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Leuci A, Dargaud Y. Blood-Induced Arthropathy: A Major Disabling Complication of Haemophilia. J Clin Med 2023; 13:225. [PMID: 38202232 PMCID: PMC10779541 DOI: 10.3390/jcm13010225] [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: 11/15/2023] [Revised: 12/19/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Haemophilic arthropathy (HA) is one of the most serious complications of haemophilia. It starts with joint bleeding, leading to synovitis which, in turn, can cause damage to the cartilage and subchondral bone, eventually inducing degenerative joint disease. Despite significant improvements in haemophilia treatment over the past two decades and recent guidelines from ISTH and WFH recommending FVIII trough levels of at least 3 IU/dL during prophylaxis, patients with haemophilia still develop joint disease. The pathophysiology of HA is complex, involving both inflammatory and degenerative components. Early diagnosis is key for proper management. Imaging can detect joint subclinical changes and influence prophylaxis. Magnetic resonance imagining (MRI) and ultrasound are the most frequently used methods in comprehensive haemophilia care centres. Biomarkers of joint health have been proposed to determine osteochondral joint deterioration, but none of these biomarkers has been validated or used in clinical practice. Early prophylaxis is key in all severe haemophilia patients to prevent arthropathy. Treatment is essentially based on prophylaxis intensification and chronic joint pain management. However, there remain significant gaps in the knowledge of the mechanisms responsible for HA and prognosis-influencing factors. Better understanding in this area could produce more effective interventions likely to ultimately prevent or attenuate the development of HA.
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Affiliation(s)
- Alexandre Leuci
- UR4609 Hemostasis & Thrombosis Research Unit, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, 69008 Lyon, France;
| | - Yesim Dargaud
- UR4609 Hemostasis & Thrombosis Research Unit, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, 69008 Lyon, France;
- Unité d’Hémostase Clinique—Centre de Référence de l’Hémophilie, Hôpital Louis Pradel Hospices Civils de Lyon, 69002 Lyon, France
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2
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Lundin B, Baghaei F, Holmström M, Petrini P, Müller G, Månsson S, Ljung R. Haemophilia A and B - evaluation of the Swedish prophylactic regimen by magnetic resonance imaging. Haemophilia 2023; 29:193-198. [PMID: 36469433 PMCID: PMC10107095 DOI: 10.1111/hae.14693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Sweden has been a pioneer in the prophylactic treatment of haemophilia. Magnetic resonance imaging (MRI) can detect small changes in joints and can therefore give an indication of a risk of developing arthropathy. AIM To use MRI to evaluate the outcome of the Swedish 'high-dose regimen' and correlate the findings to age, bleeds, joint score and physical activity. METHODS The study group comprised 48 Swedish male patients, mean age 25 years (range 12-33 years), with severe or moderate haemophilia A or B. Data on the Haemophilia Joint Health Score (HJHS) were available and physical activity was evaluated by a self-reported questionnaire. RESULTS MRI score was recorded in 188 joints. Twenty out of 48 patients had a score of ≥1 (range 1-13) in 31 joints of which 3/31 scores were in the knees and 28/31 in the ankles. No correlation was found between the number of recorded bleeds and the MRI score or between HJHS and MRI score. There was no correlation between the physical activity and the number of joint bleeds per se, but a trend (OR 3.0) that those most physically active (19/48; 39.6%), more frequently had an MRI score of ≥1 with an overweight for the right ankle. CONCLUSION The Swedish prophylactic model offers protection against haemophilia joint arthropathy but will still not prevent osteochondral changes in some patients at young age. MRI of the ankles can signal risk of future arthropathy and indicate need to modify the prophylactic regimen.
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Affiliation(s)
- Björn Lundin
- Department of Clinical Sciences Lund (IKVL) - Radiology, Lund University, Lund, Sweden and Dept. of Medical Imaging and Physiology, Skåne University Hospital, Lund/Malmö, Sweden
| | - Fariba Baghaei
- Coagulation Centre, Department of Medicine/Section of Hematology and Coagulation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margareta Holmström
- Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pia Petrini
- Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Gunilla Müller
- Institut für Radiologie und Nuklearmedizin, Stadtspital Triemli, Zürich, Switzerland
| | - Sven Månsson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Malmö, Sweden.,Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Rolf Ljung
- Department of Clinical Sciences Lund (IKVL) - Paediatrics, Lund University, Lund, Sweden
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3
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Cuesta-Barriuso R, Donoso-Úbeda E, Meroño-Gallut J, Ucero-Lozano R, Pérez-Llanes R. Hemophilic Arthropathy: Barriers to Early Diagnosis and Management. J Blood Med 2022; 13:589-601. [PMID: 36277171 PMCID: PMC9586168 DOI: 10.2147/jbm.s343924] [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] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
Hemophilia is a congenital coagulopathy characterized by a deficiency of one of the clotting factors. It is characterized by the development of hematomas and hemarthrosis, either spontaneously or after minor trauma. The recurrence of hemarthroses leads to progressive and degenerative joint damage from childhood (hemophilic arthropathy). This arthropathy is characterized by disabling physical effects that limit the functionality and quality of life of these patients. Medical progress achieved over the last decade in the drug treatment of hemophilia has improved the medium and long-term prospects of patients with more effective and long-lasting drugs. The universal use of safer, more effective and prolonged prophylactic treatments may promote the prevention of bleeding, and also therefore, of the development of hemarthrosis and joint damage. A number of imaging instruments have been developed for the assessment of hemarthrosis and hemophilic arthropathy, using ultrasound, magnetic resonance imaging and simple radiology. Different physical examination scores and questionnaires allow the assessment of joint health, self-perceived activity and functionality of patients with hemophilia. The approach to these patients should be interdisciplinary. Assessment of the processes that affect pain in these patients and the development of pain education models should be implemented. Expert advice and information to patients with hemophilia should be based on individual functional prevention diagnoses, advice on available therapies and sports practice, as well as health recommendations.
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Affiliation(s)
- Rubén Cuesta-Barriuso
- Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Oviedo, Spain,Royal Victoria Eugenia Foundation, Madrid, Spain,Correspondence: Rubén Cuesta-Barriuso, Department of Surgery and Medical-Surgical Specialties, University of Oviedo, Campus de El Cristo s/n, Faculty of Medicine, Oviedo, 33006, Spain, Tel +34 985 103 386, Email
| | - Elena Donoso-Úbeda
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
| | | | | | - Raúl Pérez-Llanes
- Department of Physiotherapy, Catholic University San Antonio-UCAM, Murcia, Spain
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4
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Taylor S, David J, Partington K, Pemberton S, Mangles S, Wells A, Curry N. A single centre, open label, pilot study evaluating the effect of intra-articular hyaluronic acid injection on pain and functionality when injected into the ankle (tibio-talar and sub-talar) joint in patients with haemophilic arthropathy. Haemophilia 2022; 28:e181-e188. [PMID: 35905300 DOI: 10.1111/hae.14639] [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: 04/20/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022]
Abstract
AIMS Ankle arthropathy commonly affects persons with haemophilia (PWH). Joint damage causes loss of movement, pain and reduced function. Current treatments are limited. Viscosupplementation has been used to treat other patient groups with joint damage. Viscosupplements serve to augment or act as a substitute for synovial fluid and may ameliorate the effects of cartilage loss by cushioning joints and reducing pain. This study evaluated intra-articular Ostenil Plus™ (HA) for ankle arthropathy in PWH. Reduction in pain was the primary outcome. METHODS A single centre open label pilot study. PWH and significant ankle arthropathy, according to MRI scores, were recruited. Participants received intra-articular HA injections at baseline and 6 months. Follow up assessments were completed three-monthly for 1 year. Pain was assessed by the Visual Analogue Scale (VAS). Participant perceptions of overall changes to pain, function and quality of life were sought. RESULTS Twenty-four participants were recruited, three withdrew. Twenty-six joints were injected. Twenty participants had severe haemophilia. Mean age 35 years. Participants reported significant reduction in pain over the study. VAS baseline: 5.62; 6 month 3.92; 12-month 3.42, P < .0001. Joint function improved together with ankle HJHS. No change was seen for EQ-5D-5L. Sixteen participants reported reductions in ankle pain and stiffness and greater confidence in undertaking physical activities. No significant adverse reactions were reported. CONCLUSION Ostenil Plus™ treatment improves pain, function and patient perception of functional ability in PWH and ankle arthropathy. This study supports the use of HA as a safe treatment in PWH.
