Hemophilic arthropathy of the elbow: prophylaxis, imaging, and the role of invasive management

Dale, Timothy M.; Saucedo, James M.; Rodríguez-Merchán, E. Carlos

doi:10.1016/j.jse.2015.06.018

Cited by 19 publications

(15 citation statements)

References 41 publications

(71 reference statements)

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“…Ultrasound is preferred in children, but if inconclusive, or if a patient needs preparation for surgery, then an MRI scan should be performed. It is of note that some abnormalities are better detected with MRI, such as subchondral cysts, cartilage loss and haemosiderin deposits [25]. To improve consistency in determining joint status, simplified innovative protocols and scoring techniques have been developed for both ultrasound and MRI, that is, the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) and the compatible additive MRI scale, respectively [26,27].…”

Section: Resultsmentioning

confidence: 99%

Evaluation of early musculoskeletal disease in patients with haemophilia

Seuser¹,

Khayat

Négrier³

et al. 2018

Blood Coagulation &Amp; Fibrinolysis

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Early joint damage in patients with haemarthrosis often escapes diagnosis because of insufficient investigation of biomechanical changes. Arthropathy in haemophilia requires complex assessment with several tools. Considering the increased emphasis on an integrated approach to musculoskeletal (MSK) outcomes, re-evaluation of MSK assessment to address individual patient needs is warranted. To advise on the optimal use of current assessment tools and strategies for tailored MSK evaluation in patients with haemophilia. A panel of experts in haemophilic arthropathy evaluated internationally recognized assessment tools through published literature and personal expertise. Each tool was considered, scored and ranked for their utility in the clinical assessment of MSK damage. Subsequently, a patient evaluation table detailing advice on type and frequency of assessments for different patient populations was constructed. To obtain a complete MSK assessment, multiple tools must be used to ensure each criterion is evaluated. For patients with haemophilia, clinical examination of the joint, disease-specific structure/function scores, and activity/participation scores including quality of life are important, and should be performed on a regular basis according to age and clinical condition. Joint imaging is recommended in the prevention, diagnosis and follow-up of haemophilic arthropathy and should be used in conjunction with joint structure and function scores. An integrated approach to MSK assessment using combinations of tools will allow earlier management of dysfunction and may improve long-term outcomes. This approach could be used in long-term follow-up of all patients independent of age and disease stage, especially in children to prevent arthropathy.

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Section: Resultsmentioning

confidence: 99%

Evaluation of early musculoskeletal disease in patients with haemophilia

Seuser¹,

Khayat

Négrier³

et al. 2018

Blood Coagulation &Amp; Fibrinolysis

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“…For mild and moderate haemophilic arthropathy of the elbow, conservative measures such as bracing and splinting along with exercises and stretching are appropriate. 6,11 Accepted: 19 When conservative treatment fails to provide sufficient relief, more invasive procedures may be indicated. All procedures should be performed under haematological coverage, and they are especially risky in patients with inhibitors (antibodies against the deficient coagulation factor that must be infused intravenously).…”

Section: Systematic Intravenous Injections Of Factor VIII (For Haemopmentioning

confidence: 99%

“…For those patients who do experience recurrent haemarthrosis with worsening arthropathy, other measures are indicated. For mild and moderate haemophilic arthropathy of the elbow, conservative measures such as bracing and splinting along with exercises and stretching are appropriate …”

Section: Introductionmentioning

confidence: 99%

Total elbow arthroplasty in haemophilia

2018

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While patients with severe haemophilic arthropathy of the elbow are likely to make gains in terms of pain control and range of motion following TEA, there are insufficient data to routinely recommend its use. Complication and infection rates are concerning, and the lack of survival analysis data makes it difficult to quantify the benefit to the patient in light of the risks and resources involved in the procedure.

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“…[ 4 ] MRI is recognized as the gold standard for the comprehensive evaluation of joints. [ 5 , 6 ] At present, the most widely used method is the International Prophylaxis Study Group (IPSG) score, which was established in 2012 [ 7 ] and is more simplified and practical than other available methods. However, because of the high cost, long scanning time, need for sedation in children, and prohibited use for certain patients (eg, patients with metal implants), MRI is not suitable for routine screening.…”

Section: Introductionmentioning

confidence: 99%

Multislice spiral computed tomography imaging in evaluating hemophilic arthropathy

Zhang

Wei

et al. 2020

Chinese Medical Journal

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Background Certain hemophilia patients are unable to cooperate with or afford magnetic resonance imaging (MRI) examinations. The purpose of our study was to explore the value of multislice spiral computed tomography (MSCT) in evaluating hemophilic arthropathy (HA). Methods Thirty-eight patients with 73 joints of HA were consecutively selected from January 2016 to May 2018 for this prospective study. All 73 joints were examined by X-ray, CT, and MRI within 2 days. The MRI scores of the joints were determined by the International Prophylaxis Study Group (IPSG) standard. The CT findings were quantified according to the IPSG standard, except for cartilage injury, which was quantified by joint space narrowing using the X-ray Pettersson score. The CT and MRI scores were compared by the paired Wilcoxon signed-rank test. The correlations between the CT score of joint space narrowing and MRI score of cartilage injury and the total CT and MRI scores were analyzed by Spearman rank correlation. The kappa test was used to compare the consistency of CT and MRI scores. Results MRI was superior to CT based on the scores for small amount of effusion ( P < 0.05), synovial hypertrophy and hemosiderin deposition in the mild groups ( P < 0.05). The CT and MRI scores were not significantly different for moderate and massive effusion, synovial hypertrophy, and hemosiderin deposition in the moderate and severe groups, bone erosion or cystic changes ( P > 0.05), and there was a high degree of consistency between the two scores (kappa > 0.81). The consistency between the Pettersson scores of joint space narrowing on CT and the IPSG scores of cartilage injury on MRI was high (kappa = 0. 774, P < 0.05). Conclusion The image scores of MSCT are generally consistent with MRI except for mild synovitis, which can be used as an alternative for the evaluation of HA.

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Hemophilic arthropathy of the elbow: prophylaxis, imaging, and the role of invasive management

Cited by 19 publications

References 41 publications

Evaluation of early musculoskeletal disease in patients with haemophilia

Evaluation of early musculoskeletal disease in patients with haemophilia

Total elbow arthroplasty in haemophilia

Multislice spiral computed tomography imaging in evaluating hemophilic arthropathy

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