School of Sport, Health and Applied Sciences, London, UK
| | - Janjap van der Net
- Center for Child Development, Exercise and physical literacy, UMC Utrecht, Utrecht, Netherlands
| | | | | | - Karen Strike
- Hamilton Niagara Regional Hemophilia Centre, McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Merel Timmer
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - David Stephensen
- Haemophilia Centre, East Kent Hospitals University NHS Trust, Canterbury, UK
- Royal London Hospital Haemophilia Centre, Barts Health NHS Trust, London, UK
| |
Collapse
|
6
|
Daffunchio C, Galatro G, Faurlin V, Neme D, Caviglia H. The hidden joint in children with haemophilia on prophylaxis. Thromb Res 2023; 226:86-92. [PMID: 37130495 DOI: 10.1016/j.thromres.2023.04.012] [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: 09/05/2022] [Revised: 03/22/2023] [Accepted: 04/11/2023] [Indexed: 05/04/2023]
Abstract
Prophylaxis is the gold standard treatment for children with haemophilia (CWH). MRI studies revealed joint damage, even with this treatment; this suggests the presence of subclinical bleeding. In the case of children with haemophilia, it is relevant to detect early signs of joint damage, as this allows the medical team to provide the appropriate treatment and follow-up, in order to avoid arthropathy development and its consequences. The aim of this study is to detect the hidden joint in children with haemophilia on prophylaxis (CWHP) and analyse, by age group, which joint is the most affected. We define the hidden joint in CWH on prophylaxis as the joint that presents joint damage secondary to repetitive bleeding episodes and is detected in the joint evaluation, despite being asymptomatic or with mild symptoms. It is most commonly caused by repetitive subclinical bleeding. METHODS This was an observational, analytical, cross-sectional study of 106 CWH on prophylaxis treated in our centre. Patients were divided according to age and type of treatment. Joint damage was defined as a HEAD-US score ≥ 1. RESULTS Patients' median age was 12 years. All had severe haemophilia. The median age of onset of prophylaxis was 2.7. Forty-seven (44.3 %) patients received primary prophylaxis (PP) and 59 (55.7 %), secondary prophylaxis. Six hundred and thirty-six joints were analysed. Type of prophylaxis and joint involvement showed statistically significant differences (p < 0.001). However, patients on PP had a greater number of damaged joints at older ages. Twenty-two % (140) of the joints scored ≥1 on HEAD-US. Cartilage was most frequently involved, followed by synovitis, and bone damage. We observed a greater frequency and degree of arthropathy in subjects aged 11 and above. Sixty (12.7 %) joints showed a HEAD-US score ≥ 1, with no history of bleeding. The ankle was the most affected joint, representing the hidden joint according to our definition. CONCLUSION Prophylaxis is the best treatment for CWH. However, symptomatic or subclinical joint bleeding may occur. The routine evaluation of joint health is relevant, particularly, of the ankle. In our study, early signs of arthropathy according to age and type of prophylaxis were detected by HEAD-US.
Collapse
Affiliation(s)
- Carla Daffunchio
- Haemophilia Foundation, Buenos Aires, Argentina; Department of Orthopaedics and Traumatology, Juan A. Fernández Hospital, Buenos Aires, Argentina.