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Affiliation(s)
- Stephanie Taylor
- Oxford Haemophilia and Thrombosis Centre, Nuffield Orthopaedic Centre, Oxford, UK
| | - Joel David
- Rheumatology Department, Nuffield Orthopaedic Centre, Oxford, UK
| | | | - Sam Pemberton
- Oxford Haemophilia and Thrombosis Centre, Nuffield Orthopaedic Centre, Oxford, UK
| | - Sarah Mangles
- Haemophilia, Haemostasis & Thrombosis Centre, Basingstoke & North Hampshire Hospital, Basingstoke, UK
| | - Anna Wells
- Haemophilia, Haemostasis & Thrombosis Centre, Basingstoke & North Hampshire Hospital, Basingstoke, UK
| | - Nicola Curry
- Oxford Haemophilia and Thrombosis Centre, Nuffield Orthopaedic Centre, Oxford, UK
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5
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Gualtierotti R, Solimeno LP, Peyvandi F. Hemophilic arthropathy: Current knowledge and future perspectives. J Thromb Haemost 2021; 19:2112-2121. [PMID: 34197690 PMCID: PMC8456897 DOI: 10.1111/jth.15444] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/15/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023]
Abstract
Hemophilia A and B are rare X-linked inherited bleeding disorders caused by complete or partial deficiency in or the absence of coagulation factors VIII and IX. Recurrent joint bleeding (hemarthrosis) is the most frequent clinical manifestation of severe hemophilia. Unless appropriately managed, even subclinical hemarthrosis can lead to the development of hemophilic arthropathy, a disabling condition characterized by joint remodelling, chronic pain, and a reduced quality of life, and eventually requires joint replacement. Given the lack of specific treatments to reduce blood-induced synovitis, the prevention of bleeding is pivotal to the maintenance of joint health. Prophylactic coagulation factor replacement therapy using extended half-life recombinant drugs has significantly improved patients' quality of life by reducing the burden of intravenous injections, and the more recent introduction of nonreplacement therapies such as subcutaneous emicizumab injections has improved treatment adherence and led to the greater protection of patients with hemophilia A. However, despite these advances, chronic arthropathy is still a significant problem. The introduction of point-of-care ultrasound imaging has improved the diagnosis of acute hemarthrosis and early hemophilic arthropathy, and allowed the better monitoring of progressive joint damage, but further research into the underlying mechanisms of the disease is required to allow the development of more targeted treatment. In the meantime, patient management should be based on the risk factors for the onset and progression of arthropathy of each individual patient, and all patients should be collaboratively cared for by multidisciplinary teams of hematologists, rheumatologists, orthopedic surgeons, and physiotherapists at comprehensive hemophilia treatment centers.
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Affiliation(s)
- Roberta Gualtierotti
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
- Angelo Bianchi Bonomi Hemophilia and Thrombosis CenterFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Luigi Piero Solimeno
- Traumatology and Orthopedic UnitFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Flora Peyvandi
- Department of Pathophysiology and TransplantationUniversità degli Studi di MilanoMilanItaly
- Angelo Bianchi Bonomi Hemophilia and Thrombosis CenterFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
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6
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Tolend M, Majeed H, Soliman M, Daruge P, Bordalo-Rodrigues M, Dertkigil SSJ, Gibikote S, Keshava SN, Stimec J, Dunn A, Li YJ, Blanchette V, Lundin B, Doria AS. Critical appraisal of the International Prophylaxis Study Group magnetic resonance image scale for evaluating haemophilic arthropathy. Haemophilia 2020; 26:565-574. [PMID: 32497355 DOI: 10.1111/hae.14032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 03/24/2020] [Accepted: 04/23/2020] [Indexed: 12/26/2022]
Abstract
A goal of the International Prophylaxis Study Group (IPSG) is to provide an accurate instrument to measure MRI-based disease severity of haemophilic arthropathy at various time points, so that longitudinal changes in disease severity can be identified to support decisions on treatment management. We review and discuss in this paper the evaluative purpose of the IPSG MRI scale in relation to its development and validation processes so far. We also critically appraise the validity, reliability and responsiveness of using the IPSG MRI scale in different clinical and research settings, and whenever applicable, compare these clinimetric properties of the IPSG MRI scale with those of its precursors, the compatible additive and progressive MRI scales.
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Affiliation(s)
- Mirkamal Tolend
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Haris Majeed
- Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Magdy Soliman
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Paulo Daruge
- Institute of Radiology, Universidade de Sao Paulo (USP), Sao Paulo, SP, Brazil
| | | | | | - Sridhar Gibikote
- Department of Radiology, Christian Medical College, Vellore, India
| | | | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Amy Dunn
- Department of Hematology, Nationwide Children's Hospital, Columbus, OH
| | - Ying-Jia Li
- Department of Radiology, Nanfang Hospital Hospital, Guangzhou, China
| | - Victor Blanchette
- Department of Hematology & Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Björn Lundin
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Canada
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7
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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
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8
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Magalhães AF, de Oliveira LCO, Pitella FA, Wichert-Ana L, Engel EE, Barbieri CH. Yttrium-90 radiosynovectomy in knees and ankles (25 joints in 22 hemophilic patients). Short-term results. Hematol Transfus Cell Ther 2020; 43:15-20. [PMID: 32036013 PMCID: PMC7910159 DOI: 10.1016/j.htct.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 10/09/2019] [Accepted: 11/21/2019] [Indexed: 12/01/2022] Open
Abstract
Introduction The radiosynovectomy (RS) is one treatment option for recurrent hemarthrosis in patients with hemophilia (PWH). A prospective cohort study was designed to evaluate the effects of the RS on the synovial membrane volume in the ankles and knees of PWH and patient characteristics related to the RS outcome. Methods In a one-year follow-up, 25 joints of 22 PWH who presented 3 bleeds or more in the same joint over the last 6 months (target joints) were subjected to the RS. Two groups were compared: those who retained target joints following the RS and those who did not (less than 3 bleeds/6 months after the RS). The groups were analyzed according to age, hemophilia type/severity, joint, body mass index (BMI), inhibitor and Hemophilia Joint Health Score 2.1 (HJHS). The magnetic resonance images (MRI) of six ankles and six knees were acquired prior to, and 6 months after, the RS. The synovial membrane volume and arthropathy MRI scale were accessed and volumes were compared and correlated with the Yttrium-90 dose injected. Results Patients with a mean age of 12 years and a mean HJHS of 6.7 (p < 0.05) retained target joints after the RS. The inhibitor, joint, type/severity of disease and BMI showed no significant differences between groups. The synovial membrane volume had a significant reduction after the RS (p = 0.03), but no correlation with the Yttrium-90 dose. In proportion to the synovial membrane volume, doses injected to the ankles were larger than those injected to the knees. Conclusion The synovial membrane volume is reduced after the RS, regardless of the effective 90Y dose.
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Affiliation(s)
- Andréa Fernandes Magalhães
- Department of Health Sciences Applied to the Locomotor System (Orthopaedics/Traumatology), Ribeirão Preto Medical School ,University of São Paulo, São Paulo, Brazil.
| | - Luciana Correa O de Oliveira
- Department of Medical Imaging, Hematology, and Clinical Oncology, Ribeirão Preto Medical School ,University of São Paulo, São Paulo, Brazil
| | - Felipe Arriva Pitella
- Department of Internal Medicine, Division of Nuclear Medicine, Ribeirão Preto Medical School ,University of São Paulo, São Paulo, Brazil
| | - Lauro Wichert-Ana
- Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Edgard Eduard Engel
- Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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9
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García-Massó X, Ye-Lin Y, Garcia-Casado J, Querol F, Gonzalez LM. Assessment of haemophilic arthropathy through balance analysis: a promising tool. Comput Methods Biomech Biomed Engin 2019; 22:418-425. [PMID: 30714398 DOI: 10.1080/10255842.2018.1561877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The purpose of this study was to develop a tool able to distinguish between subjects who have haemophilic arthropathy in lower limbs and those who do not by analyzing the centre of pressure displacement. The second objective was to assess the possible different responses of haemophiliacs and healthy subjects by creating a classifier that could distinguish between both groups. Fifty-four haemophilic patients (28 with and 26 without arthropathy) and 23 healthy subjects took part voluntarily in the study. A force plate was used to measure postural stability. A total of 276 centre of pressure displacement parameters were calculated under different conditions: unipedal/bipedal balance with eyes open/closed. These parameters were used to design a Quadratic Discriminant Analysis classifier. The arthropathy versus non-arthropathy classifier had an overall accuracy of 97.5% when only 10 features were used in its design. Similarly, the haemophiliac versus non-haemophiliac classifier had an overall accuracy of 97.2% when only 7 features were used. In conclusion, an objective haemophilic arthropathy in lower limbs evaluation system was developed by analyzing centre of pressure displacement signals. The haemophiliac vs. non-haemophiliac classifier designed was also able to corroborate the existing differences in postural control between haemophilic patients (with and without arthropathy) and healthy subjects.
