Stadieneinteilung der hämophilen Osteoarthropathie mit dem Pettersson-Score

Abstract

The degree of haemophilic osteoarthropathy was assessed by the Pettersson-score in 219 knees, elbows and ankles of 40 children and adolescents suffering from haemophilia. 55.3% of the joints were unaffected and only 8 joints showed score values greater than 8. Enlargement of epiphyses (36.1%) and irregular subchondral surface (32.9%) were the most frequent observations, while osteoporosis (5.4%) was only rarely observed. Haemophilic osteoarthropathy was most severe in the ankles, while the knees were only moderately affected. Among 11 patients 493 bleedings into 61 joints were observed during a four-year period. If the bleedings recurred, more than 3 bleedings per year always resulted in haemophilic osteoarthropathy.

Reproducibility of the Pettersson Scoring System

“…With the introduction of substitution therapy, the incidence and severity of haemophilic arthropathy have decreased over the years (7,15). In many patients, the development or progression of arthropathy can be prevented.…”

“…The concept of such a classification system was to allow a subtle grading of the extent of the pathology for the purpose of patient followup. However for some of the criteria used in the grading process the characteristic features are very vaguely defined (7,9). One such example is the assessment of irregularity of the subchondral surface, where one is asked to decide whether the irregularity is partial or complete.…”

Bewertung der hämophilen Arthropathie - MRT- und Pettersson Score im Vergleich

“…Erlemann et al [11] gaben an, dass innerhalb eines Jahres maximal 7 Blutungen in einem Gelenk auftreten dürfen, ohne dass sich eine Osteoarthropathie entwickelt. Nach Woertler et al [20] erlaubt die Anzahl der stattgefundenen Gelenkblutungen keinen sicheren Rückschluss auf die vorliegenden Gelenkveränderungen.…”

“…Im Gegensatz zu Erlemann et al [11,21] weisen wir auf die Bedeutung der Gelenkblutungen hin. So zeigen unsere Daten, dass vor der dritten Gelenkblutung die Gefahr arthropathischer Gelenkveränderungen gering, nach der dritten Gelenkblutung jedoch deutlich erhöht ist.…”

“…Arnold u. Hilgartner [5] wie auch andere Autoren [6,7] [10,11]. Der Nachweis einer synovialen Proliferation, einer beginnenden Knorpelverminderung bzw.…”