1
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Ozelo MC, Hermans C, Carcao M, Guillet B, Gu J, Guerra R, Tang L, Khair K. The effectiveness and safety of octocog alfa in patients with hemophilia A: up to 7-year follow-up of the real-world AHEAD international study. Ther Adv Hematol 2024; 15:20406207231218624. [PMID: 38371314 PMCID: PMC10874143 DOI: 10.1177/20406207231218624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/16/2023] [Indexed: 02/20/2024] Open
Abstract
Background Real-world data assessing treatment outcomes in patients with hemophilia A in routine clinical practice are limited. Objective To evaluate the effectiveness and safety of octocog alfa in patients with moderate/severe hemophilia A receiving treatment in clinical practice. Design The international Antihemophilic Factor Hemophilia A Outcome Database study is an observational, noninterventional, prospective, multicenter study. Methods This planned interim data read-out was conducted following 7 years of observation of patients receiving octocog alfa (cut-off, 30 June 2020). The primary endpoint was joint health status, assessed by the Gilbert Score. Secondary endpoints included annualized bleeding rates (ABRs), Hemophilia Joint Health Score (HJHS), health-related quality of life, consumption, and safety. This post hoc analysis stratified data by hemophilia severity at baseline [moderate, factor VIII (FVIII) 1-5%; severe, FVIII <1%]. Results Of the 711 patients in this analysis, 582 (82%) were receiving prophylaxis with octocog alfa at enrollment, and 498 (70%) had severe disease. Median Gilbert Scores were higher with on-demand therapy versus prophylaxis and scores were comparable in moderate and severe disease. In patients receiving prophylaxis, there was an improvement in HJHS Global Gait Score over 7 years of follow-up overall and in patients with severe disease. ABRs and annualized joint bleeding rates were low across all 7 years. An ABR of zero was reported in 34-56% of prophylaxis patients versus 20-40% in the on-demand group. ABRs were similar in severe and moderate disease. In total, 13/702 (1.9%) patients experienced 18 treatment-related adverse events. Conclusion These data demonstrate the long-term effectiveness and safety of octocog alfa in patients with moderate and severe hemophilia A, especially in those receiving prophylaxis. The high number of patients receiving on-demand treatment experiencing zero bleeds could be due to selection bias within the study, with patients with less severe disease more likely to be receiving on-demand treatment. Trial registration ClinicalTrials.gov: NCT02078427.
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Affiliation(s)
| | - Cedric Hermans
- St-Luc University Hospital, Université catholique de Louvain, Louvain, Belgium
| | - Manuel Carcao
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - Benoît Guillet
- Haemophilia Treatment Center, Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Joan Gu
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | - Randy Guerra
- Takeda Development Center Americas, Inc., 500 Kendal Street, Cambridge, MA 02142, USA
| | - Leilei Tang
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
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2
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Brakel BA, Sussman MS, Majeed H, Teitel J, Man C, Rayner T, Weiss R, Moineddin R, Blanchette V, Doria AS. T2 mapping magnetic resonance imaging of cartilage in hemophilia. Res Pract Thromb Haemost 2023; 7:102182. [PMID: 37767061 PMCID: PMC10520564 DOI: 10.1016/j.rpth.2023.102182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 09/29/2023] Open
Abstract
Background In hemophilia, recurrent hemarthrosis may lead to irreversible arthropathy. T2 mapping MRI may reflect cartilage changes at an earlier reversible stage of arthropathy as opposed to structural MRI. Objectives To evaluate interval changes of T2 mapping compared with the International Prophylaxis Study Group (IPSG) structural MRI scores of ankle cartilage in boys with hemophilia receiving prophylaxis. Methods Eight boys with hemophilia A (median age, 13; range, 9-17 years), 7 age- and sex-matched healthy boys (controls, median age, 15; range, 7-16 years). A multiecho spin-echo T2-weighted MRI sequence at 3.0T was used to obtain T2 maps of cartilage of boys with hemophilia and controls. Structural joint status was evaluated using the IPSG MRI score. Results T2 relaxation times of ankle cartilage increased significantly over time in both persons with hemophilia and controls (P = .002 and P = .00009, respectively). Changes in T2 relaxation time strongly correlated with changes in IPSG cartilage scores (rs = 0.93 to rs = 0.78 [P = .0007 to P = .023]), but not with changes in age (P = .304 to P = .840). Responsiveness of T2 relaxation times were higher than that of IPSG cartilage scores, with standardized response means >1.4 for T2 mapping in all regions-of-interest compared with 0.84 for IPSG cartilage scores. Baseline T2 relaxation time strongly correlated with timepoint 2 IPSG cartilage score (rs = 0.93 to rs = 0.82 [P = .001 to P = .012]) and T2 relaxation time (rs = 0.98 to rs = 0.88 [P = .00003 to P = .004]) changes in most regions-of-interest. Conclusion T2 mapping shows sensitivity to biochemical changes in cartilage prior to detectable damage using conventional MRI, offering potential for early detection of bleed-related cartilage damage in boys with hemophilia.
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Affiliation(s)
- Benjamin A. Brakel
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Marshall S. Sussman
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Haris Majeed
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Jerry Teitel
- Division of Hematology/Oncology, St Michael’s Hospital, Toronto, ON, Canada
| | - Carina Man
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Tammy Rayner
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ruth Weiss
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Division of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Victor Blanchette
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea S. Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
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3
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Manco-Johnson MJ. Long-term prophylaxis: what are our options and how to define success? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:579-585. [PMID: 36485126 PMCID: PMC9820516 DOI: 10.1182/hematology.2022000397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Currently, we are at an enviable place in hemophilia treatment. Although full prophylaxis with standard half-life recombinant or plasma-derived factor concentrates has been definitively shown to be inadequate for full protection against bleeding and arthropathy, a number of novel therapies with improved hemostatic enhancement are clinically available or in promising clinical trials. In order to compare outcomes among a number of very efficacious therapies, it is necessary to have sensitive tools employed in long-term follow-up for several years for participants with no or minimal joint disease. The tool kit must be comprehensive, with outcomes of bleeding, factor level restoration or hemostatic capacity, joint structure, joint function, pain, quality of life, and patient satisfaction. This article reviews the history of prophylaxis, the promise of emerging therapies, and the sensitive tools used to assess long-term efficacy for joint structure and function.
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Affiliation(s)
- Marilyn Jean Manco-Johnson
- Correspondence Marilyn Jean Manco-Johnson, University of Colorado Anschutz Medical Center, 13199 E Montview Blvd, Ste 100, Aurora CO, 80045; e-mail:
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4
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Schmidt DE, Michalopoulou A, Fischer K, Motwani J, Andersson NG, Pergantou H, Ranta S. Long-term joint outcomes in adolescents with moderate or severe haemophilia A. Haemophilia 2022; 28:1054-1061. [PMID: 35925557 PMCID: PMC9804743 DOI: 10.1111/hae.14636] [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: 01/30/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Favourable joint outcomes are expected with modern haemophilia A (HA) management. Evaluation of long-term treatment outcomes is hampered by the delay between bleeding episodes during childhood and resulting joint outcomes in adulthood. AIM To measure the long-term joint health of adolescents with moderate and severe HA, according to severity and inhibitor status. METHODS Pilot cross-sectional study of five European PedNet centres in moderate and severe HA patients aged 10-19 years. Structured assessment of joint status by physical examination (HJHS) and ultrasound (HEAD-US). RESULTS In total, 141 HA patients were evaluable, 100 without inhibitors (81 severe, 19 moderate HA), and 41 severe HA with current/past inhibitors. On physical examination, 12/81 (15%) of severe HA without inhibitors, 3/19 (16%) of moderate HA, and 13/41 (32%) of severe HA patients with inhibitors exhibited joint abnormalities. Inhibitor persistence, longer inhibitor duration, and a high peak inhibitor level were associated with impaired joint health. Ultrasound showed joint damage (bone or cartilage) in 13/49 (27%) of severe HA without inhibitors, 1/12 (8%) of moderate HA, and 10/28 (36%) of severe HA patients with inhibitors. A discordant ankle evaluation by ultrasound versus physical examination was present in 53/169 joints (31%). CONCLUSIONS Most adolescents with severe or moderate HA show favourable joint health. Future research with combined ultrasound and/or MRI is needed to better understand joint outcomes in the remaining patients. Patents with inhibitors showed a two-fold increased proportion with joint deterioration. Ultrasound paired with physical examination increases sensitivity for detection of joint damage.
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Affiliation(s)
- David E. Schmidt
- Childhood Cancer Research UnitDepartment of Women's and Children's HealthKarolinska InstitutetStockholmSweden,Astrid Lindgren Children´s HospitalKarolinska University HospitalStockholmSweden,Division of HematologyCoagulation UnitKarolinska University HospitalStockholmSweden
| | | | - Kathelijn Fischer
- Center for Benign HaematologyThrombosis and HaemostasisVan CreveldkliniekUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | | | - Nadine G. Andersson
- Department of Clinical SciencesPediatrics, Lund UniversityLundSweden,Department for Thrombosis and HemostasisSkåne University HospitalMalmöSweden
| | - Helen Pergantou
- Hemostasis and Thrombosis UnitHaemophilia CentreAghia Sophia Children's HospitalAthensGreece
| | - Susanna Ranta
- Childhood Cancer Research UnitDepartment of Women's and Children's HealthKarolinska InstitutetStockholmSweden,Astrid Lindgren Children´s HospitalKarolinska University HospitalStockholmSweden
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5
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Shima M, Takedani H, Kitsukawa K, Taki M, Ishiguro A, Nagao A, Yamaguchi-Suita H, Kyogoku Y, Yoshida S, Nogami K. AOZORA: long-term safety and joint health in paediatric persons with haemophilia A without factor VIII inhibitors receiving emicizumab - protocol for a multicentre, open-label, phase IV clinical study. BMJ Open 2022; 12:e059667. [PMID: 35697445 PMCID: PMC9196178 DOI: 10.1136/bmjopen-2021-059667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Persons with haemophilia A (PwHA) commonly experience regular bleeding into joints, which may result in joint damage and complications such as degenerative arthritis. Emicizumab has previously demonstrated efficacy in reducing the occurrence of joint bleeds and target joints, along with having a favourable safety profile; however, data on the long-term effects on joint health are lacking. The AOZORA study will evaluate the long-term safety and joint health of paediatric PwHA without factor (F)VIII inhibitors taking emicizumab; here, we report the details of the study protocol and baseline data. METHODS AND ANALYSIS AOZORA is a multicentre, open-label, phase IV clinical study in Japan that aims to enrol approximately 30 PwHA aged <12 years without FVIII inhibitors. The primary endpoints include a long-term safety evaluation of adverse events, laboratory test abnormalities and FVIII inhibitor development; and a long-term joint health assessment using MRI and the Hemophilia Joint Health Score. Exploratory endpoints include characterising participants' physical activities and the number of activity-related bleeds requiring coagulation factor treatment. Currently, 30 participants have been enrolled, including 20 emicizumab-naïve participants and 10 who transferred from HOHOEMI, a previous study in paediatric PwHA. ETHICS AND DISSEMINATION The AOZORA study was approved by the Institutional Review Boards of Nara Medical University and the St Marianna University Group. The study will be conducted in compliance with the Declaration of Helsinki, the standards stipulated in paragraph 3 of Article 14 and Article 80-2 of the Pharmaceuticals, Medical Devices and Other Therapeutic Products Act, the Ministerial Ordinance on Good Clinical Practice and the Ministerial Ordinance on Good Post-marketing Study Practice. Data will be published in peer-reviewed journals and presented at Global congresses. TRIAL REGISTRATION NUMBER JapicCTI-194701.
