Abstract
Even in our current era of hemophilia prophylaxis, articular complications can arise and there is a growing need for strategies in the prevention, diagnosis, and treatment of hemophilic arthropathy, a significant contributor to disability in patients with hemophilia. One useful tool, point-of-care ultrasonography (POC-US), offers diverse diagnostic and therapeutic possibilities. This article reviews the literature on the uses of POC-US in hemophilia, including early diagnosis of joint damage, differential diagnosis of articular pain, follow-up of joint injury, and guidance for both arthrocentesis and intra-articular injection. Studies show that for patients with hemophilia, POC-US enhances diagnostic accuracy and targeted treatments. Further research is required into the most efficient use of POC-US and the training needed to develop clinicians’ skills. The attributes of POC-US should be understood more fully to enable its widespread application.
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Acharya SS, Rule B, McMillan O, Humphries TJ. Point-of-care ultrasonography (POCUS) in hemophilia A: a commentary on current status and its potential role for improving prophylaxis management in severe hemophilia A. Ther Adv Hematol. 2017;8:153–166.
Altisent C, Martorell M, Crespo A, Casas L, Torrents C, Parra R. Early prophylaxis in children with severe haemophilia A: clinical and ultrasound imaging outcomes. Haemophilia. 2016;22:218–224.
American College of Rheumatology Musculoskeletal Ultrasound Task Force. Ultrasound in American rheumatology practice: report of the American College of Rheumatology musculoskeletal ultrasound task force. Arthritis Care Res (Hoboken). 2010;62:1206–1219.
Aznar JA, Abad-Franch L, Perez-Alenda S, Haya S, Cid AR, Querol F. Ultrasonography in the monitoring of management of haemarthrosis. Haemophilia. 2011;17:826–828.
Barr L, Hatch N, Roque PJ, Wu TS. Basic ultrasound-guided procedures. Crit Care Clin. 2014;30:275–304.
Berntorp E, Shapiro AD. Modern haemophilia care. Lancet. 2012;379:1447–1456.
Carulli C, Matassi F, Civinini R, Morfini M, Tani M, Innocenti M. Intra-articular injections of hyaluronic acid induce positive clinical effects in knees on patients affected by haemophilic arthropathy. Knee. 2013; 20:36–39.
Ceponis A, Wong-Sefidan I, Glass CS, von Drygalski A. Rapid musculoskeletal ultrasound for painful episodes in adult haemophilia patients. Haemophilia. 2013;19:790–798.
Chen B, Lai LP, Putcha N, Stitik TP, Foye PM, DeLisa JA. Optimal needle placement for ultrasound-guided knee joint injections or aspirations. J Trauma Treat. 2014;3:216.
Di Minno MN, Iervolino S, Soscia E, Tosetto A, Coppola A, Schiavulli M, et al. Magnetic resonance imaging and ultrasound evaluation of “healthy” joints in young subjects with severe haemophilia A. Haemophilia. 2013;19:e167–173.
Di Minno MN, Pasta G, Airaldi S, Zaottini F, Storino A, Cimino E, et al. Ultrasound for early detection of joint disease in patients with hemophilic arthropathy. J Clin Med. 2017;6(8):E77.
Doria AS. State-of-the-art imaging techniques for the evaluation of haemophilic arthropathy: present and future. Haemophilia. 2010;16 (Suppl 5):107–114.
Doria AS, Keshava SN, Mohanta A, Jarrin J, Blanchette V, Srivastava A, et al. Diagnostic accuracy of ultrasound for assessment of hemophilic arthropathy: MRI correlation. Am J Roentgenol. 2015;204:W336–347.
Fischer K, van Hout BA, van der Bom JG, Grobbee DE, van den Berg HM. Association between joint bleeds and Pettersson scores in severe haemophilia. Acta Radiol. 2002;43:528–532.
