Use of ultrasound for evaluation of painful joint episodes perceived as haemarthrosis in adult patients with severe haemophilia

Berro, Maximiliano; Elichiry, M.; Wasen, K.; Insagaray, Juan; Rodríguez, Ismael

doi:10.1111/hae.13439

Cited by 17 publications

(32 citation statements)

References 8 publications

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“…Adult populations could also benefit from insights provided by POCUS, particularly as they age and it becomes difficult to discern symptoms related to haemophilic arthropathy from bleeding or other joint pathology. 24,32,33 The reservations around the perception of the time commitments required for the use of POCUS are prominent. However, as more evidence emerges to support the efficacy of the technology, this perception may shift and justify the time investment.…”

Section: Discussionmentioning

confidence: 99%

“…Adolescents would also be well served by the insights POCUS provides to help develop an understanding of what may be happening in their joints in real time, while emphasizing the nuanced reality that pain is not always the most reliable indication of bleeding particularly early on. Adult populations could also benefit from insights provided by POCUS, particularly as they age and it becomes difficult to discern symptoms related to haemophilic arthropathy from bleeding or other joint pathology 24,32,33 …”

Section: Discussionmentioning

confidence: 99%

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Use of ultrasound for assessment of musculoskeletal disease in persons with haemophilia: Results of an International Prophylaxis Study Group global survey

et al. 2020

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Aim: The objective of this survey was to understand the global trends of imaging assessments in persons with haemophilia, focusing on point-of-care ultrasound (POCUS). Insights into the barriers impeding its widespread proliferation as a frontline imaging modality were obtained. Methods: The survey opened in September of 2017 and closed in May of 2018. Haemophilia Treatment Centres (HTCs) treating both paediatric/adult patients were the population of interest. A REDCap survey of 25 questions was disseminated to 232 clinical staff in 26 countries. Results: The majority of respondents (88.3%, 91/103) reported that POCUS is most useful to confirm or rule out a presumed acute joint bleed. European HTCs reported the highest routine use of POCUS at 59.5% (22/37) followed by HTCs in the "Other" countries of the world at 46.7% (7/15) and North American HTCs at 43.9% (25/57). At the time of the survey, physiotherapists were identified as the clinical staff who perform POCUS 52.8% (28/53) of the time, in contrast with nurses/nurse practitioners who represent only 5.7% (3/53) of users. The greatest perceived barriers to the implementation of POCUS are the lack of trained healthcare professionals who

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of ultrasound for assessment of musculoskeletal disease in persons with haemophilia: Results of an International Prophylaxis Study Group global survey

et al. 2020

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“…of motion are nonspecific, yielding inaccurate diagnoses in up to 30% to 50% of painful joint events in PWH. 11,[22][23][24] Based on conventional logic, we expected that acute painful episodes with bleeding would be associated with more time spent below specified clotting factor thresholds, lower clotting factor concentrations, or any combination of those elements in the days preceding the bleed. However, our analyses revealed that this was not the case.…”

Section: Discussionmentioning

confidence: 99%

Joint Bleeding Tendencies in Adult Patients With Hemophilia: It’s Not All Pharmacokinetics

Zhou

Barnes

Foster

et al. 2019

Clin Appl Thromb Hemost

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Hemophilic arthropathy from joint bleeding remains a complication with major morbidity in the increasingly aging patients with hemophilia. Prophylactic clotting factor infusions, based on pharmacokinetic dosing to reduce bleeding rates, are being explored more and more. However, there is little evidence on the benefits of pharmacokinetic dosing in direct association with bleeding events. Here, we prospectively followed a cohort of adult patients with hemophilia A and B (n = 26) and arthropathic joints on various clotting factor products over a period of 2 years with clinical and radiographic joint health assessments, frequent joint ultrasound, and pharmacokinetic studies. Joint bleeds and synovitis with synovial vascularity changes were objectively diagnosed by musculoskeletal ultrasound and power Doppler and analyzed in relation to pharmacokinetic, joint- and patient-specific parameters. Results revealed that, contrary to common beliefs, bleeding episodes were not readily explained by pharmacokinetic features, as they were not associated with more time spent below certain clotting factor thresholds. Joint bleeding was found to be associated with prominent vascularity changes, suggesting that vascular remodeling and leakiness may contribute to joint bleeding that cannot be prevented by clotting factor replacement alone.

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“…Over the last decade, POC-MSKUS has emerged as a critical tool in the evaluation of hemarthrosis and painful musculoskeletal episodes in PwH 32 , 37 – 40 , 66 , 67 . One group, Ceponis et al ., demonstrated that hemarthrosis was present in only one third of acute painful joints 38 and that disappointingly about two thirds of painful musculoskeletal episodes were judged incorrectly by either the patient or physician.…”

Section: A New Wave In the Evaluation Of Hemophilic Arthropathymentioning

confidence: 99%

Merging into the mainstream: the evolution of the role of point-of-care musculoskeletal ultrasound in hemophilia

Bakeer

Shapiro

2019

F1000Res

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Bleeding with resultant hemophilic arthropathy constitutes the largest cause of morbidity in patients with hemophilia. It results from repeated bleeding episodes in the joint and is characterized by synovial hypertrophy and cartilage and bony destruction. Hemophilic arthropathy assessment is a continually evolving process and is particularly challenging in children and young adults in whom joint disease may be missed or underestimated as obtaining serial “baseline” magnetic resonance imaging scans of multiple clinically asymptomatic or nearly asymptomatic joints may be unjustifiable and cost-ineffective. Musculoskeletal ultrasound—particularly, point-of-care musculoskeletal ultrasound—has emerged as a promising imaging modality for the early detection and management of hemophilic arthropathy, and for the evaluation of hemarthrosis and painful musculoskeletal episodes in patients with hemophilia. This review summarizes currently available data on the emerging role of this new imaging modality, its limitations, and gaps in knowledge. The review also raises unanswered questions, highlights the need for consolidated research efforts, and delineates future directions expected to advance this technology and optimize its use in this patient population.

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Use of ultrasound for evaluation of painful joint episodes perceived as haemarthrosis in adult patients with severe haemophilia

Cited by 17 publications

References 8 publications

Use of ultrasound for assessment of musculoskeletal disease in persons with haemophilia: Results of an International Prophylaxis Study Group global survey

Use of ultrasound for assessment of musculoskeletal disease in persons with haemophilia: Results of an International Prophylaxis Study Group global survey

Joint Bleeding Tendencies in Adult Patients With Hemophilia: It’s Not All Pharmacokinetics

Merging into the mainstream: the evolution of the role of point-of-care musculoskeletal ultrasound in hemophilia

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