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Affiliation(s)
- Midori Shima
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
| | - Hideyuki Takedani
- Department of Joint Surgery, IMSUT Hospital, The University of Tokyo, Tokyo, Japan
| | - Kaoru Kitsukawa
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masashi Taki
- Department of Pediatrics, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Akira Ishiguro
- Division of Hematology, National Center for Child Health and Development, Tokyo, Japan
| | - Azusa Nagao
- Department of Blood Coagulation, Ogikubo Hospital, Tokyo, Japan
| | | | - Yui Kyogoku
- Medical Affairs Division, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Seitaro Yoshida
- Clinical Development Division, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | - Keiji Nogami
- Department of Pediatrics, Nara Medical University, Kashihara, Japan
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6
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Magnetic resonance imaging of the knee joint in juvenile idiopathic arthritis. Reumatologia 2021; 58:416-423. [PMID: 33456085 PMCID: PMC7792535 DOI: 10.5114/reum.2020.102007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is an umbrella term for a group of diseases in children younger than 16 years old lasting six weeks or longer. Synovitis may lead to destructive and irreversible joint changes with subsequent functional impairment. Prompt diagnosis is essential to prevent permanent joint damage and preserve joint functionality. In the course of JIA both the axial and peripheral skeleton may be involved in the inflammatory process, but the knee joint is most frequently affected. New drugs and treatment protocols have forced the need for diagnosis at the earliest possible stage. Magnetic resonance imaging (MRI) allows early detection of lesions and constitutes a superior diagnostic imaging method. Synovitis, tenosynovitis, enthesitis, bursitis, osteitis, cartilage loss, bone cysts, and erosions are lesions diagnosed in JIA, and they can be precisely imaged in MRI. This article aims to present MRI inflammatory features of the knee in children with JIA based on the literature.
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7
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Khami A, Roostayi MM, Parhampour B, Heidari Z, Baharlouei H, Hoorfar H. Effect of Pulsed Electromagnetic Fields on Clinical Signs and Quality of Life in Patients with Hemophilic Arthropathy of the Knee Joint: A Randomized Controlled Trial. Adv Biomed Res 2020; 9:81. [PMID: 33912497 PMCID: PMC8059452 DOI: 10.4103/abr.abr_244_18] [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: 12/10/2018] [Revised: 01/07/2019] [Accepted: 06/01/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hemophilic arthropathy (HA) causes severe joint damage and impairs the quality of life (QoL) of hemophiliacs. This study was undertaken to evaluate the effect of pulsed electromagnetic fields (PEMFs) on the clinical signs and QoL of patients with severe hemophilia A experiencing moderate HA in the knee joint. MATERIALS AND METHODS Thirty-six severe hemophiliacs with HA of the knee joint were randomly assigned into the PEMF (n = 20) or placebo (n = 16) groups. The PEMF group received 60 min of PEMF (2 Hz, 25 Gauss for 30 min and 70 Hz, 30 Gauss for 30 min) on the knee joint, three times per week for 6 weeks. The clinical signs, QoL, and pain intensity were measured by the Hemophilia Joint Health Score, A36 Hemofilia-QoL Questionnaire, and visual analog scale, respectively, before and after treatment. RESULTS In the PEMF group, a significant difference before and after intervention in terms of clinical signs, QoL, and pain intensity (P < 0.05) was founded. Between-group analysis showed a significant improvement in clinical signs (except for atrophy, strength, and swelling duration), QoL, and pain intensity in the PEMF versus control group (P < 0.05). CONCLUSIONS PEMF can improve the clinical signs, QoL, and pain intensity of severe hemophilia A patient with moderate knee hemophilic arthropathy.
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Affiliation(s)
- Azam Khami
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohsen Roostayi
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrouz Parhampour
- Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamzeh Baharlouei
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Hoorfar
- Hemophilia Treatment Center, Clinic Seiedshohada Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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8
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Plut D, Faganel Kotnik B, Preložnik Zupan I, Ključevšek D, Vidmar G, Snoj Ž, Salapura V. Detection and evaluation of haemophilic arthropathy: Which tools may be considered more reliable. Haemophilia 2020; 27:156-163. [PMID: 33164312 DOI: 10.1111/hae.14153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/06/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Progressive arthropathy is the main cause of morbidity in patients with severe haemophilia. Diagnostic imaging can detect even subclinical arthropathy and impact prophylactic treatment. However, in most clinical settings the regular joint evaluation and follow-up are based on clinical evaluation and patient's personal reporting of problems, while diagnostic imaging is not regularly employed. AIM The aim of our prospective study was to assess how ultrasound (US), clinical examination, patient's subjective assessment and certain laboratory biomarkers correlate with magnetic resonance imaging (MRI) for detection and evaluation of haemophilic arthropathy in order to determine which tool is the most reliable. METHODS The study included 30 patients with severe haemophilia (age range 16-49 years). MRI (IPSG), US (HEAD-US), clinical examination (HJHS 2.1) and patient's subjective assessment of elbows, knees and ankles were performed; additionally, blood samples for laboratory analysis were taken (s-25-OH vitamin D, s-ferritin, s-C-terminal telopeptide of type I collagen, s-N-terminal propeptide of type I procollagen and s-cartilage oligomeric matrix protein). MRI results were used as a reference standard for joint status. Pearson's r was used to assess correlation of other methods with MRI. RESULTS The correlation with MRI was the highest for US (r = .92), considerably higher than for clinical evaluation (r = .62) and patient's subjective assessment (r = .66). There was no correlation between the presence or degree of haemophilic arthropathy and any of the laboratory biomarkers. CONCLUSION The results of our study warrant the inclusion of US into the regular follow-up of patients with severe haemophilia, where the equipment and staffing permit.
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Affiliation(s)
- Domen Plut
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Faganel Kotnik
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Division of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Irena Preložnik Zupan
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Damjana Ključevšek
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Division of Paediatrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gaj Vidmar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,University Rehabilitation Institute Republic of Slovenia, Ljubljana, Slovenia.,FAMNIT, University of Primorska, Koper, Slovenia
| | - Žiga Snoj
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Vladka Salapura
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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9
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Kuijlaars IAR, van der Net J, Feldman BM, Aspdahl M, Bladen M, de Boer W, Cuesta-Barriuso R, Matlary RED, Funk SM, Hilliard P, John JA, Kempton CL, de Kleijn P, Manco-Johnson M, Petrini P, Poonnoose P, St-Louis J, Thomas S, Timmer MA, Trakymiene SS, van Vlimmeren L, Fischer K. Evaluating international Haemophilia Joint Health Score (HJHS) results combined with expert opinion: Options for a shorter HJHS. Haemophilia 2020; 26:1072-1080. [PMID: 33058441 PMCID: PMC7821332 DOI: 10.1111/hae.14180] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 11/27/2022]
Abstract
Introduction The Hemophilia Joint Health Score (HJHS) was developed to detect early changes in joint health in children and adolescents with haemophilia. The HJHS is considered by some to be too time consuming for clinical use and this may limit broad adoption. Aim This study was a first step to develop a shorter and/or more convenient version of the HJHS for the measurement of joint function in children and young adults with haemophilia, by combining real‐life data and expert opinion. Methods A cross‐sectional multicenter secondary analysis on pooled data of published studies using the HJHS (0‐124, optimum score 0) in persons with haemophilia A/B aged 4‐30 was performed. Least informative items, scoring options and/or joints were identified. An expert group of 19 international multidisciplinary experts evaluated the results and voted on suggestions for adaptations in a structured meeting (consensus set at ≥ 80%). Results Original data on 499 persons with haemophilia from 7 studies were evaluated. Median age was 15.0 years [range 4.0‐29.9], 83.2% had severe haemophilia and 61.5% received prophylaxis. Median (IQR) HJHS total was 6.0 (1.0‐17.0). The items 'duration swelling' and 'crepitus' were identified as clinically less informative and appointed as candidates for reduction. Conclusion Analysis of 499 children and young adults with haemophilia showed that the HJHS is able to discriminate between children and adults and different treatment regimens. Reduction of the items 'duration swelling' and 'crepitus' resulted in the HJHSshort, which had the same discriminative ability. Additional steps are needed to achieve a substantially shorter HJHS assessment.