Fischer K, Poonnoose P, Dunn AL, Babyn P, Manco-Johnson MJ, David JA, et al. Participants of the International Symposium on Outcome Measures in Hemophilic Arthropathy. Choosing outcome assessment tools in haemophilia care and research: a multidisciplinary perspective. Haemophilia. 2017;23:11–24.
Foppen W, van der Schaaf IC, Fischer K. Value of routine ultrasound in detecting early joint changes in children with haemophilia using the Haemophilia Early Arthropathy Detection with UltraSound protocol. Haemophilia. 2016;22:121–125.
Foppen W, Fischer K, van der Schaaf IC. Imaging of haemophilic arthropathy: Awareness of pitfalls and need for standardization. Haemophilia. 2017;23:645–647.
Hanley J, McKernan A, Creagh MD, Classey S, McLaughlin P, Goddard N, et al. Musculoskeletal Working Party of the UKHCDO. Guidelines for the management of acute joint bleeds and chronic synovitis in haemophilia: A United Kingdom Haemophilia Centre Doctors’ Organisation (UKHCDO) guideline. Haemophilia. 2017;23:511–520.
Keshava S, Gibikote S, Mohanta A, Doria AS. Refinement of a sonographic protocol for assessment of haemophilic arthropathy. Haemophilia. 2009;15:1168–1171.
Kidder W, Nguyen S, Larios J, Bergstrom J, Ceponis A, von Drygalski A. 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. 2015;21:530–537.
Klukowska A, Czyrny Z, Laguna P, Brzewski M, Serafin-Krol MA, Rokicka Milewska R. Correlation between clinical, radiological and ultrasonographical image of knee joints in children with haemophilia. Haemophilia. 2001;7:286–92.
Ligocki CC, Abadeh A, Wang KC, Adams-Webber T, Blanchette VS, Doria AS. A systematic review of ultrasound imaging as a tool for evaluating haemophilic arthropathy in children and adults. Haemophilia. 2017;23:598–612.
Lin HM, Learch TJ, White EA, Gottsegen CJ. Emergency joint aspiration: a guide for radiologists on call. Radiographics. 2009;29:1139–58.
Lisi C, Di Natali G, Sala V, Tinelli C, Canepari M, Gamba G, Toffola ED. Interobserver reliability of ultrasound assessment of haemophilic arthropathy: radiologist vs. non-radiologist. Haemophilia. 2016;22:e211–e214.
Manners PJ, Price P, Buurman D, Lewin B, Smith B, Cole CH. Joint aspiration for acute hemarthrosis in children receiving factor VIII prophylaxis for severe hemophilia: 11-year safety data. J Rheumatol. 2015;42:885–890.
Martin EJ, Cooke EJ, Ceponis A, Barnes RF, Moran CM, Holle S, Hughes TH, Moore RE, von Drygalski A. Efficacy and safety of point-of-care ultrasound-guided intra-articular corticosteroid joint injections in patients with haemophilic arthropathy. Haemophilia. 2017;23:135–143.
Martinoli C, Della Casa Alberighi O, Di Minno G, Graziano E, Molinari AC, et al. Development and definition of a simplified scanning procedure and scoring method for Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US). Thromb Haemost. 2013;109:1170–1179.
Melchiorre D, Linari S, Innocenti M, Biscoglio I, Toigo M, Cerinic MM, Morfini M. Ultrasound detects joint damage and bleeding in haemophilic arthropathy: a proposal of a score. Haemophilia. 2011;17:112–117.
Merchan ECR, De Orbe A, Gago J. Ultrasound in the diagnosis of the early stages of hemophilic arthropathy of the knee. Acta Orthop Belg. 1992;58:122–125.
Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364:749–757.
Muça-Perja M, Riva S, Grochowska B, Mangiafico L, Mago D, Gringeri A. Ultrasonography of haemophilic arthropathy. Haemophilia. 2012;18:364–368.
Nacca C, Harris A, Tuttle J. Hemophilic arthropathy. Orthopedics. 2017;29:1–7.