| | - Gustavo Galatro
- Haemophilia Foundation, Buenos Aires, Argentina; Department of Orthopaedics and Traumatology, Juan A. Fernández Hospital, Buenos Aires, Argentina
| | | | | | - Horacio Caviglia
- Haemophilia Foundation, Buenos Aires, Argentina; Department of Orthopaedics and Traumatology, Juan A. Fernández Hospital, Buenos Aires, Argentina
| |
Collapse
|
7
|
van Leeuwen FHP, Timmer MA, de Jong PA, Fischer K, Foppen W. Screening for subclinical synovial proliferation in haemophilia: A systematic review and meta-analysis comparing physical examination and ultrasound. Haemophilia 2023; 29:445-455. [PMID: 36595617 DOI: 10.1111/hae.14737] [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: 05/11/2022] [Revised: 11/29/2022] [Accepted: 12/14/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Ultrasound is increasingly used as addition to physical examination for detection of subclinical joint changes in haemophilia. However, the added value of ultrasound to physical examination for detecting synovial proliferation is not fully established. AIM To determine the diagnostic accuracy of swelling at physical examination for ultrasound-detected synovial proliferation in haemophilia. METHODS PubMed and EMBASE were searched up to 2 August 2022. Studies reporting original data on occurrence of swelling at physical examination and synovial proliferation on ultrasound of index joints in persons with haemophilia were included. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Diagnostic accuracy parameters of swelling at physical examination for ultrasound-detected synovial proliferation were determined. Summary sensitivity and specificity were calculated using a bivariate random-effects model. RESULTS Fifteen studies reporting on swelling at physical examination and synovial proliferation on ultrasound in 2890 joints of 627 patients were included. Prevalence of subclinical synovial proliferation ranged between 0% and 55%. Sensitivity of swelling was low [summary estimate .34; 95% confidence interval (CI) .24-.46], while specificity was high (summary estimate .97; CI .92-.99). Predictive values varied widely due to inter-study differences in prevalence of synovial proliferation. CONCLUSION Joint swelling has low sensitivity for presence of ultrasound-detected synovial proliferation in haemophilia, suggesting underestimation of synovial proliferation by physical examination alone. Consequently, ultrasound screening may generate important information on synovial changes which would otherwise remain undetected.
Collapse
Affiliation(s)
- Flora H P van Leeuwen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Merel A Timmer
- Center for Benign Hematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kathelijn Fischer
- Center for Benign Hematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wouter Foppen
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
8
|
Daffunchio C, Galatro G, Rossi M, Landro M, Andreu M, Neme D, Caviglia H. Clinical and ultrasound evaluation of patients with haemophilia on prophylaxis. Haemophilia 2021; 27:641-647. [PMID: 33970513 DOI: 10.1111/hae.14312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/08/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Primary prophylaxis is the current gold standard in haemophilia care for the prevention of bleeding and ensuing joint damage. Early detection of joint bleeding, whether symptomatic or subclinical, preferably during childhood, helps prevent joint deterioration and subsequent disability. The aim of this study is to evaluate the level of agreement between the Haemophilia Joint Health Score and the Haemophilia Early Arthropathy Detection with Ultrasound tools in children with severe haemophilia on primary and secondary prophylaxis. MATERIALS AND METHODS All patients were followed up regularly at our centre. Elbows, knees and ankles were evaluated by physical examination using the Haemophilia Joint Health Score 2.1 (HJHS 2.1), and by ultrasound with HEAD-US score. RESULTS A total of 80 children with haemophilia on prophylaxis were included in this study. Mean age was 10.8 years (range 4-18). We evaluated 480 joints, of which 423 (88.1%) were concordant with both tools, whereas 57 (11.9%) were discordant; 377 (78.5%) joints scored 0 on HJHS, 370 (77%) on HEAD-US and 345 (72%) on both tools. The overall Kappa concordance coefficient was .656. For elbows, knees and ankles the respective values were .783, .522 and .589. For HJHS scores greater than 3, all joints scored ≥1 on HEAD-US. CONCLUSION HJHS and HEAD-US are used to assess joint health in children with haemophilia on prophylaxis. In this study, the level of agreement between both tools was consistent with literature values only for the elbow joint.