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Affiliation(s)
- Isolde A R Kuijlaars
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Janjaap van der Net
- Center for Child Development, Exercise and Physical Literacy, Children's Hospital of the University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Brian M Feldman
- Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine and the Institute of Health Policy Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Magnus Aspdahl
- Department of Pediatrics, Clinic of Coagulation Disorders, Karolinska University Hospital, Stockholm, Sweden
| | - Melanie Bladen
- Haemophilia Center, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Wypke de Boer
- Department of Rehabilitation, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Rubén Cuesta-Barriuso
- Department of Physiotherapy, European University of Madrid, Madrid, Spain.,Royal Victoria Eugenia Foundation, Madrid, Spain.,Fishemo CEE, Spanish Federation of Hemophilia, Madrid, Spain
| | - Ruth E D Matlary
- Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Sharon M Funk
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Pamela Hilliard
- Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Judy A John
- Department of PMR, Christian Medical College, Vellore, India
| | - Christine L Kempton
- Hemophilia of Georgia Center for Bleeding & Clotting Disorders of Emory, Emory University School of Medicine, Atlanta, GA, USA
| | - Piet de Kleijn
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marilyn Manco-Johnson
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Pia Petrini
- Department of Pediatrics, Clinic of Coagulation Disorders, Karolinska University Hospital, Stockholm, Sweden
| | - Pradeep Poonnoose
- Department of Orthopaedics, Christian Medical College, Vellore, India
| | | | - Sylvia Thomas
- Department of Radiology, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Merel A Timmer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Leo van Vlimmeren
- Department of Rehabilitation, Paediatric Physical Therapy, Radboud university medical center, Nijmegen, The Netherlands
| | - Kathelijn Fischer
- Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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10
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Strike K, Chan A, Iorio A, Maly MR, Stratford PW, Solomon P. Predictors of treatment adherence in patients with chronic disease using the Multidimensional Adherence Model: unique considerations for patients with haemophilia. ACTA ACUST UNITED AC 2020. [DOI: 10.17225/jhp00152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Adherence to treatment recommendations in patients with chronic disease is complex and is influenced by numerous factors. Haemophilia is a chronic disease with reported levels of adherence ranging from 17–82%.
Aim
Based on the theoretical foundation of the World Health Organization Multidimensional Adherence Model, the objective of this study was to identify the best combination of the variables infusion frequency, annualised bleed rate, age, distance to haemophilia treatment centre (HTC) and Haemophilia Joint Health Score (HJHS), to predict adherence to treatment recommendations in patients with haemophilia A and B on home infusion prophylaxis in Canada.
Methods
A one-year retrospective cohort study investigated adherence to treatment recommendations using two measures: 1) subjective report via home infusion diaries, and 2) objective report of inventory ordered from Canadian Blood Services. Stepwise regression was performed for both measures.
Results
Eighty-seven patients with haemophilia A and B, median age 21 years, were included. Adherence for both measures was 81% and 93% respectively. The sample consisted largely of patients performing an infusion frequency of every other day (34%). Median scores on the HJHS was 10.5; annualised bleed rate was two. Distance to the HTC was 51km. Analysis of the objective measure weakly supported greater infusion frequency as a treatment-related factor for the prediction of lower adherence, however the strength of this relationship was not clinically relevant (R2=0.048). For the subjective measure, none of the explanatory variables were significant.
Conclusion
Adherence is a multifaceted construct. Despite the use of theory, most of the variance in adherence to treatment recommendations in this sample of patients with haemophilia remains unknown. Further research on other potential predictors of adherence, and possible variables and relationships within factors of the MAM is required.
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Affiliation(s)
- Karen Strike
- School of Rehabilitation Science, Faculty of Health Science , McMaster University , Hamilton , Ontario , Canada
| | - Anthony Chan
- Department of Pediatrics , McMaster University , Hamilton , Ontario , Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact (HEI) , McMaster University , Hamilton , Ontario , Canada
| | - Monica R. Maly
- School of Rehabilitation Science, Faculty of Health Science , McMaster University , Hamilton , Ontario ; Department of Kenesiology, Faculty of Applied Health Sciences , University of Waterloo , Waterloo , Canada
| | - Paul W. Stratford
- School of Rehabilitation Science, Faculty of Health Science , McMaster University , Hamilton , Ontario , Canada
| | - Patricia Solomon
- School of Rehabilitation Science, Faculty of Health Science , McMaster University , Hamilton , Ontario , Canada
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11
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Jang H, von Drygalski A, Wong J, Zhou JY, Aguero P, Lu X, Cheng X, Ball ST, Ma Y, Chang EY, Du J. Ultrashort echo time quantitative susceptibility mapping (UTE-QSM) for detection of hemosiderin deposition in hemophilic arthropathy: A feasibility study. Magn Reson Med 2020; 84:3246-3255. [PMID: 32662904 DOI: 10.1002/mrm.28388] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to investigate the feasibility of ultrashort echo time quantitative susceptibility mapping (UTE-QSM) for assessment of hemosiderin deposition in the joints of hemophilic patients. METHODS The UTE-QSM technique was based on three sets of dual-echo 3D UTE Cones data acquired with TEs of 0.032/2.8, 0.2/3.6, and 0.4/4.4 ms. The images were processed with iterative decomposition of water and fat with echo asymmetry and least-squares estimation to estimate the B0 field map in the presence of fat. Then, the projection onto dipole field (PDF) algorithm was applied to acquire a local field map generated by tissues, followed by application of the morphology-enabled dipole inversion (MEDI) algorithm to estimate a final susceptibility map. Three healthy volunteers and three hemophilic patients were recruited to evaluate the UTE-QSM technique's ability to assess hemosiderin in the knee or ankle joint at 3T. One patient subsequently underwent total knee arthroplasty after the MR scan. The synovial tissues harvested from the knee joint during surgery were processed for histological analysis to confirm iron deposition. RESULTS UTE-QSM successfully yielded tissue susceptibility maps of joints in both volunteers and patients. Multiple regions with high susceptibility over 1 ppm were detected in the affected joints of hemophilic patients, while no localized regions with high susceptibility were detected in asymptomatic healthy volunteers. Histology confirmed the presence of iron in regions where high susceptibility was detected by UTE-QSM. CONCLUSION The UTE-QSM technique can detect hemosiderin deposition in the joint, and provides a potential sensitive biomarker for the diagnosis and prognosis of hemophilic arthropathy.
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Affiliation(s)
- Hyungseok Jang
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Annette von Drygalski
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Jonathan Wong
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Jenny Y Zhou
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Peter Aguero
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Xing Lu
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Xin Cheng
- Department of Histology and Embryology, Jinan University, Guangzhou, China
| | - Scott T Ball
- Orthopedic Surgery, University of California San Diego, San Diego, California, USA
| | - Yajun Ma
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Eric Y Chang
- Department of Radiology, University of California San Diego, San Diego, California, USA.,Radiology Service, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Jiang Du
- Department of Radiology, University of California San Diego, San Diego, California, USA
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12
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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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13
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Dover S, Blanchette VS, Srivastava A, Fischer K, Abad A, Feldman BM. Clinical outcomes in hemophilia: Towards development of a core set of standardized outcome measures for research. Res Pract Thromb Haemost 2020; 4:652-658. [PMID: 32548565 PMCID: PMC7292657 DOI: 10.1002/rth2.12331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/14/2020] [Accepted: 02/24/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION A lack of uniformity in the choice of outcome measurement in hemophilia care and research has led to studies with incomparable results. We identified a need to define core outcome measures for use in research and clinical care of persons with hemophilia. OBJECTIVE To move toward a core set of outcome measures for the assessment of persons with hemophilia in research and practice. METHODS A modified nominal groups process was conducted with an international group of hemophilia experts, including persons with hemophilia as follows. Step 1: item generation for all potential outcome measures. Step 2: survey where respondents voted on the relative importance and usefulness of each item. Steps 3/4: 2-day meeting where attendees voted for items they valued, followed by open discussion and a second round of voting. Step 5: survey where respondents selected their top five items from those with >50% agreement at the meeting. RESULTS The highest ranked items for the pediatric core set (% agreement) are treatment satisfaction (92.7%), joint health (83.3%), a measure of access to treatment (82.5%), a measure of treatment adherence (72.5%), and generic performance based physical function (72.1%). The highest ranked items for the adult core set (% agreement) are total bleeding events (88.1%), EuroQol five dimensions (85.4%), treatment adherence (82.1%), joint health (79.1%), and number/location of bleeds per unit time (78.6%). CONCLUSION This process generated a list of preferred outcome measures to consider for assessment in persons with hemophilia. This information now requires refinement to define optimal core sets for use in different clinical/research contexts.
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Affiliation(s)
- Saunya Dover
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Victor S. Blanchette
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
- Division of Hematology/OncologyThe Hospital for Sick ChildrenTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
| | - Alok Srivastava
- Department of HematologyChristian Medical CollegeVelloreIndia
| | - Kathelijn Fischer
- Van CreveldkliniekUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Audrey Abad
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
| | - Brian M. Feldman
- Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoONCanada
- Department of PediatricsUniversity of TorontoTorontoONCanada
- Institute of Health PolicyManagement & Evaluationthe Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
- Division of RheumatologyThe Hospital for Sick ChildrenTorontoONCanada
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14
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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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15
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Bakeer N, Shapiro AD. Merging into the mainstream: the evolution of the role of point-of-care musculoskeletal ultrasound in hemophilia. F1000Res 2019; 8. [PMID: 31431824 PMCID: PMC6619375 DOI: 10.12688/f1000research.16039.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2019] [Indexed: 01/19/2023] Open
Abstract
Bleeding with resultant hemophilic arthropathy constitutes the largest cause of morbidity in patients with hemophilia. It results from repeated bleeding episodes in the joint and is characterized by synovial hypertrophy and cartilage and bony destruction. Hemophilic arthropathy assessment is a continually evolving process and is particularly challenging in children and young adults in whom joint disease may be missed or underestimated as obtaining serial "baseline" magnetic resonance imaging scans of multiple clinically asymptomatic or nearly asymptomatic joints may be unjustifiable and cost-ineffective. Musculoskeletal ultrasound-particularly, point-of-care musculoskeletal ultrasound-has emerged as a promising imaging modality for the early detection and management of hemophilic arthropathy, and for the evaluation of hemarthrosis and painful musculoskeletal episodes in patients with hemophilia. This review summarizes currently available data on the emerging role of this new imaging modality, its limitations, and gaps in knowledge. The review also raises unanswered questions, highlights the need for consolidated research efforts, and delineates future directions expected to advance this technology and optimize its use in this patient population.