Nguyen S, Lu X, Ma Y, Du J, Chang EY, von Drygalski A. Musculoskeletal ultrasound for intra-articular bleed detection: a highly sensitive imaging modality compared to conventional magnetic resonance imaging. J Thromb Haemost. 2017. https://doi.org/10.1111/jth.13930
Nicolaou S, Talsky A, Khashoggi K, Venu V. Ultrasound-guided interventional radiology in critical care. Crit Care Med. 2007;35(Suppl):S186–S197.
Oldenburg J, Zimmermann R, Katsarou O, Zanon E, Kellermann E, Lundin B, et al. Potential biomarkers of haemophilic arthropathy: correlations with compatible additive magnetic resonance imaging scores. Haemophilia. 2016;22:760–764.
Poonnoose PM, Hilliard P, Doria AS, Keshava SN, Gibikote S, Kavitha ML, et al. Correlating clinical and radiological assessment of joints in haemophilia: results of a cross sectional study. Haemophilia. 2016;22:925–933.
Querol F, Rodriguez-Merchan EC. The role of ultrasonography in the diagnosis of the musculo-skeletal problems of haemophilia. Haemophilia. 2012;18:e215–e226.
Querol F, Cortina V, Cid AR, Haya S, Aznar JA. Clinical and echographical control protocol of haemarthrosis in haemophilia patients with inhibitors: evaluation of the efficacy of recombinant factor VIIa in the evolution process (EFFISEVEN protocol). Haemophilia. 2008;14 (Suppl 6):36–44.
Robertson JD, Connolly B, Hilliard P, Wedge J, Babyn P, Carcao M. Acute haemarthrosis of the hip joint: rapid convalescence following ultrasound-guided needle aspiration. Haemophilia. 2009;15:390–393.
Rodriguez-Merchan EC. Bleeding in hemophilia. Cardiovasc Hematol Disord Drug Targets. 2016;16:21–24.
Rodriguez-Merchan EC, Jimenez-Yuste V, Aznar JA, Hedner U, Knobe K, Lee CA, et al. Joint protection in haemophilia. Haemophilia. 2011;17 (Suppl 2):1–23.
Rodriguez-Merchan EC, De la Corte-Rodriguez H, Jimenez-Yuste V. Radiosynovectomy in haemophilia: long-term results of 500 procedures performed in a 38-year period. Thromb Res. 2014;134:985–990.
Sierra-Aisa C, Lucía Cuesta JF, Rubio Martínez A, Fernández Mosteirín N, Iborra Muñoz A, Abío Calvete M, et al. Comparison of ultrasound and magnetic resonance imaging for diagnosis and follow-up of joint lesions in patients with haemophilia. Haemophilia. 2014;20:e51–e57.
Strike KL, Iorio A, Jackson S, Lawson W, Scott L, Squire S, et al. Point-of-care ultrasonography in haemophilia care: recommendations for training and competency evaluation. Haemophilia. 2015;21:828–831.
Timmer MA, Foppen W, Schutgens RE, Pisters MF, Fischer K. Comparing findings of routine Haemophilia Joint Health Score and Haemophilia Early Arthropathy Detection with UltraSound assessments in adults with haemophilia. Haemophilia. 2017;23:e141–e143.
Zukotynski K, Jarrin J, Babyn PS, Carcao M, Pazmino-Canizares J, Stain AM, et al. Sonography for assessment of haemophilic arthropathy in children: a systematic protocol. Haemophilia. 2007;13:293–304.
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Hortensia De la Corte-Rodriguez, MD, PhD; E. Carlos Rodriguez-Merchan, MD, PhD; and Víctor Jimenez-Yuste, MD, PhD, declare that they have no conflicts of interest.
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De la Corte-Rodriguez, H., Rodriguez-Merchan, E.C. & Jimenez-Yuste, V. Point-of-care Ultrasonography in Orthopedic Management of Hemophilia: Multiple Uses of an Effective Tool. HSS Jrnl 14, 307–313 (2018). https://doi.org/10.1007/s11420-018-9604-x
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DOI: https://doi.org/10.1007/s11420-018-9604-x