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Affiliation(s)
- Xavier García-Massó
- a Departamento de Didáctica de la Expresión Musical Plástica y Corporal , Universidad de Valencia , Valencia , España
| | - Yiyao Ye-Lin
- b Centro de Investigación e Innovación en Bioingeniería (CI2B) , Universitat Politècnica de València , Valencia , España
| | - Javier Garcia-Casado
- b Centro de Investigación e Innovación en Bioingeniería (CI2B) , Universitat Politècnica de València , Valencia , España
| | - Felipe Querol
- c Departamento de Fisioterapia , Universidad de Valencia , Valencia , España.,d Unidad de Trombosis y Hemostasia Hospital Universitario La FE , Valencia , España
| | - Luis-Millan Gonzalez
- e Departamento de Educación Física y Deportiva , Universidad de Valencia , Valencia , España
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10
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von Drygalski A, Moore RE, Nguyen S, Barnes RFW, Volland LM, Hughes TH, Du J, Chang EY. Advanced Hemophilic Arthropathy: Sensitivity of Soft Tissue Discrimination With Musculoskeletal Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1945-1956. [PMID: 29363781 PMCID: PMC6057843 DOI: 10.1002/jum.14541] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 05/09/2023]
Abstract
OBJECTIVES Point-of-care musculoskeletal ultrasound (US) is increasingly used by hemophilia providers to guide management; however, pathologic tissue differentiation with US is uncertain. We sought to determine the extent to which point-of-care musculoskeletal US can identify and discriminate pathologic soft tissue changes in hemophilic arthropathy. METHODS Thirty-six adult patients with hemophilia A/B were prospectively enrolled. Point-of-care musculoskeletal US examinations were performed on arthropathic joints (16 knees, 10 ankles, and 10 elbows) using standard views by a musculoskeletal US-trained and certified hematologist, who recorded abnormal intra-articular soft tissue accumulation. Within 3 days, magnetic resonance imaging was performed using conventional and multiecho ultrashort echo time sequences. Soft tissue identification (synovial proliferation with or without hemosiderin, fat, and/or blood products) was performed by a musculoskeletal radiologist. Findings obtained with both imaging modalities were compared and correlated in a blinded fashion. RESULTS There was perfect agreement between the modalities on the presence of abnormal soft tissue (34 of 36 cases). However, musculoskeletal US was unable to discriminate between coagulated blood, synovium, intrasynovial or extrasynovial fat tissue, or hemosiderin deposits because of wide variations in echogenicity. CONCLUSIONS Musculoskeletal US is valuable for point-of-care imaging to determine the presence of soft tissue accumulation in discrete areas. However, because of limitations of musculoskeletal US in discriminating the nature of pathologic soft tissues and detecting hemosiderin, magnetic resonance imaging will be required if such discrimination is clinically important.
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Affiliation(s)
- Annette von Drygalski
- University of California San Diego, Department of Medicine, Division of Hematology/Oncology, San Diego, CA, USA
- The Scripps Research Institute, Department of Molecular and Experimental Medicine, La Jolla, CA, USA
| | - Randy E Moore
- General Musculoskeletal Imaging Inc, Cincinnati, OH, USA
| | - Sonha Nguyen
- University of California San Diego, Department of Medicine, Division of Hematology/Oncology, San Diego, CA, USA
| | - Richard FW Barnes
- University of California San Diego, Department of Medicine, Division of Hematology/Oncology, San Diego, CA, USA
| | - Lena M Volland
- University of California San Diego, Department of Medicine, Division of Hematology/Oncology, San Diego, CA, USA
| | - Tudor H. Hughes
- University of California San Diego, Department of Radiology, San Diego, CA, USA
| | - Jiang Du
- University of California San Diego, Department of Radiology, San Diego, CA, USA
| | - Eric Y Chang
- VA San Diego Healthcare System, Radiology Service, San Diego, USA
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11
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R CB, A TO, S PA, J CJ, F Q, J NM, JA LP. Using the Hemophilia Joint Health Score for assessment of children: Reliability of the Spanish version. Physiother Theory Pract 2018; 35:341-347. [DOI: 10.1080/09593985.2018.1443356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Cuesta-Barriuso R
- Department of Physiotherapy, School of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain
- Real Fundación Victoria Eugenia, Madrid, Spain
- Fishemo-Federación Española de Hemofilia, Madrid, Spain
| | - Torres-Ortuño A
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Pérez-Alenda S
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Carrasco Juan J
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Querol F
- Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Nieto-Munuera J
- Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain
| | - López-Pina JA
- Department of Basic Psychology and Methodology, University of Murcia, Murcia, Spain
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12
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Manco-Johnson MJ, Lundin B, Funk S, Peterfy C, Raunig D, Werk M, Kempton CL, Reding MT, Goranov S, Gercheva L, Rusen L, Uscatescu V, Pierdominici M, Engelen S, Pocoski J, Walker D, Hong W. Effect of late prophylaxis in hemophilia on joint status: a randomized trial. J Thromb Haemost 2017; 15:2115-2124. [PMID: 28836341 DOI: 10.1111/jth.13811] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Indexed: 11/29/2022]
Abstract
Essentials High-quality data are lacking on use of prophylaxis in adults with hemophilia and arthropathy. SPINART was a 3-year randomized clinical trial of late/tertiary prophylaxis vs on-demand therapy. Prophylaxis improved function, quality of life, activity and pain but not joint structure by MRI. Prophylaxis improves function but must start before joint bleeding onset to prevent arthropathy. SUMMARY Background Limited data exist on the impact of prophylaxis on adults with severe hemophilia A and pre-existing joint disease. Objectives To describe 3-year bleeding, joint health and structure, health-related quality-of-life (HRQoL) and other outcomes from the open-label, randomized, multinational SPINART study. Patients/Methods Males aged 12-50 years with severe hemophilia A, ≥ 150 factor VIII exposure days, no inhibitors and no prophylaxis for > 12 consecutive months in the past 5 years were randomized to sucrose-formulated recombinant FVIII prophylaxis or on-demand therapy (OD). Data collected included total and joint bleeding events (BEs), joint structure (magnetic resonance imaging [MRI]), joint health (Colorado Adult Joint Assessment Scale [CAJAS]), HRQoL, pain, healthcare resource utilization (HRU), activity, and treatment satisfaction. Results Following 3 years of prophylaxis, adults maintained excellent adherence, with a 94% reduction in BEs despite severe pre-existing arthropathy; 35.7% and 76.2% of prophylaxis participants were bleed-free or had fewer than two BEs per year, respectively. As compared with OD, prophylaxis was associated with improved CAJAS scores (least squares [LS] mean, - 0.31 [n = 42] versus + 0.63 [n = 42]) and HAEMO-QoL-A scores (LS mean, + 3.98 [n = 41] versus - 6.00 [n = 42]), less chronic pain (50% decrease), and approximately two-fold less HRU; activity, Euro QoL-5D-3L (EQ-5D-3L) scores and satisfaction scores also favored prophylaxis. However, MRI score changes were not different for prophylaxis versus OD (LS mean, + 0.79 [n = 41] versus + 0.96 [n = 38]). Conclusions Over a period of 3 years, prophylaxis versus OD in adults with severe hemophilia A and arthropathy led to decreased bleeding, pain, and HRU, better joint health, activity, satisfaction, and HRQoL, but no reduction in structural arthropathy progression, suggesting that pre-existing joint arthropathy may be irreversible.