Collapse
Affiliation(s)
- Carla Daffunchio
- Haemophilia Foundation of Argentina, Buenos Aires, Argentina.,Department of Orthopaedics and Traumatology, Juan A. Fernandez Hospital, Buenos Aires, Argentina
| | - Gustavo Galatro
- Haemophilia Foundation of Argentina, Buenos Aires, Argentina.,Department of Orthopaedics and Traumatology, Juan A. Fernandez Hospital, Buenos Aires, Argentina
| | - Martín Rossi
- Haemophilia Foundation of Argentina, Buenos Aires, Argentina
| | - María Landro
- Department of Orthopaedics and Traumatology, Juan A. Fernandez Hospital, Buenos Aires, Argentina
| | - Mauro Andreu
- Department of Orthopaedics and Traumatology, Juan A. Fernandez Hospital, Buenos Aires, Argentina
| | - Daniela Neme
- Haemophilia Foundation of Argentina, Buenos Aires, Argentina
| | - Horacio Caviglia
- Haemophilia Foundation of Argentina, Buenos Aires, Argentina.,Department of Orthopaedics and Traumatology, Juan A. Fernandez Hospital, Buenos Aires, Argentina
| |
Collapse
|
9
|
Jiménez-Yuste V, de la Corte-Rodríguez H, Álvarez-Román MT, Martín-Salces M, Querol F, Bonanad S, Mingot-Castellano ME, Fernández-Mosteirín N, Canaro M, Santamaría A, Núñez R, García-Frade LJ, Martinoli C, Kim HK. Ultrasound evaluation of joint damage and disease activity in adult patients with severe haemophilia A using the HEAD-US system. Haemophilia 2021; 27:479-487. [PMID: 33620134 DOI: 10.1111/hae.14280] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) system and scoring scale has proven to be an accurate and time-efficient imaging method for identifying joint damage in patients with haemophilia. AIM Observational, multicentre, cross-sectional study conducted in 8 centres in Spain that assessed the joint status of adult patients with severe haemophilia A (SHA) using HEAD-US. METHODS Joint status of the elbow, knee and ankle was evaluated in adults with SHA receiving on-demand (OD) treatment, or primary (PP), secondary (SP), tertiary (TP) or intermittent (IP) prophylaxis. RESULTS Of the 95 patients enrolled, 87 received prophylaxis (6.3% PP, 38.9% SP, 43.2% TP and 3.2% IP). Mean age was 35.2 years, and 59% of patients had not undergone image testing in the last year. The HEAD-US score was 0 in all joints in 6.3% of patients. The ankle was the most affected joint, regardless of treatment regimen. Patients receiving OD treatment, TP or IP had the overall worst scores, mainly in the ankles and elbows; a similar but milder profile was observed in patients on SP; and patients on PP had the best score in all joints. CONCLUSION Joint function may be effectively preserved in patients with SHA on PP, but OD treatment or later initiation of prophylaxis does not seem to prevent progression of arthropathy. Disease worsening was observed in patients OD, TP or IP, most often affecting ankles and elbows. Closer ultrasound imaging monitoring may improve management of these patients.
Collapse
Affiliation(s)
- Víctor Jiménez-Yuste
- Department of Haematology, Hospital Universitario La Paz, Autonoma University, Madrid, Spain
| | | | | | | | - Felipe Querol
- University of Valencia and Haemostasis and Thrombosis Unit, Department of Haematology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Santiago Bonanad
- Haemostasis and Thrombosis Unit. Department of Haematology, Hospital Universitari i Politècnic La Fe, University of Valencia, Valencia, Spain
| | - María Eva Mingot-Castellano
- Department of Haematology, Hospital Regional Universitario de Málaga, Malaga, Spain.,Department of Haematology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Mariana Canaro
- Department of Haemostasis and Thrombosis, Hospital Universitario Son Espases, Mallorca, Spain
| | - Amparo Santamaría
- Department of Thrombosis and Haemostasis, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ramiro Núñez
- Department of Haematology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Carlo Martinoli
- Dipartimento di Scienze della Salute Department of Health Sciences (DISSAL) and IRCCS Ospedale Policlinico San Martino, Genova, University of Genoa, Genoa, Italy
| | | |
Collapse
|
10
|
Måseide RJ, Berntorp E, Astermark J, Hansen J, Olsson A, Bruzelius M, Frisk T, Aspdahl M, Nummi V, Tjønnfjord GE, Holme PA. Haemophilia early arthropathy detection with ultrasound and haemophilia joint health score in the moderate haemophilia (MoHem) study. Haemophilia 2021; 27:e253-e259. [PMID: 33550602 DOI: 10.1111/hae.14245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Detection of early arthropathy is crucial for the management of haemophilia, but data on moderate haemophilia are limited. Therefore, we evaluated joint health and treatment modalities in Nordic patients with moderate haemophilia A (MHA) and B (MHB). AIM To explore and compare the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) and Haemophilia Joint Health Score (HJHS) to detect early arthropathy in moderate haemophilia. METHODS A cross-sectional, multicentre study covering Nordic patients with MHA and MHB. Arthropathy was evaluated by HEAD-US and HJHS 2.1. RESULTS We assessed 693 joints in 118 patients. HEAD-US scores (medians [interquartile ranges]) were as follows: elbows 0 points (0-0), knees 0 (0-0) and ankles 0 (0-1). Respectively, by HJHS: elbows 0 (0-1), knees 0 (0-1) and ankles 0 (0-1). Cartilage (14%) and bone (13%) were most commonly affected by HEAD-US. Frequent HJHS findings were crepitus on motion in knees (39%), and loss of flexion (23%) and extension (13%) in ankles. HEAD-US correlated strongly with HJHS (elbows r = .70, knees r = .60 and ankles r = .65), but 24% had discordant scores. Joints with HJHS zero points, 5% captured HEAD-US ≥1 point. Moreover, 26% had HJHS findings without HEAD-US pathology. Notably, 31% of knees had crepitus on motion and normal HEAD-US. CONCLUSION Overall, the joints attained low scores implying good joint health. HEAD-US correlated strongly with HJHS. In 5%, HEAD-US detected subclinical pathology. Crepitus on motion was frequently reported despite normal HEAD-US, thus not necessarily reflecting arthropathy. HEAD-US therefore improves the joint assessment in moderate haemophilia.