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Affiliation(s)
- Nihal Bakeer
- Indiana Hemophilia and Thrombosis Center, 8326 Naab Road, Indianapolis, IN, 46260, USA
| | - Amy D Shapiro
- Indiana Hemophilia and Thrombosis Center, 8326 Naab Road, Indianapolis, IN, 46260, USA
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16
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Physical activity improved by adherence to prophylaxis in an Italian population of children, adolescents and adults with severe haemophilia A: the SHAPE Study. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 18:152-158. [PMID: 31184581 DOI: 10.2450/2019.0040-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/26/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Physical activity in people with haemophilia (PWH) reduces the development of severe arthropathy, but it must be performed after regular, proper prophylaxis. Strict adherence to treatment is crucial to achieving effectiveness and established outcomes. The primary aim of this study was to collect prospective data on adherence to prophylaxis for over 36 months. A secondary aim was to verify whether adherence correlates with physical activity. MATERIALS AND METHODS Italian patients with severe haemophilia A treated on prophylaxis with octocog alfa were included in the study. Physical findings were assessed by the Haemophilia and Exercise Project (HEP)-Test-Q and the Early Prophylaxis Immunologic Challenge (EPIC)-Norfolk Physical Activity Questionnaire; orthopaedic status was assessed by the Hemophilia Joint Health Score (HJHS). Adherence was measured as percentage of empty vials returned with respect to the prescribed amount. RESULTS Forty-two PWH were enrolled: 31% children, 21.4% adolescents, and 47.6% adults. Type, frequency and impact of physical activities differed among the three groups. The HEP-Test-Q showed the highest impairments in the domains "endurance" and "strength/co-ordination". Eight percent of patients were classified as adherent to prophylaxis. Among them, 50% had at least one bleeding episode in the year before enrolment; this percentage dropped during the three years of the study. While remaining stable in the "non-adherent" group, the HJHS score decreased in the "adherent" patients. The mean number of school/work days lost was lower in adherent patients (from 3.4±6.8 to 0.2±0.9) than in non-adherent ones. DISCUSSION PWH with better orthopaedic scores reported better physical performance. Adherence to long-term prophylaxis proved to be high and correlated with a reduction in bleeds, target joints, school/work days lost, and with a performance improvement in endurance sports activities over time.
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17
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Chozie NA, Primacakti F, Gatot D, Setiabudhy RD, Tulaar ABM, Prasetyo M. Comparison of the efficacy and safety of 12‐month low‐dose factor VIII tertiary prophylaxis vs on‐demand treatment in severe haemophilia A children. Haemophilia 2019; 25:633-639. [DOI: 10.1111/hae.13770] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Novie A. Chozie
- Pediatric Hematology‐Oncology Division, Department of Child Health, Dr. Cipto Mangunkusumo Hospital Faculty of Medicine Universitas Indonesia Jakarta Indonesia
| | - Fitri Primacakti
- Pediatric Hematology‐Oncology Division, Department of Child Health, Dr. Cipto Mangunkusumo Hospital Faculty of Medicine Universitas Indonesia Jakarta Indonesia
| | - Djajadiman Gatot
- Pediatric Hematology‐Oncology Division, Department of Child Health, Dr. Cipto Mangunkusumo Hospital Faculty of Medicine Universitas Indonesia Jakarta Indonesia
| | - Rahajuningsih D. Setiabudhy
- Department of Clinical Pathology, Dr. Cipto Mangunkusumo Hospital Faculty of Medicine Universitas Indonesia Jakarta Indonesia
| | - Angela B. M. Tulaar
- Department of Physical Rehabilitation, Dr. Cipto Mangunkusumo Hospital Faculty of Medicine Universitas Indonesia Jakarta Indonesia
| | - Marcel Prasetyo
- Department of Radiology, Dr. Cipto Mangunkusumo Hospital Faculty of Medicine Universitas Indonesia Jakarta Indonesia
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18
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Liu S, Li K, Zhao X, Cong H, Li Q, Chen L. Survey of non‐physiotherapy department medical staff in China and their understanding of physiotherapy in comprehensive management of haemophilia. Haemophilia 2019; 25:493-499. [PMID: 30866137 DOI: 10.1111/hae.13720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/26/2019] [Accepted: 02/11/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Shufen Liu
- Department of Physical Medicine & Rehabilitation, Peking Union Medical College Hospital Chinese Academy of Medical School & Peking Union Medical College Beijing China
| | - Kuixing Li
- Department of Hematology, Peking Union Medical College Hospital Chinese Academy of Medical School & Peking Union Medical College Beijing China
| | - Xiaoyi Zhao
- Department of Physical Medicine & Rehabilitation, Peking Union Medical College Hospital Chinese Academy of Medical School & Peking Union Medical College Beijing China
| | - Hui Cong
- Department of Healthcare, Peking Union Medical College Hospital Chinese Academy of Medical School & Peking Union Medical College Beijing China
| | - Qing Li
- Department of Physical Medicine & Rehabilitation, Peking Union Medical College Hospital Chinese Academy of Medical School & Peking Union Medical College Beijing China
| | - Lixia Chen
- Department of Physical Medicine & Rehabilitation, Peking Union Medical College Hospital Chinese Academy of Medical School & Peking Union Medical College Beijing China
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19
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Zhang N, Lv Y, Liu Y, Yin G, Hu D, Wu R, Peng Y. T2 mapping in the quantitative evaluation of articular cartilage changes in children with hemophilia: A pilot study. Pediatr Investig 2018; 2:242-247. [PMID: 32851273 PMCID: PMC7331352 DOI: 10.1002/ped4.12099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 11/28/2018] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Joint disease affects more than 90% of severe hemophiliacs. Early diagnosis is critical in preventing hemophilic arthritis. Magnetic resonance imaging (MRI) enables visualization of early arthropathic changes and plays an important role in treatment. OBJECTIVE To evaluate the role of T2 mapping in detecting early cartilage lesions in the knee and ankle joints of children with hemophilic arthropathy. METHODS Target joints of 15 male patients with clinically confirmed moderate or severe hemophilia were evaluated with MRI. In addition to routine MRI protocols (T1WI, T2_FFE, T2_SPAIR, PDW_TSE), T2 mapping was used to evaluate the articular cartilage of target joints. RESULTS The mean T2 value of the distal femoral cartilage was 46.72 ± 10.94 ms, which is higher than the reported age-matched normal value (40.27 ± 3.50 ms). The mean T2 value of the proximal tibial cartilage was 45.60 ± 8.82 ms, which is higher than the reported normal value (31.15 ± 1.86 ms). Four examined joints (two ankles, two knees) showed normal morphology with no abnormal signal on routine MR sequences. However, T2 mapping showed locally increased T2 values in the cartilage, along with uneven color scales. INTERPRETATION The quantitative assessment method of T2 mapping might be helpful to early diagnosis for articular cartilage lesions. It might be a potential tool for early assessment of cartilage changes and quantification of lesion's severity for hemophilia joint.
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Affiliation(s)
- Ningning Zhang
- Department of RadiologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Yanqiu Lv
- Department of RadiologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Yue Liu
- Department of RadiologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Guangheng Yin
- Department of RadiologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Di Hu
- Department of RadiologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Runhui Wu
- Department of HemotologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
| | - Yun Peng
- Department of RadiologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingChina
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20
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McLaughlin P, Morris R, Chowdary P. Investigating the relationship between the HJHS and HAL in routine clinical practice: A retrospective review. Haemophilia 2018; 24:988-994. [PMID: 30295404 DOI: 10.1111/hae.13614] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/12/2018] [Accepted: 08/26/2018] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Comprehensive musculoskeletal assessment for monitoring joint health in haemophilia includes both physical assessment with Haemophilia Joint Health Score (HJHS) and assessment of self-reported function by Haemophilia Activities List (HAL). METHODS Correlation between physical assessment and joint function was undertaken between HJHS and HAL in patients with SHA and SHB who had both assessments at the same visit over a one-year period. RESULTS Data from 120 patients (96-SHA/24 = SHB) with a median age 33 years (range 19-73) were included. Median total HJHS was 19, increasing with age: 18-30 years-7, 31-50 years-25 and 51-73 years-44. Similarly, median total HAL score was 80 with decreased function associated with increasing age: 18-30 years-90.4, 31-59 years-71.7, 51-73 years-49.5. Median Total HJHS and HAL demonstrated strong correlation (rs = 0.66, P < 0.01). Moderate-to-strong correlations were seen across the entire age group between the HJHS LL and UL subtotals and corresponding limb HAL domains. Within age groups, correlations were less significant particularly for the upper UL domains in HAL and the UL HJHS score. The wide range of ROM in joints categorized as markedly affected (ie, ROM loss score = 3) highlights the potential ceiling effect of this domain score and its use in chronically damaged joints. CONCLUSION HJHS and HAL showed moderate-to-strong correlation with discrepancy in some individual patients. Prospective studies are required to better understand the clinical utility of both especially in severe joint disease where HAL may have a potential advantage.
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Affiliation(s)
- Paul McLaughlin
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Richard Morris
- Bristol Medical School Population Health Sciences, University of Bristol, Bristol, UK
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
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21
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Attempting to remedy sub-optimal medication adherence in haemophilia: The rationale for repeated ultrasound visualisations of the patient's joint status. Blood Rev 2018; 33:106-116. [PMID: 30146094 DOI: 10.1016/j.blre.2018.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 07/14/2018] [Accepted: 08/17/2018] [Indexed: 01/01/2023]
Abstract
Haemophilia is marked by joint bleeding (haemarthrosis) leading to cartilage damage (arthropathy). Lifelong prophylaxis-initiated after the first bleeding episode-leads to a dramatic decrease in arthropathy in haemophilia patients. However, adherence to continuous intravenous administrations of factor VIII (FVIII) or FIX products is challenging, and patients potentially suffer from breakthrough bleedings while on prophylaxis. Newer FVIII/FIX products with enhanced convenience attributes and/or easier infusion procedures are intended to improve adherence. However, pharmacokinetic data should be harmonised with information from individual attitudes and treatment needs, to tailor intravenous dosing and scheduling in patients who receive extended half-life products. Nor is there sound evidence as to how subcutaneous non-FVIII/FIX replacement approaches (concizumab; emicizumab; fitusiran) or single intravenous injections of adeno-associated viral vectors (when employing gene therapy) will revolutionize adherence in haemophilia. In rheumatoid arthritis, repeated ultrasound examination of a patient's major joints is a valuable tool to educate patients and parents to understand the disease and provide an objective framework for clinicians to acknowledge patient's adherence. Joint ultrasound examination in haemophilia significantly correlates with cartilage damage, effusion, and synovial hypertrophy evaluated by magnetic resonance imaging. Furthermore, in patients with haemophilia undergoing prophylaxis with an extended half-life product for a ≈ 2.8 year period, a significant continued improvement in joint health is detected at the physical examination. This provides the rationale for studies on repeated ultrasound examinations of joint status to attempt to remedy sub-optimal medication adherence and help identify which approach is most suited on which occasion and for which patient.