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Affiliation(s)
| | - B Lundin
- Lund University and Skåne University Hospital, Lund, Sweden
| | - S Funk
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - C Peterfy
- Spire Sciences, Inc., Boca Raton, FL, USA
| | - D Raunig
- ICON Medical Imaging, Warrington, PA, USA
| | - M Werk
- Martin-Luther-Krankenhaus, Akademisches Lehrkrankenhaus der Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - M T Reding
- University of Minnesota, Minneapolis, MN, USA
| | - S Goranov
- UMHAT Sveti Georgi and Medical University, Plovdiv, Bulgaria
| | | | - L Rusen
- S. C. SANADOR SRL, Bucharest, Romania
| | - V Uscatescu
- Institutul Clinic Fundeni, Bucharest, Romania
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13
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Soliman M, Daruge P, Dertkigil SSJ, De Avila Fernandes E, Negrao JR, de Aguiar Vilela Mitraud S, Sakuma ETI, Fernandes ARC, Zhang N, Huo A, Li YJ, Zhou F, Rodrigues BM, Mohanta A, Blanchette VS, Doria AS. Imaging of haemophilic arthropathy in growing joints: pitfalls in ultrasound and MRI. Haemophilia 2017; 23:660-672. [PMID: 28574216 DOI: 10.1111/hae.13249] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/28/2022]
Abstract
The purpose of this review was to summarize the current knowledge on the utilization of magnetic resonance imaging (MRI) and ultrasound (US) for assessing arthropathy in children and adolescents with haemophilia and to recognize the limitations of each imaging modality and pitfalls in the diagnosis of soft tissue and osteochondral abnormalities. Awareness of MRI and US limitations and pitfalls in the assessment of joints in persons with haemophilia is essential for accurate diagnosis and optimal management of haemophilic arthropathy.
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Affiliation(s)
- M Soliman
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - P Daruge
- Institute of Radiology, Universidade de Sao Paulo (USP), Sao Paulo, SP, Brazil
| | - S S J Dertkigil
- Department of Radiology, Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
| | - E De Avila Fernandes
- Department of Radiology, Universidade de Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - J R Negrao
- Department of Radiology, Universidade de Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | | | - E T I Sakuma
- Department of Radiology, Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
| | - A R C Fernandes
- Department of Radiology, Universidade de Federal de Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - N Zhang
- Department of Radiology, Beijing Children's Hospital, Beijing, China
| | - A Huo
- Department of Radiology, Beijing Children's Hospital, Beijing, China
| | - Y-J Li
- Department of Radiology, Nanfang Hospital, Guangzhou, China
| | - F Zhou
- Department of Radiology, Nanfang Hospital, Guangzhou, China
| | - B M Rodrigues
- Institute of Radiology, Universidade de Sao Paulo (USP), Sao Paulo, SP, Brazil
| | - A Mohanta
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - V S Blanchette
- Department of Hematology & Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - A S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
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14
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Hermans C, Auerswald G, Benson G, Dolan G, Duffy A, Jiménez-Yuste V, Ljung R, Morfini M, Lambert T, Osooli M, Zupančić Šalek S. Outcome measures for adult and pediatric hemophilia patients with inhibitors. Eur J Haematol 2017; 99:103-111. [DOI: 10.1111/ejh.12881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Cedric Hermans
- Division of Haematology; Cliniques Universitaires Saint-Luc; Brussels Belgium
| | - Günter Auerswald
- Klinikum Bremen-Mitte; Professor Hess Children's Hospital; Bremen Germany
| | - Gary Benson
- Northern Ireland Haemophilia Comprehensive Care Centre; Belfast Ireland
| | - Gerry Dolan
- Department of Haematology; Queens Medical Centre; Nottingham UK
| | - Anne Duffy
- Irish Haemophilia Society; Dublin Ireland
| | - Victor Jiménez-Yuste
- Hospital Universitario La Paz; Unidad de Coagulopatías; Servicio de Hematología; Universidad Autonoma de Madrid; Madrid Spain
| | - Rolf Ljung
- Department of Paediatrics and Malmö Centre for Thrombosis and Haemostasis; Lund University; Skåne University Hospital; Malmö Sweden
| | - Massimo Morfini
- Past President of Italian Association of Haemophilia Centres (AICE); Florence Italy
| | - Thierry Lambert
- Hemophilia Care Center; Bicêtre AP-HP Hospital and Faculté de Médecine Paris XI; Paris France
| | - Mehdi Osooli
- Malmö Center for Thrombosis and Haemostasis; Department of Translational Medicine; Skåne University Hospital; Malmö Sweden
| | - Silva Zupančić Šalek
- National Haemophilia and Thrombophilia Centre; Department of Haematology; University Hospital Centre Zagreb; Rebro, Zagreb Croatia
- School of Medicine; University of Zagreb; Zagreb Croatia
- School of Medicine; University of Osijek; Osijek Croatia
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15
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Wang Z, Zhang Y, Ge YH, Liu HJ, Liu YH, Zhao JJ, Dou YC, Lei PC. [Therapeutic response of radiosynovectomy with p-32 colloid in 326 patients with hemophilic arthropathy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:39-43. [PMID: 28219224 PMCID: PMC7348404 DOI: 10.3760/cma.j.issn.0253-2727.2017.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Indexed: 11/25/2022]
Abstract
Objective: To observe the therapeutic response of radiosynovectomy with p-32 colloid on hemophilic arthropathy, and to assess the effects of radiosynovectomy with Denver Score on hemophilic arthritis staging. Methods: Radiosynovectomy with p-32 colloid was performed on 326 hemophilic arthritis patients (405 joints) , and recorded bleeding before and after treatment. The MRI performance of 102 joints was evaluated by using Denver scoring system, then was divided into 0-6 and 7-10 groups. Finally, the differences between 2 groups were analyzed. Results: Average pain score of all hemophilic arthritis patients at 6 months, 1, 2 and 3 years post treatment decreased from 3.2±2.4 (n=326) to 1.2±0.6 (n=285, P=0.021) , 1.7±0.5 (n=242, P=0.032) , 2.1±1.1 (n=212, P=0.030) and 2.2±1.6 (n=176, P=0.037) , respectively. The frequency of bleeding in 405 joints at 1, 2 and 3 years post treatment decreased from 15.1±3.6 to 2.1±0.7, 4.3±0.6, and 4.8±0.8 times per year (P<0.01) , respectively; Meanwhile, the proportions of significantly ameliorated joints' activities were observed as of 68.50% (248/362) , 58.39% (181/310) , 55.67% (162/239) and 42.61% (75/176) , respectively. The frequencies of haemarthrosis at 1 and 2 years post treatment in patients with 0-6 Denver Score (45 target joints) reduced from 13.0±1.9 to 1.3±0.6 (P=0.002) and 3.1±0.9 (P=0.009) times per year, respectively, which also decreased in 7-10 group (57 target joints) from 16.6±2.1 to 3.1±0.9 (P=0.008) and 5.7±1.1 (P=0.004) times per year, respectively. There was no statistical difference between 0-6 and 7-10 groups before treatment in the terms of haemarthrosis frequency (P=0.773) . However, 7-10 group had higher haemarthrosis frequency at 1 and 2 years post treatment compare with 0-6 group (P=0.028 and 0.042, respectively) . Synovial volumes in 29 joints reduced after 6 month when compared with baseline [ (2 362.15±32.41) mm(3) vs (3 012.40±39.78) mm(3), t=7.621, P<0.001]. Conclusion: Radiosynovectomy with p-32 colloid on haemophilic synovitis was a safe and effective procedure. The patients with Denver Score of 0-7 had lower frequency of haemarthrosis.
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Affiliation(s)
- Z Wang
- Department of Hematology, Henan Province People's Hospital, Zhengzhou 450003, China
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16
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Liu C, Guo J, Cui Q, Li D, Zeng Y. Clinical and imaging analysis of subclinical hemophilia combined with coxarthrosis: case report and literature review. SPRINGERPLUS 2016; 5:2058. [PMID: 27995035 PMCID: PMC5133214 DOI: 10.1186/s40064-016-3727-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 11/23/2016] [Indexed: 11/10/2022]
Abstract
Introduction The incidence of subclinical hemophilic arthritis is low, with this case reports and literature review, we hope clinicians could pay more attention to the diagnosis of subclinical hemophilic arthritis and prevent the misdiagnosis and mistreatment. Case presentation We analyzed the imaging feature, and therapy of a subclinical hemophilia case with hip lesion by reporting its clinical manifestations, imaging features and therapy procedure, and reviewing literatures. Results Hemophilia is a sex-linked recessive hereditary hemorrhagic disease, and the pathogenesis of subclinic hemophilia is concealed, which often involves joint lesion. The imaging of joint lesion of hemophilia cases is typical, which facilitates the differential diagnosis with other joint diseases. The current treatment is mainly supplementary or replacement therapy. Conclusion Hemophilic arthritis cases, especially the mild or subclinical cases without family history and with an older age of onset, are not common. The disease should be further understood, and early diagnosis and treatment is crucial to prevent the progressive development of joint diseases.