Collapse
Affiliation(s)
- Ragnhild J Måseide
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Berntorp
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jan Astermark
- Department of Translational Medicine, Lund University, Malmö, Sweden.,Department of Haematology, Skåne University Hospital, Malmö, Sweden
| | - Jessica Hansen
- Rehabilitation Unit, Emergency care/Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Anna Olsson
- Department of Medicine, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Maria Bruzelius
- Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.,Department of Haematology, Karolinska University Hospital, Stockholm, Sweden
| | - Tony Frisk
- Pediatric Coagulation, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Aspdahl
- Function Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Vuokko Nummi
- Coagulation Disorders Unit, Haematology, Comprehensive Cancer Centre, Helsinki University Hospital and Research Program in Systems Oncology, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Geir E Tjønnfjord
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål A Holme
- Department of Haematology, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
11
|
Guedes VG, Wachholz PA, Thomas S, Souza SAL. Monitoring the joint health of patients with haemophilia in a middle-income country: Considerations on the use of the Haemophilia Joint Health Score. Haemophilia 2020; 27:e267-e269. [PMID: 32897616 DOI: 10.1111/hae.14135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Vanessa Giroto Guedes
- Blood Center of Marília Medical School - FAMEMA, Marília, São Paulo, Brazil.,Radiology Department, Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, Brazil
| | | | - Sylvia Thomas
- Radiology Department, Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, Brazil
| | - Sergio Augusto Lopes Souza
- Radiology Department, Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, Brazil
| |
Collapse
|
12
|
De la Corte-Rodriguez H, Rodriguez-Merchan EC, Alvarez-Roman MT, Martin-Salces M, Martinoli C, Jimenez-Yuste V. HJHS 2.1 and HEAD-US assessment in the hemophilic joints: How do their findings compare? Blood Coagul Fibrinolysis 2020; 31:387-392. [PMID: 32815914 DOI: 10.1097/mbc.0000000000000934] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: In hemophilic patients methods are needed to better diagnose joint damage early, so that treatments can be adjusted to slow the progression of hemophilic arthropathy. The aim of this study is to investigate the relationship between the Hemophilia Joint Health Score version 2.1 (HJHS 2.1) and hemophilia early arthropathy detection with ultrasound (HEAD-US) scales, as well as each of their individual items, to better understand the value each provides on the joint condition of patients with hemophilia. The study included data from patients with hemophilia older than 16 years of age, who attended a routine check-up. HJHS 2.1 and HEAD-US assessments were performed on the elbows, knees and ankles. We studied the correlations and agreements between the two scales and analyzed the relationship between the various items of the HJHS 2.1 (inflammation, duration, atrophy, crepitation, flexion deficit, extension deficit, pain, strength, gait) and HEAD-US (synovitis, cartilage and bone). The study included 203 joints from 66 patients with hemophilia (mean age, 34 years). We found a good correlation between the two scales (r = 0.717). However, HJHS 2.1 revealed only 54% of the cases with synovitis and 75% of the cases with osteochondral damage. HEAD-US detected several relevant physical and functional aspects in less than 53% of the cases. HJHS 2.1 and HEAD-US provide complementary data on joint disease in adults with hemophilia; both assessments should therefore, be made available. HEAD-US presented the added value of detecting early joint changes (synovitis and osteochondral damage), while HJHS 2.1 showed the added value of detecting relevant physical and functional changes.