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Abstract
In juvenile idiopathic arthritis (JIA), imaging is increasingly used in clinical practice. In this paper we discuss imaging of the knee, the clinically most commonly affected joint in JIA. In the last decade, a number of important steps have been made in the development of imaging outcome measures in children with JIA knee involvement. Ultrasound is undergoing a fast validation process, which should be accomplished within the next few years. The validation processes of MRI as an imaging biomarker for clinical trials in the JIA knee are at an advanced stage, with important data available on the feasibility, reliability and validity of the Juvenile Arthritis MRI Scoring system. Moreover, both US and MRI data are emerging on the normal appearance of the growing knee joint.
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23
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Barnes RFW, Cramer TJ, Hughes TH, von Drygalski A. The hypertension of hemophilia is associated with vascular remodeling in the joint. Microcirculation 2017. [PMID: 28627086 DOI: 10.1111/micc.12387] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Hemophilic arthropathy is associated with pronounced vascular joint remodeling. Also, compared to the general population, PWH have a higher prevalence of hypertension not explained by usual risk factors. As vascular remodeling in various vascular beds is a hallmark of hypertension, we hypothesized that vascular joint remodeling is associated with elevated blood pressures and hypertension. METHODS Elbows, knees, and ankles of 28 adult PWH were evaluated for vascular abnormalities with MSKUS/PD, as well as for radiographic and clinical status and pain. Logistic and linear regression models were fitted to examine associations between hypertension, blood pressure, and PD score. RESULTS The extent of vascular abnormalities was associated with hypertension and blood pressures. Hypertensive patients had a higher PD score compared to nonhypertensive patients, and the risk of hypertension increased steeply with PD score. SBP was also strongly associated with PD score, while DBP was only weakly associated. CONCLUSIONS Vascular remodeling in hemophilic joints is associated with hypertension and elevated blood pressures. As hypertension is a grave risk factor for intracranial hemorrhage, a prominent cause of mortality in hemophilia patients, future studies are needed to address the causal pathways between vascular joint remodeling and blood pressure.
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Affiliation(s)
- Richard F W Barnes
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Thomas J Cramer
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Tudor H Hughes
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Annette von Drygalski
- Department of Medicine, University of California San Diego, San Diego, CA, USA.,Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
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Hemke R, Tzaribachev N, Nusman CM, van Rossum MAJ, Maas M, Doria AS. Magnetic Resonance Imaging (MRI) of the Knee as an Outcome Measure in Juvenile Idiopathic Arthritis: An OMERACT Reliability Study on MRI Scales. J Rheumatol 2017; 44:1224-1230. [PMID: 28572469 DOI: 10.3899/jrheum.160821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE There is increasing evidence that early therapeutic intervention improves longterm joint outcome in juvenile idiopathic arthritis (JIA). Given the existence of highly effective treatments, there is an urgent need for reliable and accurate measures of disease activity and joint damage in JIA. Our objective was to assess the reliability of 2 magnetic resonance imaging (MRI) scoring methods: the Juvenile Arthritis MRI Scoring (JAMRIS) system and the International Prophylaxis Study Group (IPSG) consensus score, for evaluating disease status of the knee in patients with JIA. METHODS Four international readers independently scored an MRI dataset of 25 JIA patients with clinical knee involvement. Synovial thickening, joint effusion, bone marrow changes, cartilage lesions, bone erosions, and subchondral cysts were scored using the JAMRIS and IPSG systems. Further, synovial enhancement, infrapatellar fat pad heterogeneity, tendinopathy, and enthesopathy were scored. Interreader reliability was analyzed by using the generalized κ, ICC, and the smallest detectable difference (SDD). RESULTS ICC regarding interreader reliability ranged from 0.33 (95% CI 0.12-0.52, SDD = 0.29) for enthesopathy up to 0.95 (95% CI 0.92-0.97, SDD = 3.19) for synovial thickening. Good interreader reliability was found concerning joint effusion (ICC 0.93, 95% CI 0.89-0.95, SDD = 0.51), synovial enhancement (ICC 0.90, 95% CI 0.85-0.94, SDD = 9.85), and bone marrow changes (ICC 0.87, 95% CI 0.80-0.92, SDD = 10.94). Moderate to substantial reliability was found concerning cartilage lesions and bone erosions (ICC 0.55-0.72, SDD 1.41-13.65). CONCLUSION The preliminary results are promising for most of the scored JAMRIS and IPSG items. However, further refinement of the scoring system is warranted for unsatisfactorily reliable items such as bone erosions, cartilage lesions, and enthesopathy.
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Affiliation(s)
- Robert Hemke
- From the Department of Radiology, Academic Medical Center, University of Amsterdam; Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Diagnostic Imaging, the Hospital for Sick Children, Toronto, Ontario, Canada. .,R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; N. Tzaribachev, MD, PhD, Pediatric Rheumatology Research Institute; C.M. Nusman, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; M.A. van Rossum, MD, PhD, Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, and Amsterdam Rheumatology and Immunology Center Reade; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, the Hospital for Sick Children.
| | - Nikolay Tzaribachev
- From the Department of Radiology, Academic Medical Center, University of Amsterdam; Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Diagnostic Imaging, the Hospital for Sick Children, Toronto, Ontario, Canada.,R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; N. Tzaribachev, MD, PhD, Pediatric Rheumatology Research Institute; C.M. Nusman, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; M.A. van Rossum, MD, PhD, Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, and Amsterdam Rheumatology and Immunology Center Reade; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, the Hospital for Sick Children
| | - Charlotte M Nusman
- From the Department of Radiology, Academic Medical Center, University of Amsterdam; Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Diagnostic Imaging, the Hospital for Sick Children, Toronto, Ontario, Canada.,R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; N. Tzaribachev, MD, PhD, Pediatric Rheumatology Research Institute; C.M. Nusman, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; M.A. van Rossum, MD, PhD, Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, and Amsterdam Rheumatology and Immunology Center Reade; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, the Hospital for Sick Children
| | - Marion A J van Rossum
- From the Department of Radiology, Academic Medical Center, University of Amsterdam; Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Diagnostic Imaging, the Hospital for Sick Children, Toronto, Ontario, Canada.,R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; N. Tzaribachev, MD, PhD, Pediatric Rheumatology Research Institute; C.M. Nusman, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; M.A. van Rossum, MD, PhD, Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, and Amsterdam Rheumatology and Immunology Center Reade; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, the Hospital for Sick Children
| | - Mario Maas
- From the Department of Radiology, Academic Medical Center, University of Amsterdam; Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Diagnostic Imaging, the Hospital for Sick Children, Toronto, Ontario, Canada.,R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; N. Tzaribachev, MD, PhD, Pediatric Rheumatology Research Institute; C.M. Nusman, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; M.A. van Rossum, MD, PhD, Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, and Amsterdam Rheumatology and Immunology Center Reade; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, the Hospital for Sick Children
| | - Andrea S Doria
- From the Department of Radiology, Academic Medical Center, University of Amsterdam; Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany; Department of Diagnostic Imaging, the Hospital for Sick Children, Toronto, Ontario, Canada.,R. Hemke, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; N. Tzaribachev, MD, PhD, Pediatric Rheumatology Research Institute; C.M. Nusman, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; M.A. van Rossum, MD, PhD, Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, and Amsterdam Rheumatology and Immunology Center Reade; M. Maas, MD, PhD, Department of Radiology, Academic Medical Center, University of Amsterdam; A.S. Doria, MD, PhD, MSc, Department of Diagnostic Imaging, the Hospital for Sick Children
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Sari TT, Chozie NA, Gatot D, Tulaar AB, Dharma R, Sukrisman L, Bardosono S, Achmad HR, Prasetyo M. Clinical and ultrasound joint outcomes in severe hemophilia A children receiving episodic treatment in Indonesian National Hemophilia Treatment Center. MEDICAL JOURNAL OF INDONESIA 2017. [DOI: 10.13181/mji.v26i1.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Recurrent joint bleeds leading to arthropathy is the main problem in severe hemophilia children. This study aimed to investigate joint status in severe hemophilia A children receiving episodic treatment in Cipto Mangunkusumo Hospital, Jakarta.Methods: A cross-sectional study was conducted in Cipto Mangunkusumo Hospital as Indonesian National Hemophilia Treatment Center on children (4–18 years) with severe hemophilia A, who previously received episodic treatment, with no history of inhibitor factor VIII. Hemophilia Joint Health Score was evaluated according to HJHS version 2.1 2011. Joint ultrasonography was done for six index joints (bilateral elbows, knees and ankles) using Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) methods. Data of age of first joint bleed, number of target joints and inhibitor factor VIII were obtained from the Pediatric Hemophilia Registry and medical records.Results: There were 59 subjects aged 4 to 18 years. Twenty-nine out of 59 (49.2%) subjects experienced first joint bleed before of 2 years of age. The most common of joint bleeds was a right ankle. Mean total HJHS was 8.71±8.73. Subjects aged 4–10 years showed lower HJHS (4.6±3.7) as compared to subjects aged >10–18 years (12.3±10.3), p<0.001; 95% CI=4.9–13. Mean HEAD-US scores in subjects aged 4–10 years (18.7±5.6) was lower than in subjects aged >10–18 years (28±7.9), p<0.001, 95% CI= -12.9–-5.6.Conclusion: HJHS and HEAD-US scores of severe hemophilia A children receiving episodic treatment aged 4–10 years are lower compared to subjects aged >10–18 years, indicating more severe joint destruction in older children and progressivity of joint damage over time. It is important to start prophylactic treatment to prevent progressivity of joint damage.