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Affiliation(s)
- Cheng Liu
- Department of Orthopedics, The Affiliated Hospital of Academy of Military Medical Sciences, PLA 307th Hospital, Beijing, 100071 China
| | - Jun Guo
- Department of Orthopedics, The Affiliated Hospital of Academy of Military Medical Sciences, PLA 307th Hospital, Beijing, 100071 China
| | - Qiu Cui
- Department of Orthopedics, The Affiliated Hospital of Academy of Military Medical Sciences, PLA 307th Hospital, Beijing, 100071 China
| | - Dingfeng Li
- Department of Orthopedics, The Affiliated Hospital of Academy of Military Medical Sciences, PLA 307th Hospital, Beijing, 100071 China
| | - Yanjun Zeng
- Beijing University of Technology, 100 Pingleyuan, Chaoyang District, Beijing, 100022 China
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17
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Hong W, Raunig D, Lundin B. SPINART study: validation of the extended magnetic resonance imaging scale for evaluation of joint status in adult patients with severe haemophilia A using baseline data. Haemophilia 2016; 22:e519-e526. [DOI: 10.1111/hae.13022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2016] [Indexed: 11/27/2022]
Affiliation(s)
| | - D. Raunig
- ICON Medical Imaging Warrington PA USA
| | - B. Lundin
- Department of Clinical Sciences Lund University, Department of Diagnostic Radiology Lund Sweden
- Center for Medical Imaging and Physiology Skåne University Hospital Lund Sweden
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18
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Fischer K, Poonnoose P, Dunn AL, Babyn P, Manco-Johnson MJ, David JA, van der Net J, Feldman B, Berger K, Carcao M, de Kleijn P, Silva M, Hilliard P, Doria A, Srivastava A, Blanchette V. Choosing outcome assessment tools in haemophilia care and research: a multidisciplinary perspective. Haemophilia 2016; 23:11-24. [DOI: 10.1111/hae.13088] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2016] [Indexed: 01/23/2023]
Affiliation(s)
- K. Fischer
- Van Creveldkliniek; University Medical Center Utrecht; Utrecht The Netherlands
| | - P. Poonnoose
- Department of Orthopaedics; Christian Medical College; Vellore Tamil Nadu India
| | - A. L. Dunn
- Division of Hematology and Oncology; Nationwide Children's Hospital and The Ohio State University; Columbus OH USA
| | - P. Babyn
- Department of Medical Imaging; University of Saskatchewan and Saskatoon Health Region Royal University Hospital; Saskatoon SK Canada
| | - M. J. Manco-Johnson
- Section of Hematology/Oncology/Bone Marrow Transplantation; Department of Pediatrics; University of Colorado Anschutz Medical Campus and Children's Hospital; Aurora CO USA
| | - J. A. David
- Department of PMR; Christian Medical College; Vellore Tamil Nadu India
| | - J. van der Net
- Child Health Services; Child Development and Exercise Center; University Medical Center and Children's Hospital; Utrecht The Netherlands
| | - B. Feldman
- Division of Rheumatology; Department of Paediatrics and Child Health Evaluative Sciences; Research Institute; Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - K. Berger
- Division of Haematology/Oncology; University Hospital of Munich; Munich Germany
| | - M. Carcao
- Division of Haematology/Oncology; Department of Paediatrics and Child Health Evaluative Sciences; Research Institute; Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - P. de Kleijn
- Department of Rehabilitation, Nursing Science and Sports, and Van Creveldkliniek; University Medical Center Utrecht; Utrecht The Netherlands
| | - M. Silva
- Department of Orthopaedic Surgery; Orthopaedic Institute for Children; David Geffen School of Medicine at UCLA; Los Angeles CA USA
| | - P. Hilliard
- Department of Rehabilitation; Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - A. Doria
- Department of Diagnostic Imaging; Research Institute; Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - A. Srivastava
- Department of Haematology; Christian Medical College; Vellore Tamil Nadu India
| | - V. Blanchette
- Division of Haematology/Oncology; Department of Paediatrics and Child Health Evaluative Sciences; Research Institute; Hospital for Sick Children; University of Toronto; Toronto ON Canada
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19
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Gupta AK, Jana M. Hemophilia Management and Follow-up: Role of Radiological and Functional Assessment of the Disease Severity. Indian J Pediatr 2015; 82:1084-5. [PMID: 26400035 DOI: 10.1007/s12098-015-1882-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Arun Kumar Gupta
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Manisha Jana
- Department of Radio-diagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India
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20
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van den Berg HM, Feldman BM, Fischer K, Blanchette V, Poonnoose P, Srivastava A. Assessments of outcome in haemophilia - what is the added value of QoL tools? Haemophilia 2015; 21:430-5. [PMID: 26032397 DOI: 10.1111/hae.12731] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Access to treatment and especially to long-term regular replacement treatment with clotting factor concentrates (prophylaxis) have caused dramatic contrasts in the clinical picture between haemophilia populations. An individual patient with severe haemophilia age 20 years can have normal joints or can be severely crippled and unable to work. Assessment of outcome in a standardized way has therefore become essential. AIM Discuss the relevance and utility of the different outcome assessment tools in patient groups with different access to treatment. METHODS In the last decade new outcome assessment tools specific for haemophilia have been developed that measure all aspects of health according to the International Classification of Functioning, Disability and Health (ICF) model. These tools are directed at assessing the clinical and radiological status of joints as well as overall functioning, such as participation and psychosocial aspects, evaluating overall health-related quality of life (HRQOL). For deciding which tools to use in clinical practice or research, one needs to consider the specific context with regard to disease burden, healthcare environment and socioeconomic background of the patients being evaluated. CONCLUSION Prospective systematic assessment of outcome in haemophilia and related bleeding disorders is important. Based upon recent literature a critical appraisal of outcome tools is described.
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Affiliation(s)
- H M van den Berg
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B M Feldman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.,Departments of Paediatrics, Medicine, and the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - K Fischer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
| | - V Blanchette
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - P Poonnoose
- Department of Orthopaedics, Christian Medical College, Vellore, India
| | - A Srivastava
- Department of Haematology, Christian Medical College, Vellore, India
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21
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Boehlen F, Graf L, Berntorp E. Outcome measures in haemophilia: a systematic review. Eur J Haematol 2015; 76:2-15. [PMID: 24957102 DOI: 10.1111/ejh.12369] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 01/03/2023]
Abstract
Haemophilia A and B are hereditary X-linked disorders due to deficiency (or absence) of coagulation factor VIII or IX, respectively. Bleeding risk is related to the severity of factor deficiency. Repeated joint bleeding can lead to a severe haemophilic arthropathy resulting in disabilities. Outcome measurements in persons with haemophilia (PWH) have been limited to laboratory evaluation (factor VIII or IX levels) and clinical outcomes (such as bleeding frequency), morbidity (for example linked with arthropathy) and mortality. Due to the new standard of care of PWH, there is a need to consider other outcome measures, such as the early detection and quantification of joint disease, health-related quality of life (QoL) and economic or cost-utility analyses. To investigate this, we performed a 10-yr systematic overview of outcome measures in haemophilia. Only clinical trials including at least 20 patients with haemophilia A or B were included. To facilitate the search strategy, eight issues of outcome measures were selected: physical scores, imaging technique scores, functional scores, QoL measurement, mortality, bleeding frequency, cost and outcome and bone mineral density. The results of these will be discussed. Clearly defined outcomes in haemophilia care are important for many reasons, to evaluate new treatments, to justify treatment strategies, to allow a good follow-up, to perform studies and to allocate resources. The use of such scoring systems is clearly recommended by experts in haemophilia care. However, most centres do not perform such scores outside clinical trials due to reasons such as lack of time and resources.
