Usefulness of a simple self-administered joint condition assessment sheet to predict the need for orthopaedic intervention in the management of haemophilic arthropathy

INTRODUCTION

Detecting signs of joint deterioration is important for early effective orthopaedic intervention in managing haemophilic arthropathy.

AIM

We developed a simple, patient self-administered sheet to evaluate the joint condition, and assessed the predictive ability of this assessment sheet for the need for an orthopaedic intervention.

METHODS

This was a single-centre, cross-sectional study. The association between the score of each of the four items of the assessment sheet (bleeding, swelling, pain and physical impairment) and the results of radiological findings and physical examinations based on Haemophilia Joint Health Score 2.1 was assessed. An optimal scoring system was explored by the area under the curve (AUC). The cut-off value for the need for surgery or physiotherapy was determined using the receiver operating characteristic curve procedure.

RESULTS

Forty-two patients were included. The 'physical impairment' item showed the highest correlation coefficient with the results of radiographic and physical examinations (range: 0.57-0.76). The AUC of finally adjusted scoring indicates good ability to discriminate between patients with and without a need for orthopaedic intervention. The positive predictive value was the highest at a cut-off value of 4 points for knees (63.0%) and ankles (70.0%), at 5 points for elbows (66.7%) and the highest predictive accuracy at the cut-off value of 4 points for all the joints. The linear trend of the need for an orthopaedic intervention was observed with an increasing score.

CONCLUSION

The joint condition assessment sheet can help clinicians assess the need for orthopaedic intervention for haemophilic arthropathy in Japanese patients with haemophilia.

Intramural müllerian adenosarcoma of the uterus with adenomyosis

We studied a case of intramural müllerian adenosarcoma of the uterus in a 51-year-old woman. The tumor measured 4 cm in diameter, was located in the lateral wall of the uterine body, and was accompanied by adenomyosis. The tumor was composed of glands with no epithelial cell atypia and a sarcomatous component evidenced by cell pleomorphism and a high mitotic count. The ratios of mitotic cells to glandular cells in the tumor, in the overlying endometrium in proliferative phase, and in the adenomyomatous tissue, were 5:10,000, 20:10,000, and less than 1:10,000, respectively. These observations seem to indicate that the glandular component of the tumor is a benign, neoplastic part, and the present tumor developed in a preexisting endometriotic focus.