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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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27
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Batt K, Recht M, Cooper DL, Iyer NN, Kempton CL. Construct validity of patient-reported outcome instruments in US adults with hemophilia: results from the Pain, Functional Impairment, and Quality of life (P-FiQ) study. Patient Prefer Adherence 2017; 11:1369-1380. [PMID: 28860720 PMCID: PMC5558590 DOI: 10.2147/ppa.s141390] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND People with hemophilia (PWH) experience frequent joint bleeding, resulting in pain and functional impairment. Generic and disease-specific patient-reported outcome (PRO) instruments have been used in clinical studies, but rarely in the comprehensive hemophilia care setting. OBJECTIVE The objective of this study was to assess construct validity of PRO instruments measuring pain, functional impairment, and health-related quality of life in US PWH with a history of joint pain/bleeding. METHODS Adult male PWH completed 4 PRO instruments (EQ-5D-5L with visual analog scale, Brief Pain Inventory v2 Short Form [BPI], SF-36v2, Hemophilia Activities List [HAL]) and underwent a musculoskeletal examination (Hemophilia Joint Health Score v2.1 [HJHS]). Construct validity between index and domain scores was evaluated by Pearson product-moment correlation coefficient. RESULTS A total of 381 PWH were enrolled. EQ-5D-5L Mobility correlated with BPI, SF-36v2, and HAL domains related to pain, physical function, and activity of the lower extremities. EQ-5D-5L Self-Care correlated only with HAL Self-Care. EQ-5D-5L Usual Activities correlated with BPI Pain Interference and domains within SF-36v2 and HAL related to pain and physical function/activities (particularly those involving the lower extremities). EQ-5D-5L Pain/Discomfort correlated with Bodily Pain and Physical Summary on SF-36v2, HAL Overall Activity, and all BPI pain domains. EQ-5D-5L Anxiety/Depression correlated with social/emotional/mental aspects of SF-36v2. On BPI, most pain domains correlated with Bodily Pain and Physical Health Summary on SF-36v2 and Overall Activity on HAL. On SF-36v2, Physical Functioning, Role Physical, Bodily Pain, and Physical Health summary scores correlated with all the domains of HAL except Self-Care. For HJHS, Ankle and Total scores correlated with SF-36v2 Physical Functioning and HAL Lying/Sitting, Leg Function, Complex Lower Extremity Activity, and Overall Activity. CONCLUSION All PRO instruments have high construct validity but provide different levels of detail in describing effects of hemophilia. Instrument choice may depend on individuals' symptoms, treatment planning goals, or outcome tracking research objectives, with consideration for administrative burden.
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Affiliation(s)
- Katharine Batt
- Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
- Correspondence: Katharine Batt, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27101, USA, Tel +1 336 716 0443, Fax +1 336 713 5445, Email
| | - Michael Recht
- The Hemophilia Center, Oregon Health & Science University, Portland, OR
| | | | | | - Christine L Kempton
- Departments of Pediatrics and Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
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Moderate-intensity exercise improves the thromboelastography coagulation index in children with severe hemophilia A. Blood Coagul Fibrinolysis 2016; 27:797-803. [PMID: 26656895 DOI: 10.1097/mbc.0000000000000493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This pilot study explored the effect of moderate-intensity exercise on factor VIII (FVIII) activity and global hemostatic status of the children with severe hemophilia A. Eleven children aged 6 to 15 years with severe hemophilia A participated in a moderate-intensity exercise test by using Recumbent Cross Trainer (NuStep, T5XR) for at least 10 min after reaching the target heart rate or until volitional exhaustion within a safety framework. Blood samples were collected pre and postexercise for plasma FVIII: C and thromboelastography (TEG) parameters and coagulation index. The average duration of exercise was 11.8 min (10-13 min). There was no report on bleeding events or adverse symptoms requiring termination of the exercise test. The average FVIII activity of the 11 children was 0.66 (0.5-0.8) IU/dl before and 0.93 (0.5-2.3) IU/dl after exercise. The increase of FVIII in the 11 children as a group was not statistically significant (P = 0.052). There were significant changes of TEG measurements, with shortening of R (P < 0.05), and increase in K decrease (P < 0.05), alpha angle (P < 0.05), maximum amplitude (P < 0.05), and coagulation index (P < 0.01). Among the 11 children, the relative coagulation index increase after exercise was greater than 50% in seven (63.6%), less than 20% in three (27.3%), and less than 10% in one (9.1%). TEG analysis showed that the global hemostatic function for the children with severe hemophilia A can be enhanced after moderate-intensity exercise.
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29
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St-Louis J, Urajnik DJ, Ménard F, Cloutier S, Klaassen RJ, Ritchie B, Rivard GE, Warner M, Blanchette V, Young NL. Generic and disease-specific quality of life among youth and young men with Hemophilia in Canada. BMC HEMATOLOGY 2016; 16:13. [PMID: 27158500 PMCID: PMC4858890 DOI: 10.1186/s12878-016-0052-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/27/2016] [Indexed: 11/20/2022]
Abstract
Background This study was undertaken to explore the longitudinal patterns of health-related quality of life (HRQoL) among youth and young adults with Hemophilia A (HA) over a 3-year period. This report presents the baseline characteristics of the study cohort. Methods Males, 14 to 29 years of age, with predominantly severe HA were recruited from six treatment centres in Canada. Subjects completed a comprehensive survey. HRQoL was measured using: the CHO-KLAT2.0 (youth), Haemo-QoL-A (young adults) and the SF-36v2 (all). Results 13 youth (mean age = 15.7, range = 12.9-17.9 years) and 33 young adults (mean age = 23.6; range = 18.4 -28.7 years) with moderate (7 %) and severe (93 %) HA were enrolled. All were on a prophylactic regimen with antihemophilic factor (Helixate FS®) during the study. The youth had minimal joint damage (mean HJHS = 5.2) compared to young adults (mean HJHS = 13.3). The mean HRQoL scores for youth were: 79.2 (SD = 11.9) for the CHO-KLAT, and 53.0 (5.5) and 52.3 (6.8) for the SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores respectively. The mean HRQoL scores for young adults were: 85.8 (9.5) for the Haemo-Qol-A, and 50.8 (6.4) and 50.9 (8.8) for PCS and MCS respectively. PCS and MCS scores were comparable to published Canadian norms, however significant differences were found for the domains of Physical Functioning and Bodily Pain. The disease-specific HRQoL scores were weakly correlated with the PCS for youth (CHO-KLAT vs. PCS r = 0.28, p = 0.35); and moderately correlated for the MCS (r = 0.39, p = 0.19). Haemo-QoL-A scores for young adults were strongly correlated with the PCS (r = 0.53, p = 0.001); and weakly correlated with the MCS (r = 0.26, p = 0.13). Joint status as assessed by HJHS was correlated with PCS scores. A history of lifelong prophylaxis resulted in better PCS but worse MCS scores. Conclusion Despite having hemophilia, the youth in this cohort have minimal joint disease and good HRQoL. The young adults demonstrated more joint disease and slightly worse HRQoL in the domains of physical functioning and pain. The data presented here provide new information to inform the selection of Health Related Quality of Life (HRQoL) instruments for use in future clinical trials involving persons with hemophilia. Trial registration ClinicalTrials.gov : NCT01034904. Study funded by CSL Behring Canada. Electronic supplementary material The online version of this article (doi:10.1186/s12878-016-0052-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J St-Louis
- CHU Sainte-Justine, Montréal, Canada ; Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | | | - F Ménard
- CHU Sainte-Justine, Montréal, Canada
| | - S Cloutier
- Hôpital de l'Enfant-Jésus, Quebec city, Canada
| | - R J Klaassen
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - B Ritchie
- University of Alberta, Edmonton, Canada
| | | | - M Warner
- McGill University Health Centre, Montréal, Canada
| | - V Blanchette
- University of Toronto, Toronto, Canada ; Hospital for Sick Children, Toronto, Canada
| | - N L Young
- Laurentian University, Sudbury, Canada ; Hospital for Sick Children, Toronto, Canada
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Bhat V, Olmer M, Joshi S, Durden DL, Cramer TJ, Barnes RFW, Ball ST, Hughes TH, Silva M, Luck JV, Moore RE, Mosnier LO, von Drygalski A. Vascular remodeling underlies rebleeding in hemophilic arthropathy. Am J Hematol 2015; 90:1027-35. [PMID: 26257191 DOI: 10.1002/ajh.24133] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 07/17/2015] [Accepted: 07/20/2015] [Indexed: 01/10/2023]
Abstract
Hemophilic arthropathy is a debilitating condition that can develop as a consequence of frequent joint bleeding despite adequate clotting factor replacement. The mechanisms leading to repeated spontaneous bleeding are unknown. We investigated synovial, vascular, stromal, and cartilage changes in response to a single induced hemarthrosis in the FVIII-deficient mouse. We found soft-tissue hyperproliferation with marked induction of neoangiogenesis and evolving abnormal vascular architecture. While soft-tissue changes were rapidly reversible, abnormal vascularity persisted for months and, surprisingly, was also seen in uninjured joints. Vascular changes in FVIII-deficient mice involved pronounced remodeling with expression of α-Smooth Muscle Actin (SMA), Endoglin (CD105), and vascular endothelial growth factor, as well as alterations of joint perfusion as determined by in vivo imaging. Vascular architecture changes and pronounced expression of α-SMA appeared unique to hemophilia, as these were not found in joint tissue obtained from mouse models of rheumatoid arthritis and osteoarthritis and from patients with the same conditions. Evidence that vascular changes in hemophilia were significantly associated with bleeding and joint deterioration was obtained prospectively by dynamic in vivo imaging with musculoskeletal ultrasound and power Doppler of 156 joints (elbows, knees, and ankles) in a cohort of 26 patients with hemophilia at baseline and during painful episodes. These observations support the hypothesis that vascular remodeling contributes significantly to bleed propagation and development of hemophilic arthropathy. Based on these findings, the development of molecular targets for angiogenesis inhibition may be considered in this disease.