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Affiliation(s)
- Françoise Boehlen
- Division of Angiology and Haemostasis, University Hospitals and School of Medicine, Geneva, Switzerland
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22
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Optimal treatment strategies for hemophilia: achievements and limitations of current prophylactic regimens. Blood 2015; 125:2038-44. [DOI: 10.1182/blood-2015-01-528414] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Abstract
Prophylactic application of clotting factor concentrates is the basis of modern treatment of severe hemophilia A. In children, the early start of prophylaxis as primary or secondary prophylaxis has become the gold standard in most countries with adequate resources. In adults, prophylaxis is reasonably continued when started as primary or secondary prophylaxis in childhood to maintain healthy joint function. Initial data support that adult patients with already existing advanced joint arthropathy benefit from tertiary prophylaxis with significantly lowered number of bleeds, almost complete absence of target joints, and less time off from work. Current prophylactic regimens, although very effective, do not completely prevent joint disease in a long-term perspective. Joint arthropathy in primary prophylaxis develops over many years, sometimes over a decade or even longer time periods. The ankle joints are the first and most severely affected joints in those patients and thus may serve in outcome assessment as an indicator of early joint arthropathy when followed by ultrasound or magnetic resonance imaging. Optimized outcome and best use of available resources is expected from individualization of therapy regimens, which comprises the individual’s bleeding pattern, condition of the musculoskeletal system, level of physical activity and the pharmacokinetic profile of the substituted coagulation factor, and most recently includes novel products with extended half-lives.
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23
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Schwarz R, Ljung R, Tedgård U. Various regimens for prophylactic treatment of patients with haemophilia. Eur J Haematol 2015; 94 Suppl 77:11-6. [PMID: 25560789 DOI: 10.1111/ejh.12496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2014] [Indexed: 02/06/2023]
Abstract
Haemophilia prophylaxis is superior to on-demand treatment to prevent joint damage. 'High-dose prophylaxis' as used in Sweden is more effective in preventing arthropathy than an 'intermediate-dose regimen' (the Netherlands) and the Canadian tailored primary prophylaxis. Prophylaxis may reduce the risk of developing inhibitors. There is no difference in inhibitor risk between plasma derived and recombinant factor VIII (rFVIII) products but the Rodin study showed increased risk with second-generation rFVIII products. MRI is a new and very sensitive tool to detect the symptoms of early arthropathy but some results (soft tissue changes in 'bleed-free joints') still need to be investigated. Ultrasound is a very helpful method to aid diagnosis especially during the acute phase of a bleed. The risk of infection with central venous access remains a matter of debate. A fully implanted central venous access device (CVAD) has a significant lower risk of infection compared to external CVADs. Patient's age under 6 yr and inhibitor presence are additional risk factors for infections. The role of arteriovenous fistulae needs to be investigated because significant complications have been reported. Disease-specific quality of life instruments are complementary to generic instruments evaluating QoL in patients with haemophilia and have become important health outcome measures.
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24
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Oldenburg J, Zimmermann R, Katsarou O, Theodossiades G, Zanon E, Niemann B, Kellermann E, Lundin B. Controlled, cross-sectional MRI evaluation of joint status in severe haemophilia A patients treated with prophylaxis vs. on demand. Haemophilia 2014; 21:171-179. [PMID: 25470205 PMCID: PMC4359687 DOI: 10.1111/hae.12539] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2014] [Indexed: 01/06/2023]
Abstract
In patients with haemophilia A, factor VIII (FVIII) prophylaxis reduces bleeding frequency and joint damage compared with on-demand therapy. To assess the effect of prophylaxis initiation age, magnetic resonance imaging (MRI) was used to evaluate bone and cartilage damage in patients with severe haemophilia A. In this cross-sectional, multinational investigation, patients aged 12-35 years were assigned to 1 of 5 groups: primary prophylaxis started at age <2 years (group 1); secondary prophylaxis started at age 2 to <6 years (group 2), 6 to <12 years (group 3), or 12-18 years (group 4); or on-demand treatment (group 5). Joint status at ankles and knees was assessed using Compatible Additive MRI scoring (maximum and mean ankle; maximum and mean of all 4 joints) and Gilbert scores in the per-protocol population (n = 118). All prophylaxis groups had better MRI joint scores than the on-demand group. MRI scores generally increased with current patient age and later start of prophylaxis. Ankles were the most affected joints. In group 1 patients currently aged 27-35 years, the median of maximum ankle scores was 0.0; corresponding values in groups 4 and 5 were 17.0 and 18.0, respectively [medians of mean index joint scores: 0.0 (group 1), 8.1 (group 2) and 13.8 (group 4)]. Gilbert scores revealed outcomes less pronounced than MRI scores. MRI scores identified pathologic joint status with high sensitivity. Prophylaxis groups had lower annualized joint bleeds and MRI scores vs. the on-demand group. Primary prophylaxis demonstrated protective effects against joint deterioration compared with secondary prophylaxis.
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25
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The investigation of relationship between joint findings and serum angiogenic and inflammatory factor levels in severe hemophilia A patients. Blood Coagul Fibrinolysis 2014; 25:703-8. [DOI: 10.1097/mbc.0000000000000131] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Blanchette VS, O’Mahony B, McJames L, Mahlangu JN. Assessment of outcomes. Haemophilia 2014; 20 Suppl 4:114-20. [DOI: 10.1111/hae.12426] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
Affiliation(s)
- V. S. Blanchette
- Division of Hematology/Oncology; Department of Pediatrics; University of Toronto; Hospital for Sick Children; Toronto ON Canada
| | - B. O’Mahony
- European Haemophilia Consortium; Irish Haemophilia Society; Cumann Haemifile Na hEireann; Dublin 8 Ireland
| | - L. McJames
- National Blood Authority; Lyneham NSW Australia
| | - J. N. Mahlangu
- Division of Molecular Medicine and Haematology; Faculty of Health Sciences; NHLS and University of the Witwatersrand; Parktown Johannesburg South Africa
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Foppen W, van der Schaaf IC, Witkamp TD, Fischer K. Is joint effusion on MRI specific for haemophilia? Haemophilia 2013; 20:582-6. [DOI: 10.1111/hae.12338] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2013] [Indexed: 11/28/2022]
Affiliation(s)
- W. Foppen
- Department of Radiology; University Medical Center (UMC) Utrecht; Utrecht The Netherlands
| | - I. C. van der Schaaf
- Department of Radiology; University Medical Center (UMC) Utrecht; Utrecht The Netherlands
| | - T. D. Witkamp
- Department of Radiology; University Medical Center (UMC) Utrecht; Utrecht The Netherlands
| | - K. Fischer
- Van Creveldkliniek; Department of Haematology, and Julius Center for Health Sciences and Primary Care; University Medical Center (UMC) Utrecht; Utrecht The Netherlands
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28
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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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29
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Sierra Aisa C, Lucía Cuesta JF, Rubio Martínez A, Fernández Mosteirín N, Iborra Muñoz A, Abío Calvete M, Guillén Gómez M, Moretó Quintana A, Rubio Félix D. Comparison of ultrasound and magnetic resonance imaging for diagnosis and follow-up of joint lesions in patients with haemophilia. Haemophilia 2013; 20:e51-7. [DOI: 10.1111/hae.12268] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2013] [Indexed: 11/28/2022]
Affiliation(s)
- C. Sierra Aisa
- Hospital Universitario de Cruces; San Vicente de Barakaldo Spain
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30
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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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31
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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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Abstract
Physical medicine and rehabilitation aim to evaluate, diagnose and treat disability in haemophiliac patients, while preventing injury or deterioration. They also aim to maintain the greatest degree of functional capacity and independence in patients with haemophilia, or to return them to that state. Rehabilitation, together with clotting factor replacement therapy, has revolutionized the management of these patients in developed countries and reduced their morbidity/mortality rates. A knowledge of the musculoskeletal signs and symptoms of haemophilia is essential for providing a treatment which is suitable and customized. Physical medicine and rehabilitation techniques, which are based on physical means, are intended to reduce the impact which these injuries and their consequences or sequelae can have on the quality of life of patients with haemophilia. Under ideal haemostatic control conditions (primary prophylaxis), people with haemophilia could achieve good physical condition which will allow them to enjoy both physical activity and a daily life without limitations. Currently, children undergoing primary prophylaxis are quite close to this ideal situation. For these physical activities to be carried out, the safest possible situations must be sought.