Collapse
Affiliation(s)
| | | | | | | | - Carlo Martinoli
- Department of Health Sciences (DISSAL), University of Genoa
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | |
Collapse
|
13
|
Måseide RJ, Berntorp E, Astermark J, Olsson A, Bruzelius M, Frisk T, Nummi V, Lassila R, Tjønnfjord GE, Holme PA. Joint health and treatment modalities in Nordic patients with moderate haemophilia A and B – The MoHem study. Haemophilia 2020; 26:891-897. [DOI: 10.1111/hae.14114] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/29/2020] [Accepted: 07/08/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Ragnhild J. Måseide
- Department of Haematology Oslo University Hospital Oslo Norway
- Research Institute of Internal Medicine Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Erik Berntorp
- Department of Translational Medicine Lund University Malmö Sweden
| | - Jan Astermark
- Department of Translational Medicine Lund University Malmö Sweden
- Department of Haematology Skåne University Hospital Malmö Sweden
| | - Anna Olsson
- Department of Medicine Sahlgrenska University Hospital Gothenburg Sweden
| | - Maria Bruzelius
- Molecular Medicine and Surgery Karolinska Institute Stockholm Sweden
- Department of Haematology Karolinska University Hospital Stockholm Sweden
| | - Tony Frisk
- Pediatric Coagulation Karolinska University Hospital Stockholm Sweden
| | - Vuokko Nummi
- Coagulation Disorders Unit Haematology Comprehensive Cancer Centre Helsinki University Hospital and Research Program in Systems Oncology Faculty of Medicine Helsinki University Helsinki Finland
| | - Riitta Lassila
- Coagulation Disorders Unit Haematology Comprehensive Cancer Centre Helsinki University Hospital and Research Program in Systems Oncology Faculty of Medicine Helsinki University Helsinki Finland
| | - Geir E. Tjønnfjord
- Department of Haematology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Pål A. Holme
- Department of Haematology Oslo University Hospital Oslo Norway
- Research Institute of Internal Medicine Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| |
Collapse
|
14
|
Rayment R, Chalmers E, Forsyth K, Gooding R, Kelly AM, Shapiro S, Talks K, Tunstall O, Biss T. Guidelines on the use of prophylactic factor replacement for children and adults with Haemophilia A and B. Br J Haematol 2020; 190:684-695. [PMID: 32390158 DOI: 10.1111/bjh.16704] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 01/19/2023]
Affiliation(s)
| | | | | | | | - Anne M Kelly
- Cambridge University Hospitals NHS foundation Trust, Cambridge, UK
| | - Susan Shapiro
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kate Talks
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Oliver Tunstall
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Tina Biss
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | |
Collapse
|
15
|
Hashem F, Bladen M, Carroll L, Dodd C, Drechsler WI, Lowery D, Patel V, Pellatt-Higgins T, Saloniki E, Stephensen D. Protocol for a feasibility randomised controlled trial of a musculoskeletal exercise intervention versus usual care for children with haemophilia. BMJ Open 2019; 9:e029474. [PMID: 31375620 PMCID: PMC6688743 DOI: 10.1136/bmjopen-2019-029474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Haemophilia is a rare, inherited disorder in which blood does not clot normally, resulting in bleeding into joints and muscles. Long-term consequence is disabling joint pain, stiffness, muscle weakness, atrophy and reduced mobility. The purpose of this proposed feasibility of a randomised controlled trial (RCT) is to test the feasibility of an age-appropriate physiotherapy intervention designed to improve muscle strength, posture and the way boys use their joints during walking and everyday activities. METHODS AND ANALYSIS A small-scale two-centre RCT of a 12-week muscle strengthening exercise intervention versus usual care for young children with haemophilia will be conducted. Primary outcomes will be safety and adherence to the exercise intervention. Secondary outcomes will include recruitment, retention and adverse event rates, clinical data, muscle strength, joint biomechanics and foot loading patterns during walking, 6 min timed walk, timed-up-and-down-stairs, EQ-5D-Y, participants' perceptions of the study, training requirements and relevant costs. Recruitment, follow-up, safety and adherence rates will be described as percentages. Participant diary and interview data will be analysed using a framework analysis. Demographic and disease variable distributions will be analysed for descriptive purposes and covariant analysis. Estimates of differences between treatment arms (adjusted for baseline) and 75% and 95% CIs will be calculated. ETHICS AND DISSEMINATION The study has ethical approval from the London-Fulham Research Ethics Committee (17/LO/2043) as well as Health Research Authority approval. As well as informing the design of the definitive trial, results of this study will be presented at local, national and international physiotherapy and haemophilia meetings as well as manuscripts submitted to peer-reviewed journals. We will also share the main findings of the study to all participants and the Haemophilia Society.