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Affiliation(s)
- Vikas Bhat
- Department of Molecular and Experimental Medicine; The Scripps Research Institute; La Jolla California
- Department of Medicine; University of California San Diego; San Diego California
| | - Merissa Olmer
- Department of Molecular and Experimental Medicine; The Scripps Research Institute; La Jolla California
| | - Shweta Joshi
- Department of Pediatrics; University of California San Diego; California
| | - Donald L. Durden
- Department of Pediatrics; University of California San Diego; California
| | - Thomas J. Cramer
- Department of Medicine; University of California San Diego; San Diego California
| | - Richard FW Barnes
- Department of Medicine; University of California San Diego; San Diego California
| | - Scott T. Ball
- Department of Orthopaedic Surgery; University of California San Diego; San Diego California
| | - Tudor H. Hughes
- Department of Radiology; University of California San Diego; San Diego California
| | - Mauricio Silva
- Orthopedic Institute for Children University of California Los Angeles; Los Angeles California
| | - James V. Luck
- Orthopedic Institute for Children University of California Los Angeles; Los Angeles California
| | | | - Laurent O. Mosnier
- Department of Molecular and Experimental Medicine; The Scripps Research Institute; La Jolla California
| | - Annette von Drygalski
- Department of Molecular and Experimental Medicine; The Scripps Research Institute; La Jolla California
- Department of Medicine; University of California San Diego; San Diego California
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Wyseure T, Mosnier LO, von Drygalski A. Advances and challenges in hemophilic arthropathy. Semin Hematol 2015; 53:10-9. [PMID: 26805902 DOI: 10.1053/j.seminhematol.2015.10.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2004] [Revised: 11/05/2004] [Accepted: 12/01/2005] [Indexed: 12/13/2022]
Abstract
Hemophilic arthropathy is a form of joint disease that develops secondary to joint bleeding and presents with synovial hypertrophy, cartilage and bony destruction. The arthropathy can develop despite clotting factor replacement and is especially disabling in the aging population. Pathobiological tissue changes are triggered by release of hemoglobin and iron deposition in the joint, but the sequence of events and the molecular mechanisms resulting in joint deterioration are incompletely understood. Treatment options other than clotting factor replacement are limited. Improvements in the treatment of hemophilia necessitate a better understanding of the processes that lead to this disabling condition and better diagnostic tools. Towards that end, studies of the molecular mechanisms leading to the arthropathy, as well as the development of sensitive imaging techniques and biomarkers are needed. These will pave the way to identify the cause of acute pain such as joint bleeding or synovitis, detect early, potentially reversible structural changes, and predict progression of disease. This review describes current imaging techniques and the development of high resolution musculoskeletal ultrasound with power Doppler to afford point-of-care diagnosis and management, the potential utility of diagnostic biomarkers, and summarizes our current knowledge of the pathobiology of hemophilic arthropathy.
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Affiliation(s)
- Tine Wyseure
- The Scripps Research Institute, Department of Molecular and Experimental Medicine, La Jolla, CA, USA
| | - Laurent O Mosnier
- The Scripps Research Institute, Department of Molecular and Experimental Medicine, La Jolla, CA, USA
| | - Annette von Drygalski
- The Scripps Research Institute, Department of Molecular and Experimental Medicine, La Jolla, CA, USA; University of California at San Diego, Department of Medicine, San Diego, CA, USA.
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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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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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Boadas A, Osorio M, Gibraltar A, Rosas MM, Berges A, Herrera E, Gadea S, Gutiérrez MÁ, Salazar F, Ruiz-Sáez A. Favourable impact of regular swimming in young people with haemophilia: experience derived from ‘Desafio del Caribe’ project. Haemophilia 2014; 21:e12-8. [DOI: 10.1111/hae.12576] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2014] [Indexed: 11/27/2022]
Affiliation(s)
- A. Boadas
- Centro Nacional de Hemofilia; Banco Municipal de Sangre DC; Caracas Venezuela
| | - M. Osorio
- Federación de Hemofilia de la República Mexicana A.C.; DF México México
| | - A. Gibraltar
- Federación de Hemofilia de la República Mexicana A.C.; DF México México
| | - M. M. Rosas
- Centro Nacional de Hemofilia; Banco Municipal de Sangre DC; Caracas Venezuela
| | - A. Berges
- Federación de Hemofilia de la República Mexicana A.C.; DF México México
| | - E. Herrera
- Asociación Venezolana para la Hemofilia; Caracas Venezuela
| | - S. Gadea
- Federación de Hemofilia de la República Mexicana A.C.; DF México México
| | - M. Á. Gutiérrez
- Federación de Hemofilia de la República Mexicana A.C.; DF México México
| | - F. Salazar
- Asociación Venezolana para la Hemofilia; Caracas Venezuela
| | - A. Ruiz-Sáez
- Centro Nacional de Hemofilia; Banco Municipal de Sangre DC; Caracas Venezuela
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Abstract
Hemophilia is a hematological disorder characterized by a partial or complete deficiency of clotting factor VIII or IX. Its bleeding complications primarily affect the musculoskeletal system. Hemarthrosis is a major hemophilia-related complication, responsible for a particularly debilitating chronic arthropathy, in the long term. In addition to clotting factor concentrates, usually prescribed by the hematologist, managing acute hemarthrosis and chronic arthropathy requires a close collaboration between the orthopedic surgeon and physiotherapist. This collaboration, comprising a coagulation and musculoskeletal specialist, is key to effectively preventing hemarthrosis, managing acute joint bleeding episodes, assessing joint function, and actively treating chronic arthropathy. This paper reviews, from a practical point of view, the pathophysiology, clinical manifestations, and treatment of hemarthrosis and chronic hemophilia-induced arthropathy for hematologists, orthopedic surgeons, and physiotherapists.
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Affiliation(s)
- Sébastien Lobet
- Hemostasis-Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium ; Division of Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Cedric Hermans
- Hemostasis-Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Catherine Lambert
- Hemostasis-Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Abstract
INTRODUCTION There is growing evidence that subclinical joint bleeding early in life may lead to subtle changes in joint function, gait, and muscle development in young children with haemophilia. The early identification of such changes provides an opportunity for clinicians to intervene before irreversible structural changes occur. MATERIALS AND METHODS We have undertaken motion analysis of the knee in 273 children (mean age 9.8 years) with haemophilia A, haemophilia B, or von Willebrand disease and compared the results with those from 200 healthy age- and sex-matched controls (mean age 10.3 years). We have also completed detailed orthopaedic assessments and evaluated overall fitness in most of these children. RESULTS There was a clear correlation between total motion score and age: r(2)=0.47 for the healthy children and r(2)=0.69 for the haemophilic children. The differences were most striking in children aged 3-4 years. Significant between-group differences were also observed in the comparison of knee bends, gait scores, and rhythmicity. Orthopaedic examinations revealed previously clinically silent pressure pains in the ligaments of the knee joints of 38% of children and in the ligaments and capsule of the ankle joints of 60% of children. The five-item fitness check showed significant deficits relative to controls in overall fitness, endurance, coordination, and flexibility. CONCLUSIONS Children and adolescents with haemophilia show significant functional impairments relative to normal controls. Early comprehensive assessments of the musculoskeletal system should be made so that individualized physical, physiotherapy, and sports therapy programmes can be developed.
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Khanum F, Bowen DJ, Kerr BC, Collins PW. Joint health scores in a haemophilia A cohort from Pakistan with minimal or no access to factor VIII concentrate: correlation with thrombin generation and underlying mutation. Haemophilia 2013; 20:426-34. [PMID: 24354535 DOI: 10.1111/hae.12326] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 12/01/2022]
Abstract
Haemophilia A is associated with recurrent joint bleeding which leads to synovitis and debilitating arthropathy. Coagulation factor VIII level is an important determinant of bleed number and development of arthropathy . The aim of this study was to compare the haemophilia joint health score (HJHS) and Gilbert score with severity, age, thrombin generation (TG) and underlying mutation in a haemophilia A cohort which had minimal access to haemostatic replacement therapy. Ninety-two haemophilia A individuals were recruited from Pakistan. Age, age at first bleed, target joints, haemophilic arthropathy joints, HJHS and Gilbert score were recorded. A strong correlation was found between HJHS and Gilbert score (r = 0.98), both were significantly higher in severe (n = 59) compared with non-severe (n = 29) individuals before the age of 12 years (P ≤ 0.01) but not thereafter. When individuals were divided according to developmental age (<12 years, 12-16 years and >16 years), both HJHS and Gilbert score were significantly lower in the youngest group (P ≤ 0.001), there was no difference between 12-16 years and >16 years. In severe individuals there was no correlation between in vitro TG and joint score, whereas in non-severe individuals there was a weak negative correlation. In the severe group, no significant difference was observed for either joint score according to the underlying mutation type (inversion, missense, nonsense, frameshift). In this cohort of haemophilia A individuals with minimal access to haemostatic treatment, haemophilic arthropathy correlated with severity and age; among severe individuals, joint health scores did not relate to either the underlying mutation or in vitro TG.