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Lundin B, Manco-Johnson ML, Ignas DM, Moineddin R, Blanchette VS, Dunn AL, Gibikote SV, Keshava SN, Ljung R, Manco-Johnson MJ, Miller SF, Rivard GE, Doria AS. An MRI scale for assessment of haemophilic arthropathy from the International Prophylaxis Study Group. Haemophilia 2012; 18:962-70. [DOI: 10.1111/j.1365-2516.2012.02883.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2012] [Indexed: 11/29/2022]
Affiliation(s)
- B. Lundin
- Department of Clinical Sciences Lund, Division of Diagnostic Radiology and Center for Medical Imaging and Physiology; Lund University, Skåne University Hospital; Lund; Sweden
| | - M. L. Manco-Johnson
- Department of Radiology and Hemophilia & Thrombosis Center; University of Colorado; Denver; CO; USA
| | - D. M. Ignas
- Child Health Evaluative Sciences; The Hospital for Sick Children; Toronto; Ontario; Canada
| | - R. Moineddin
- University of Toronto; Public Health, Family and Community Medicine; Toronto; Ontario; Canada
| | - V. S. Blanchette
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children and Department of Pediatrics; University of Toronto; Toronto; Ontario; Canada
| | - A. L. Dunn
- Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta; Emory University School of Medicine; Atlanta; GA; USA
| | - S. V. Gibikote
- Department of Radiology; Christian Medical College; Vellore; Tamil Nadu; India
| | - S. N. Keshava
- Department of Radiology; Christian Medical College; Vellore; Tamil Nadu; India
| | - R. Ljung
- Department of Paediatrics; Lund University; Skåne University Hospital; Malmö-Lund; Sweden
| | - M. J. Manco-Johnson
- Department of Pediatrics and the Hemophilia & Thrombosis Center; University of Colorado; Denver; CO; USA
| | - S. F. Miller
- St. Jude Children's Research Hospital; Memphis; TN; USA
| | - G. E. Rivard
- CHU Sainte Justine; University of Montreal; Montreal; Quebec; Canada
| | - A. S. Doria
- Department of Diagnostic Imaging; The Hospital for Sick Children; Toronto; Ontario; Canada
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34
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MONAHAN PAULE, DORIA ANDREAS, LJUNG ROLF, JIMÉNEZ-YUSTE VICTOR. Optimizing joint function: new knowledge and novel tools and treatments. Haemophilia 2012; 18 Suppl 5:17-26. [DOI: 10.1111/j.1365-2516.2012.02888.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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POONNOOSE P, KESHAVA S, GIBIKOTE S, FELDMAN BM. Outcome assessment and limitations. Haemophilia 2012; 18 Suppl 4:125-30. [DOI: 10.1111/j.1365-2516.2012.02837.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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36
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Knobe K, Berntorp E. Haemophilia and joint disease: pathophysiology, evaluation, and management. JOURNAL OF COMORBIDITY 2011; 1:51-59. [PMID: 29090136 PMCID: PMC5556421 DOI: 10.15256/joc.2011.1.2] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/01/2011] [Indexed: 12/25/2022]
Abstract
In patients with haemophilia, regular replacement therapy with clotting factor concentrates (prophylaxis) is effective in preventing recurrent bleeding episodes into joints and muscles. However, despite this success, intra-articular and intramuscular bleeding is still a major clinical manifestation of the disease. Bleeding most commonly occurs in the knees, elbows, and ankles, and is often evident from early childhood. The pathogenesis of haemophilic arthropathy is multifactorial, with changes occurring in the synovium, bone, cartilage, and blood vessels. Recurrent joint bleeding causes synovial proliferation and inflammation (haemophilic synovitis) that contribute to end-stage degeneration (haemophilic arthropathy); with pain and limitation of motion severely affecting patients' quality of life. If joint bleeding is not treated adequately, it tends to recur, resulting in a vicious cycle that must be broken to prevent the development of chronic synovitis and degenerative arthritis. Effective prevention and management of haemophilic arthropathy includes the use of early, aggressive prophylaxis with factor replacement therapies, as well as elective procedures, including restorative physical therapy, analgesia, aspiration, synovectomy, and orthopaedic surgery. Optimal treatment of patients with haemophilia requires a multidisciplinary team comprising a haematologist, physiotherapist, orthopaedic practitioner, rehabilitation physician, occupational therapist, psychologist, social workers, and nurses. Journal of Comorbidity 2011;1:51-59.
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Affiliation(s)
- Karin Knobe
- Lund University, Malmö Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
| | - Erik Berntorp
- Lund University, Malmö Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
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37
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Olivieri M, Kurnik K, Pfluger T, Bidlingmaier C. Identification and long-term observation of early joint damage by magnetic resonance imaging in clinically asymptomatic joints in patients with haemophilia A or B despite prophylaxis. Haemophilia 2011; 18:369-74. [PMID: 22032268 DOI: 10.1111/j.1365-2516.2011.02682.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Severe haemophilia is associated with recurrent joint bleeds, which can lead to haemophilic arthropathy. Subclinical joint bleeds have also been associated with joint damage detected using magnetic resonance imaging (MRI). We investigated the development of early changes in clinically asymptomatic joints using MRI in haemophilia A or B patients receiving prophylactic therapy. In this single-centre retrospective cohort study, patients with clinical evidence of joint damage in one ankle and one clinically asymptomatic ankle, in which we performed an MRI scan of both ankles in one session, were enrolled. MRI findings were graded using a 4-point scoring system (0 = normal findings and III = severe joint damage). Since 2000, 38 MRIs in 26 patients have been performed. Starting at a median age of 4 years, 23 patients received prophylaxis 2-3 times weekly. On-demand treatment was performed in three patients. Eight patients (31%) presented with an MRI score of 0, 12 (46%) had a score of I, four (15%) had a score of II, and two (8%) had a score of III in the clinically unaffected ankle. The six patients with MRI scores of II and III had started regular prophylaxis between the ages of 2 years and 15 years; none had developed an inhibitor or experienced a clinically evident bleed in the asymptomatic ankle. During our study, five of 26 patients had a worsening of MRI findings without experiencing a joint bleed. Early morphological changes in clinically asymptomatic ankles can be detected using MRI, despite adequate prophylaxis.
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Affiliation(s)
- M Olivieri
- Department of Pediatric Hemostaseology, Pediatric Hemophilia Center, Dr. von Hauner's Children's Hospital, University of Munich, Munich, Germany.
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38
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MUÇA-PERJA M, RIVA S, GROCHOWSKA B, MANGIAFICO L, MAGO D, GRINGERI A. Ultrasonography of haemophilic arthropathy. Haemophilia 2011; 18:364-8. [DOI: 10.1111/j.1365-2516.2011.02672.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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39
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RODRIGUEZ-MERCHAN EC, JIMENEZ-YUSTE V, AZNAR JA, HEDNER U, KNOBE K, LEE CA, LJUNG R, QUEROL F, SANTAGOSTINO E, VALENTINO LA, CAFFARINI A. Joint protection in haemophilia. Haemophilia 2011; 17 Suppl 2:1-23. [DOI: 10.1111/j.1365-2516.2011.02615.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Ozülker T, Ozülker F, Derin E, Altun M, Aydoğan G, Türkkan E, Adaş M, Tonbul M, Ozpaçacı T, Sezgin F, Değirmenci H. The efficacy of magnetic resonance imaging and x-ray in the evaluation of response to radiosynovectomy in patients with hemophilic arthropathy. Mol Imaging Radionucl Ther 2011; 20:38-44. [PMID: 23487524 PMCID: PMC3590945 DOI: 10.4274/mirt.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 06/29/2011] [Indexed: 02/07/2023] Open
Abstract
Objective: We aimed to assess the role of Magnetic Resonance Imaging (MRI) and X-Ray in the evaluation of response to radiosynovectomy (RS) in patients with hemophilic arthropathy. Material and Methods: Eleven patients who suffered from hemophilic arthropathy with a mean age of 11.7 (range between 7-15) were included in this study. 148-185 MBq Yttrium 90 silicate (Y-90) was administered intraarticularly to ten knee joints and one patient was treated with intraarticular 74 MBq Rhenium 186 (Re-186) injection into his ankle. Before radiosynovectomy, plain anteroposterior and lateral X-rays of the target joints were obtained by standard technique. The follow-up MRI and X-ray studies of the patients were done 6 months after RS. Pettersson hemophilic arthropathy scales were utilized to stage the condition of the joints on plain X-ray and classification of the investigated joints on MRI were done according to Denver score. The clinical assessment of the efficacy of the RS was made with the comparison of the average bleedings before and after the intervention. Results: During the 6-month follow-up period after RS, an improvement in number of hemarthrosis 75% or greater compared with the prior six months occurred in six joints (54.5%). The Pettersson scores worsened in 1/11 (9%), remained unchanged in 9/11 (81.8%), and improved in 1/11 (9%) joints. At the 6-month follow-up, the MRI score worsened in one (9%) and was unchanged in 10/11 joints (90.9%). Conclusion: MRI is a more sensitive tool than plain radiography for evaluating and follow-up of joint disease in persons with hemophilia, but both methods don’t show correlation with the therapeutic response Conflict of interest:None declared.