Collapse
Affiliation(s)
- Ferhana Hashem
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - Melanie Bladen
- Haemophilia Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | | | - Charlene Dodd
- Haemophilia Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Wendy I Drechsler
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - David Lowery
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - Vishal Patel
- Haemophilia Centre, Barts Health NHS Trust, London, UK
| | - T Pellatt-Higgins
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - Eirini Saloniki
- Centre for Health Service Studies, University of Kent, Canterbury, Kent, UK
| | - David Stephensen
- Haemophilia Centre, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
- Haemophilia Centre, Barts Health NHS Trust, London, UK
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Diagnostic accuracy of haemophilia early arthropathy detection with ultrasound (HEAD-US): a comparative magnetic resonance imaging (MRI) study. Radiol Oncol 2019; 53:178-186. [PMID: 31194690 PMCID: PMC6572497 DOI: 10.2478/raon-2019-0027] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/25/2019] [Indexed: 01/12/2023] Open
Abstract
Background Repeated haemarthroses affect approximately 90% of patients with severe haemophilia and lead to progressive arthropathy, which is the main cause of morbidity in these patients. Diagnostic imaging can detect even subclinical arthropathy changes and may impact prophylactic treatment. Magnetic resonance imagining (MRI) is generally the gold standard tool for precise evaluation of joints, but it is not easily feasible in regular follow-up of patients with haemophilia. The development of the standardized ultrasound (US) protocol for detection of early changes in haemophilic arthropathy (HEAD-US) opened new perspectives in the use of US in management of these patients. The HEAD-US protocol enables quick evaluation of the six mostly affected joints in a single study. The aim of this prospective study was to determine the diagnostic accuracy of the HEAD-US protocol for the detection and quantification of haemophilic arthropathy in comparison to the MRI. Patients and methods The study included 30 patients with severe haemophilia. We evaluated their elbows, ankles and knees (overall 168 joints) by US using the HEAD-US protocol and compared the results with the MRI using the International Prophylaxis Study Group (IPSG) MRI score. Results The results showed that the overall HEAD-US score correlated very highly with the overall IPSG MRI score (r = 0.92). Correlation was very high for the evaluation of the elbows and knees (r ≈ 0.95), and slightly lower for the ankles (r ≈ 0.85). Conclusions HEAD-US protocol proved to be a quick, reliable and accurate method for the detection and quantification of haemophilic arthropathy.
Collapse
|
18
|
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: 22] [Impact Index Per Article: 4.4] [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.
Collapse
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
| |
Collapse
|
19
|
Stephensen D, Bladen M, McLaughlin P. Recent advances in musculoskeletal physiotherapy for haemophilia. Ther Adv Hematol 2018; 9:227-237. [PMID: 30181843 PMCID: PMC6116756 DOI: 10.1177/2040620718784834] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/27/2018] [Indexed: 12/16/2022] Open
Abstract
Physiotherapy is directed towards the movement needs and potential of individuals, providing treatment and rehabilitation to develop, maintain and restore maximum movement and functional ability throughout the lifespan. Recent systematic reviews and randomized controlled trials have extended evidence for the clinical efficacy of physiotherapy interventions and rehabilitation for people with haemophilia. This narrative review synthesizes recent evidence to discuss; differentiating musculoskeletal bleeding and haemophilic arthropathy, efficacy of physiotherapy and rehabilitation for acute musculoskeletal bleeding and arthropathy, as well as monitoring musculoskeletal health. Whilst robust evidence is emerging, there is a need for more well designed randomized clinical studies with larger numbers and homogeneity of participants and collaboration of all researchers and clinicians to identify a core set of outcome measures that can be used to monitor musculoskeletal health.
Collapse
Affiliation(s)
- David Stephensen
- East Kent Hospitals University NHS Foundation
Trust, Ethelbert Road, Canterbury CT1 3NG, UK
| | - Melanie Bladen
- Great Ormond Street Hospital for Children NHS
Foundation Trust, London, UK
| | | |
Collapse
|