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Affiliation(s)
- F Khanum
- Department of Haematology, Cardiff University, School of Medicine, Cardiff, UK
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Sun J, Hilliard PE, Feldman BM, Zourikian N, Chen L, Blanchette VS, Luke KH, Poon MC. Chinese Hemophilia Joint Health Score 2.1 reliability study. Haemophilia 2013; 20:435-40. [DOI: 10.1111/hae.12330] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- J. Sun
- Hematology Department; Nanfang Hospital; Southern Medical University; Guangzhou China
| | - P. E. Hilliard
- Department of Rehabilitation Services; The Hospital for Sick Children and University of Toronto; Toronto ON Canada
| | - B. M. Feldman
- Division of Rheumatology; The Hospital for Sick Children and University of Toronto; Toronto ON Canada
| | - N. Zourikian
- Centre Hospitalier Universitaire Sainte-Justine, and Université de Montréal; Montreal QC Canada
| | - L. Chen
- Department of Physical Medicine and Rehabilitation; Chinese Academy of Medical Science & Peking Union Medical College; Beijing China
| | - V. S. Blanchette
- Pediatric Thrombosis and Hemostasis Program; The Hospital for Sick Children and University of Toronto; Toronto ON Canada
| | - K. H. Luke
- Department of Pediatrics, Pathology and Laboratory Medicine; Children's Hospital of Eastern Ontario and University of Ottawa; Ottawa ON Canada
| | - M-C. Poon
- Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program; Calgary Foothills Medical Center; Calgary AB Canada
- University of Calgary; Calgary AB Canada
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Auerswald G, Šalek SZ, Benson G, Elezović I, Lambert T, Morfini M, Pasi J, Remor E, Santagostino E, Salaj P, Ljung R. Beyond patient benefit: clinical development in hemophilia. Hematology 2013; 17:1-8. [DOI: 10.1179/102453312x13221316477372] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Günter Auerswald
- Klinikum Bremen-Mitte, Professor Hess Children’s Hospital, Bremen, Germany
| | - Silva Zupančić Šalek
- National Haemophilia and Thrombophilia Centre, Division of Haematology, Department of Internal Medicine, University Hospital Centre Rebro, Zagreb, Croatia
| | - Gary Benson
- Northern Ireland Haemophilia Comprehensive Care Centre, Belfast, Northern Ireland, UK
| | - Ivo Elezović
- Institute of HaematologyClinical Centre of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Thierry Lambert
- Hemophilic Care CenterBicêtre AP-HP Hospital and Faculté de Médecine Paris XI, Paris, France
| | - Massimo Morfini
- Agency for Hemophilia – Reference Center for Inherited Bleeding Disorders of Tuscany, Department of Emergency and Reception, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - John Pasi
- Haemophilia Centre, Barts and the London School of Medicine and Dentistry, London, UK
| | - Eduardo Remor
- Department of Psychobiology and HealthFaculty of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Santagostino
- IRCCS Cà Granda Foundation, Maggiore Hospital Policlinico and University of Milan, Italy
| | - Peter Salaj
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Rolf Ljung
- Lund University, Department of Paediatrics and Malmö Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden
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Foppen W, Sluiter D, Witkamp TD, Mali WPTM, Fischer K. Haemophilic magnetic resonance imaging score in healthy controls playing sports. Haemophilia 2013; 19:939-43. [DOI: 10.1111/hae.12191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
- W. Foppen
- Department of Radiology; University Medical Center (UMC) Utrecht; Utrecht The Netherlands
| | - D. Sluiter
- Department of Rehabilitation, Nursing Science and Sports; UMC Utrecht; Utrecht The Netherlands
| | - T. D. Witkamp
- Department of Radiology; University Medical Center (UMC) Utrecht; Utrecht The Netherlands
| | - W. P. T. M. Mali
- Department of Radiology; University Medical Center (UMC) Utrecht; Utrecht The Netherlands
| | - K. Fischer
- Van Creveld Clinic; Department of Haematology; Julius Center for Health Sciences and Primary Care; UMC Utrecht; Utrecht The Netherlands
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Ferreira AA, Bustamante-Teixeira MT, Leite ICG, Corrêa CSL, Rodrigues DDOW, da Cruz DT. Clinical and functional evaluation of the joint status of hemophiliac adults at a Brazilian blood center. Rev Bras Hematol Hemoter 2013; 35:23-8. [PMID: 23580880 PMCID: PMC3621631 DOI: 10.5581/1516-8484.20130010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 07/10/2012] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Hemophilia is a potentially disabling condition as hemophilic arthropathy develops early in life and is progressive, especially in patients treated in an on-demand regime. OBJECTIVE This study aimed to describe the structural joint status and the functional independence score of hemophiliac adults and correlate structural damage with the functional deficits found in these patients. METHODS Hemophiliacs at the Juiz de Fora Regional Blood Center - HEMOMINAS Foundation, aged 18 years and over and treated in an on-demand regime, were clinically evaluated in respect to structural joint damage using the World Federation of Hemophilia Physical Examination Scale (WFH-PE) and functional deficits using the Functional Independence Score in Hemophilia (FISH). The Spearman rank test was used to evaluate the correlation between the two scores. RESULTS Thirty-nine patients were evaluated. The mean age was 36.8 years. Target joints were detected in 69.2% of patients studied. The mean Physical Examination Scale and Functional Independence Score were 16.87 and 25.64, respectively. Patients with mild hemophilia showed no significant joint involvement. Patients with severe or moderate hemophilia had similar results regarding structural damage (p-value < 0.001) and functional deficits (p-value = 0.001). There was statistical significance in the correlation between the two scores (r = -0.850; p-value = 0.01). CONCLUSIONS The World Federation of Hemophilia Physical Examination Scale and Functional Independence Score in Hemophilia may be useful to clinically assess structural joint damage and functional deficits in hemophiliacs as the tools are inexpensive and easy to administer and may be able to detect hemophilic arthropathy, which results from recurrent hemarthrosis and is common in the population studied.
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42
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Feldman BM. Issues in the measurement of quality of life in hemophilia. Rev Bras Hematol Hemoter 2013; 35:299-301. [PMID: 24255605 PMCID: PMC3832302 DOI: 10.5581/1516-8484.20130118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 09/25/2013] [Indexed: 11/27/2022] Open
Affiliation(s)
- Brian M. Feldman
- Hospital for Sick Children, University of Toronto, Toronto, Canada
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43
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Saulyte Trakymiene S, Clausen N, Poulsen LH, Ingerslev J, Rageliene L. Progression of haemophilic arthropathy in children: a Lithuanian--Danish comparative study. Haemophilia 2012; 19:212-8. [PMID: 23167920 DOI: 10.1111/hae.12058] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 11/29/2022]
Abstract
Recurrent bleeding into joints initiates a sequence of events leading to a progressive joint damage in people with severe haemophilia. This is a continuous process during childhood and adolescence, therefore joint abnormalities may be minimal on physical examination in very young children - even those receiving on-demand treatment. The aim of our study was to quantify the burden of arthropathy in Lithuanian patients who had been treated exclusively by on-demand substitution and compare their physical joint health with age-matched Danish patients who received prophylaxis from an early age. Boys, aged 4-17 years, with severe haemophilia and no signs of inhibitors were included in the study. Joint outcome based on the Haemophilia Joint Health Score (HJHS) was analysed in two different treatment groups and compared within the matched pairs. In total, 32 (16 in each treatment group) patients were enroled. A total of 192 joints were evaluated. Joint status according to treatment strategy was strikingly different: 27.4 for on-demand vs. 3.3 for prophylaxis (<0.001) group. Significance of the difference in joint status comparing different treatment strategies was equally strong both in younger (4-9 years) and older (10-17 years) patient groups: 2.2 vs. 12.5 (P = 0.0002) and 3.9 vs. 36.3 (P < 0.0001) respectively. The results further demonstrate the unequivocal effect of prophylaxis on joint status and give an insight into early and late manifestations of joint impairment based on the HJHS in haemophilia patients with treatment on-demand compared with joint changes that may develop over the time with the preventative treatment.
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Affiliation(s)
- S Saulyte Trakymiene
- Clinic of Children's Diseases, Vilnius University and Centre for Pediatric Hematology/Oncology, Children's Hospital, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
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44
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Abstract
Standardized outcome measures allow us to be more objective when measuring the impact of therapy on persons with haemophilia. Many excellent measures have been developed for haemophilia - especially in the health domains of structure and function, and activities; excellent health status/health-related quality-of-life tools have also been developed for haemophilia. Studies from other disciplines suggest that the use of standardized outcome measures in daily practice leads to improvement in quality of care. Because of their potential complexity, measures must be chosen that are practical for use in clinic. Future research should be focussed on the best ways to implement the use of standardized outcome measures in haemophilia practice.
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Affiliation(s)
- B M Feldman
- Institute of Health Policy Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada.
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45
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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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46
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FORSYTH AL, RIVARD GÉ, VALENTINO LA, ZOURIKIAN N, HOFFMAN M, MONAHAN PE, VAN MEEGEREN MER, FORRIOL F. Consequences of intra-articular bleeding in haemophilia: science to clinical practice and beyond. Haemophilia 2012; 18 Suppl 4:112-9. [DOI: 10.1111/j.1365-2516.2012.02835.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Haemophilia care has undergone substantial improvements during the past 40-50 years. Early clotting factor concentrates were not sufficiently refined to enable self-administered treatment at home until the 1970s. Unfortunately, these advances led to transmission of viral diseases including HIV and hepatitis, resulting in an increased burden of morbidity and mortality, especially during the 1980s. Throughout the past two decades, product development, including the advent of recombinant concentrates, has greatly improved the safety and availability of therapy and the focus of care is shifting towards prevention and management of disease sequelae. Long-term substitution therapy (prophylaxis) of the missing clotting factor is the recommended treatment in severe haemophilia, but several research issues remain to be elucidated such as when to start and how to optimise these regimens, and when or whether to stop this expensive treatment. The major side-effect of treatment, development of inhibitors to the infused concentrate, is the main threat to the health of patients and consequently the goal of intense research. Development of new products with improved pharmacokinetics is the next step to improved therapy.
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Affiliation(s)
- Erik Berntorp
- Lund University, Malmö Centre for Thrombosis and Haemostasis, Skåne University Hospital, Malmö, Sweden.
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49
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Groen W, van der Net J, Bos K, Abad A, Bergstrom BM, Blanchette VS, Feldman BM, Funk S, Helders P, Hilliard P, Manco-Johnson M, Petrini P, Zourikian N, Fischer K. Joint health and functional ability in children with haemophilia who receive intensive replacement therapy. Haemophilia 2011; 17:783-90. [PMID: 21790897 DOI: 10.1111/j.1365-2516.2011.02606.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Joint physical examination is an important outcome in haemophilia; however its relationship with functional ability is not well established in children with intensive replacement therapy. Boys aged 4-16 years were recruited from two European and three North American treatment centres. Joint physical structure and function was measured with the Haemophilia Joint Health Score (HJHS) while functional ability was measured with the revised Childhood Health Assessment Questionnaire (CHAQ₃₈. Two haemophilia-specific domains were created by selecting items of the CHAQ₃₈ that cover haemophilia-specific problems. Associations between CHAQ, HJHS, cumulative number of haemarthroses and age were assessed. A total of 226 subjects - mean 10.8 years old (SD 3.8) - participated; the majority (68%) had severe haemophilia. Most severe patients (91%) were on prophylactic treatment. Lifetime number of haemarthroses [median=5; interquartile range (IQR)=1-12] and total HJHS (median = 5; IQR=1-12) correlated strongly (ρ = 0.51). Total HJHS did not correlate with age and only weakly (ρ=-0.19) with functional ability scores (median=0; IQR=-0.06-0). Overall, haemarthroses were reported most frequently in the ankles. Detailed analysis of ankle joint health scores revealed moderate associations (ρ=0.3-0.5) of strength, gait and atrophy with lower extremity tasks (e.g. stair climbing). In this population, HJHS summating six joints did not perform as well as individual joint scores, however, certain elements of ankle impairment, specifically muscle strength, atrophy and gait associated significantly with functional loss in lower extremity activities. Mild abnormalities in ankle assessment by HJHS may lead to functional loss. Therefore, ankle joints may warrant special attention in the follow up of these children.
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Affiliation(s)
- W Groen
- Child Development and Exercise Center, University Medical Center Utrecht, University Children's Hospital, Utrecht, The Netherlands
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50
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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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