Monitoring of Joint Health is an Important Part of Hemophilia Care

Introduction

Joint bleeding can lead to inflammatory and subsequently destructive changes. The result is arthropathy associated with significant morbidity in people with hemophilia. Hemophilic arthropathy is accompanied by pain and deterioration of overall experience and quality of life. Effective prevention of joint damage is limited by relatively limited knowledge of pathogenesis and focused on preventing the bleeding itself.

Prophylaxis, i.e., the administration of the missing factor VIII or IX concentrate, can help prevent bleeding. Studies have clearly shown that early prophylaxis, ideally started before the first joint bleed, can improve long-term outcomes associated with joint health.

Available Tools and Their Significance

Existing options for monitoring joint health are very important for recognizing early joint damage so that overall care can be adjusted. These include the following:

MRI, US

The most sensitive imaging method is considered to be magnetic resonance imaging (MRI), which provides a detailed image of the joint and allows the detection of early changes such as synovial hypertrophy or soft tissue damage. However, it is a time-consuming and expensive method, and in pediatric patients, it often requires general anesthesia.

Ultrasound (US) examination is a slightly less sensitive method for early changes but much more accessible. It allows the assessment of synovial hypertrophy, cartilage changes, or superficial bone parts. Additionally, it can provide an image of multiple joints in one examination. It is usually usable even in children without the need for sedation or general anesthesia. For various reasons, ultrasound can be easily incorporated into routine clinical practice.

HJHS

No less important part of monitoring individuals with hemophilia is also the clinical examination, such as the assessment of joint health according to the HJHS (Hemophilia Joint Health Score). However, the sensitivity of this method does not reach that of imaging techniques. From a clinician's perspective, their combination is desirable.

Biomarkers

Another possible method for assessing joint health, although more from a research perspective, is the use of biomarkers associated with cartilage and bone formation, vascularization, or angiogenesis. These can potentially identify the onset and progression of early joint damage.

Conclusion

It must be stated that the development of hemophilic arthropathy represents a complex process, and it is therefore necessary to effectively utilize all diagnostic and therapeutic options to prevent its development.

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Source:

Gooding R., Thachil J., Alamelu J. et al. Review asymptomatic joint bleeding and joint health in haemophilia: a review of variables, methods, and biomarkers. J Blood Med 2021; 12: 209–220, doi: 10.2147/JBM.S304597.