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Affiliation(s)
- Tamer Ozülker
- Okmeydanı Training Hospital, Nuclear Medicine, İstanbul, Turkey
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41
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Den Uijl IEM, De Schepper AMA, Camerlinck M, Grobbee DE, Fischer K. Magnetic resonance imaging in teenagers and young adults with limited haemophilic arthropathy: baseline results from a prospective study. Haemophilia 2011; 17:926-30. [PMID: 21435115 DOI: 10.1111/j.1365-2516.2011.02513.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The clinical relevance of subtle changes on magnetic resonance imaging (MRI) for evaluating haemophilia treatment is unknown. To determine the relationship of findings on MRI with joint function and bleeding in joints with apparently very mild arthropathy, a prospective study was performed. Knees and ankles of 26 patients, 13-26 years, were scanned. Two blinded radiologists scored the MRI (IPSG consensus score) and the radiography [Pettersson score (PS)]. Clinical function (HJHS) was scored by one physiotherapist. Life-time number of bleeds was collected from patient files. Of 104 joints scanned, three were excluded because of previous arthrodesis or trauma. Remaining 101 MRI scores correlated weakly with clinical function (r = 0.27, P = 0.01) and less with lifetime number of bleeds (r = 0.16, P = 0.14). MRI scores were 0 in 58 joints, including 27 with major bleeds. In three joints of patients playing intensive sports MRI showed minor changes (MRI score = 1) in the absence of bleeds. Agreement was reasonable between PS and MRI score (r = 0.41, P < 0.01). In 30% of joints, MRI detected abnormalities in soft-tissue and cartilage, while PS was 0 points. No evidence of occult haemorrhages was found. Instead, we found no abnormalities on MRI in 43 joints with a history of repeated joint bleeding. Haemosiderin seemed associated with the time between assessment and last bleed; joints that had suffered a bleed long before MRI had hardly haemosiderin, while those with a recent bleed showed haemosiderin, suggesting joint damage may be reversible. Abnormalities detected by MRI, but not by PS were minor and their clinical implications are not yet clear.
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Affiliation(s)
- I E M Den Uijl
- van Creveldkliniek, dept Haematology, UMC Utrecht, The Netherlands.
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42
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Melchiorre D, Linari S, Innocenti M, Biscoglio I, Toigo M, Cerinic MM, Morfini M. Ultrasound detects joint damage and bleeding in haemophilic arthropathy: a proposal of a score. Haemophilia 2010; 17:112-7. [PMID: 21070482 DOI: 10.1111/j.1365-2516.2010.02380.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Haemarthrosis triggers haemophilic arthropathy (HA) because bleeding starts synovitis immediately, damages cartilage and leads to loss of function and disability. The aim of our study was to investigate the capacity of ultrasonography (US) in detecting bleeding and joint damage in HA. The joints of 62 patients (pts) with haemophilia A or haemophilia B were consecutively evaluated and scored (score ranging from 0 to 21) for effusion (E), bone remodelling (BR), cartilage damage (CD), synovial hypertrophy (SH), haemosiderin (H), osteophytes (O), haemarthrosis (Hae), erosion (Er) and fibrotic septa (FS) with US. X-rays [Pettersson Score (PXS)] were performed in 61 patients and clinical evaluation [World Federation Haemophiliac orthopaedic score (WFHO)] was performed in all patients. A total of 20 healthy subjects and 20 patients affected by Rheumatoid Arthritis (RA) were used as controls. Power Doppler US (PDUS) was performed in all patients on the knee, ankle and elbow joints. A total of 83 joints were studied (50 knees; 12 elbows and 21 ankles). US showed effusion in 57 joint, bone remodelling in 62, cartilage damage in 64, synovial hypertrophy in 45, haemosiderin in 39, osteophytes in 30, haemarthrosis in 24, erosion in 5 and fibrotic septa in 3. The X-rays score showed remodelling in 47 joints, narrowing joint space in 44, displacement/angulation in 39, osteoporosis in 42, subchondral irregularity in 44, subchondral cyst formation in 37, osteophytes in 36 and erosions in 25. The US score in healthy subjects was always ≤ 5 (range 0 to 4). In haemophiliacs, 34 of 83 joints showed US score ≤ 5, and 49 US score > 5. Joints with US score ≤ 5 had a low PXS (SRCC = 0.375, P < 0.01) and joints with US score > 5 showed a high PXS (SRCC = 0.440, P < 0.01). A significant correlation between US score and PXS for bone remodelling [Spearman's rho Correlation Coefficient (SRCC) = 0.429, P < 0.01] and for osteophytes (SRCC = 0.308, P < 0.05) was found. The correlation between the US score and number of bleedings in 83 joints was very significant (SRCC = 0.375, P < 0.01). A total of 24 bleeding joints were identified and verified with aspiration of haematic fluid. US may detect bone and cartilage alterations and synovitis. Indeed, PDUS identified bleeding also in asymptomatic joints and was able to show different entity of haemarthrosis. US may be a feasible and reliable tool to evaluate joint modifications in HA.
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Affiliation(s)
- D Melchiorre
- Department of Bio Medicine, University of Florence, Florence, Italy.
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43
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TAKEDANI H, FUJII T, KOBAYASHI Y, HAGA N, TATSUNAMI S, FUJII T. Inter-observer reliability of three different radiographic scores for adult haemophilia. Haemophilia 2010; 17:134-8. [DOI: 10.1111/j.1365-2516.2010.02389.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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DORIA AS. State-of-the-art imaging techniques for the evaluation of haemophilic arthropathy: present and future. Haemophilia 2010; 16 Suppl 5:107-14. [DOI: 10.1111/j.1365-2516.2010.02307.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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46
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Imaging and staging of haemophilic arthropathy. Clin Radiol 2009; 64:1119-28. [DOI: 10.1016/j.crad.2009.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 07/16/2009] [Accepted: 07/20/2009] [Indexed: 11/22/2022]
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47
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Feldman BM, Funk S, Lundin B, Doria AS, Ljung R, Blanchette V. Musculoskeletal measurement tools from the International Prophylaxis Study Group (IPSG). Haemophilia 2008; 14 Suppl 3:162-9. [PMID: 18510537 DOI: 10.1111/j.1365-2516.2008.01750.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- B M Feldman
- Division of Rheumatology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
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48
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BOSSARD D, CARRILLON Y, STIELTJES N, LARBRE JP, LAURIAN Y, MOLINA V, DIRAT G. Management of haemophilic arthropathy. Haemophilia 2008; 14 Suppl 4:11-9. [DOI: 10.1111/j.1365-2516.2008.01734.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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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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50
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Abstract
The pathophysiology of haemophilic synovitis is complex and not as well understood on a molecular level as we have thought. The repeated bleeding episodes and synovial hypertrophy occurring within the joint. Iron and other red-cell debris are phagocytized, and hydrolytic enzymes are produced leading to the destruction of articular cartilage is a simplistic model. However, how iron stimulates this destructive cascade remains speculative and poorly understood. Diagnostic options include radiographic examination using horizontal beam technique, which may reveal a fat blood fluid level, and computed tomography scanning or magnetic resonance imaging.
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Affiliation(s)
- N J Goddard
- Department of Orthopaedics, Royal Free Hospital, London, UK.
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