Advertisement

Ultrasonography of Knee Joint in Hemophilia A: What the Eyes Cannot See

  • Arijit NagEmail author
  • Shounak Ghosh
  • Debanjali Sinha
  • Sumantro Mondal
  • Siddhartha Shankar Roy
  • Alakendu Ghosh
  • Maitreyyee Bhattacharyya
Original Article
  • 18 Downloads

Abstract

Haemophilia is the most common inherited coagulopathy. Approximately 94% patients suffer from joint disability. An imaging modality to detect joint damage can help in monitoring. Ultrasonography (USG) provides a low cost and reliable imaging alternative to magnetic resonance imaging. This study aims at the detection of subclinical knee-joint involvement by USG, in patients with moderate to severe Haemophilia. 27 patients suffering from moderate and severe Haemophilia and 27 age-matched controls were studied. USG of bilateral knee joints was done to analyse cartilage and synovial thickness, synovial vascularity and resistive index of vascular flow along with synovial collection. The relevant clinical parameters (age at diagnosis and study enrolment, severity of haemophilia A, annualized bleeding rates, total number of joint bleeds, spontaneous and provoked bleed, number of episodes treated with factor VIII injection) were noted. The USG findings were correlated to the clinical parameters and subclinical joint bleed detection looked for. 13 patients [18 out of 54 joints (33.33%)] showed increased vascular signals with mean resistive-index (RI) 0.67 (± 0.086; 95% CI: 0.62–0.70). The mean synovial thickness in persons with haemophilia (PwH) was higher than the control subset (p < 0.05 on all counts). The mean cartilage thickness was lower in PwH than in controls. On a subset analysis, there was significant difference between the mean cartilage thickness between moderate PwH and age matched controls (p < 0.0001). 3 patients (11.1%) showed evidence of joint collection (hemarthrosis) despite having no clinical evidence of joint involvement. Through the findings of our study, we do infer that ultrasonography can detect subclinical synovial inflammation and cartilage damage in haemophilia patients that may affect long term articular outcome. It is also a useful modality for detection of sub clinical joint bleed.

Keywords

Haemophilia Ultrasonography Knee joint 

Notes

Compliance with Ethical Standards

Conflict of interest

All the authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all the patients.

References

  1. 1.
    Kar A, Mirkazemi R, Singh P, Potnis-Lele M, Lohade S, Lalwani A et al (2007) Disability in Indian patients with haemophilia. Haemophilia 13:398–404CrossRefGoogle Scholar
  2. 2.
    Hemophilia WF of (2016) Report of the Annual Global Survey 2016Google Scholar
  3. 3.
    Doria AS, Keshava SN, Mohanta A et al (2015) Diagnostic accuracy of ultrasound for assessment of hemophilic arthropathy: MRI correlation. AJR Am J Roentgenol 204:W336–W347CrossRefGoogle Scholar
  4. 4.
    Foppen W, van der Schaaf IC, Fischer K (2016) Value of routine ultrasound in detecting early joint changes in children with haemophilia using the “Haemophilia Early Arthropathy Detection with UltraSound” protocol. Haemophilia 22:121–125CrossRefGoogle Scholar
  5. 5.
    Østergaard M, Szkudlarek M (2005) Ultrasonography: a valid method for assessing rheumatoid arthritis? Arthritis Rheumatol 52:681–686CrossRefGoogle Scholar
  6. 6.
    Keen HI, Conaghan PG (2009) Ultrasonography in osteoarthritis. Radiol Clin N Am 47:581–594CrossRefGoogle Scholar
  7. 7.
    Guermazi A, Eckstein F, Helliolegraverandgastineau M-P, Conaghan PG, Burstein D, Keen H, Roemer FW (2009) Osteoarthritis: current role of imaging. Med Clin N Am 93:101–126CrossRefGoogle Scholar
  8. 8.
    Jansen NWD, Roosendaal G, Lafeber FPJG (2008) Understanding haemophilic arthropathy: an exploration of current open issues. Br J Haematol 143:632–640CrossRefGoogle Scholar
  9. 9.
    Melchiorre D, Linari S, Innocenti M, Biscoglio I, Toigo M, Cerinic MM, Morfini M (2011) Ultrasound detects joint damage and bleeding in haemophilic arthropathy: a proposal of a score. Haemophilia 17:112–117CrossRefGoogle Scholar
  10. 10.
    Martinoli C, Della Casa Alberighi O, Di Minno G et al (2013) Development and definition of a simplified scanning procedure and scoring method for Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US). Thromb Haemost 109:1170–1179CrossRefGoogle Scholar
  11. 11.
    Kidder W, Nguyen S, Larios J, Bergstrom J, Ceponis A, von Drygalski A (2015) Point-of-care musculoskeletal ultrasound is critical for the diagnosis of hemarthroses, inflammation and soft tissue abnormalities in adult patients with painful haemophilic arthropathy. Haemophilia 21:530–537CrossRefGoogle Scholar
  12. 12.
    Sierra Aisa C, Lucía Cuesta JF, Rubio Martínez A, Fernández Mosteirín N, Iborra Muñoz A, Abío Calvete M, Guillén Gómez M, Moretó Quintana A, Rubio Félix D (2014) Comparison of ultrasound and magnetic resonance imaging for diagnosis and follow-up of joint lesions in patients with haemophilia. Haemophilia 20:e51–e57CrossRefGoogle Scholar
  13. 13.
    Gupta S, Siddiqi A-E-A, Soucie JM, Manco-Johnson M, Kulkarni R, Lane H, Ingram-Rich R, Gill JC, Joint Outcomes Committee of Universal Data Collection and the Hemophilia Treatment Centres Network the JOC of UDC and the HTC (2013) The effect of secondary prophylaxis versus episodic treatment on the range of motion of target joints in patients with haemophilia. Br J Haematol 161:424–433CrossRefGoogle Scholar
  14. 14.
    Wyseure T, Mosnier LO, von Drygalski A (2016) Advances and challenges in hemophilic arthropathy. Semin Hematol 53:10–19CrossRefGoogle Scholar

Copyright information

© Indian Society of Hematology and Blood Transfusion 2018

Authors and Affiliations

  1. 1.Institute of Hematology and Transfusion MedicineKolkataIndia
  2. 2.Department of MedicineMedical College and HospitalKolkataIndia
  3. 3.Department of RheumatologyIPGME&RKolkataIndia
  4. 4.IPGME&RKolkataIndia

Personalised recommendations