The role of ultrasonography in the diagnosis of the musculo‐skeletal problems of haemophilia

Abstract

Recurrent haemarthrosis is the final cause of haemophilic arthrosic disease in haemophilia patients. Therefore, it is essential to diagnose it early, both clinically and by imaging. In addition, haemophilia patients experience chronic synovitis, joint degeneration, muscle haematoma and pseudotumours. The objective of this article is to highlight the value of ultrasounds in the diagnosis and control of the evolution of musculo-skeletal problems in haemophilia patients. To this end, we have performed a literature search in the PubMed, Web of Science(®) (WOS) and SciVerse bases, using the following keywords: hemophilia or haemophilia and ultrasonography (US), ultrasound, echography and sonography. The search was limited to studies published in English between the years 1991 and 2011, finding a total of 221 references. After reviewing the title or abstract for evidence of the use of US for the diagnosis of musculo-skeletal lesions in haemophilia, we selected 24 of these references. We added data collected from our experience to the most important data found in the references. Our main conclusion is that US is highly valuable for the diagnosis of musculo-skeletal diseases in haemophilia. It is a fast, effective, safe, available, comparative, real-time technique that can help us confirm the clinical examination. It is particularly important in acute haemarthrosis, as it can be used to objectively identify the presence of blood in the joints, measure its size, pinpoint its location, assess its evolution and confirm its complete disappearance.

Clinical, instrumental, serological and histological findings suggest that hemophilia B may be less severe than hemophilia A

“…14,15 The introduction into clinical practice of the ultrasound (US) evaluation coupled with the US score 16 allows frequent monitoring of the evolution of arthropathy in HA and HB. 17 Another crucial parameter of bone biology is the molecular triad consisting of osteoprotegerin (OPG), receptor activator of nuclear factor-kB (RANK) and RANK ligand (RANKL), which tightly controls bone turnover and is involved in the severity of arthropathy, as demonstrated in HA. 18,19 OPG is a member of the tumor necrosis factor receptor superfamily, acts as a decoy receptor for RANKL, and competes with RANK for binding to RANKL.…”

Clinical and ultrasound joint outcomes in severe hemophilia A children receiving episodic treatment in Indonesian National Hemophilia Treatment Center

“…9 Ultrasound has been used to assess the joint swelling and differentiate acute bleeding or chronic synovitis without acute bleeding. 10 Martinoli et al 11 developed ultrasound procedure and scoring method named Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) to evaluate knee, elbow, and ankle joint in order to improve sensivity in detecting early sign of arthropathy, using systematical, easy, and fast technique. Joint ultrasound is a potential tool for monitoring hemophilic arthropathy in a developing country as Indonesia, because it is less expensive, widely available, and has a good sensitivity to evaluate soft tissue.…”

Orthopedic disorders of the knee in hemophilia: A current concept review

“…Ultrasonography (US) can be used to demonstrate hypertrophy of the synovium and the presence of fluid [13,14] . However, validation of US for the assessment of HA has not been established yet [15][16][17] .…”