Objectives Musculoskeletal ultrasound (US) is used increasingly to examine hemophilic arthropathy. However, quantitative algorithms to document findings are lacking. We developed and sought to validate a protocol quantifying hemophilic joint abnormalities. Methods Thirty‐one patients with hemophilia were examined serially for 2 years with musculoskeletal US (≈600 joint examinations and ≈6000 images). Based on the spectrum of pathologies, a quantitative algorithm, named Joint Tissue Activity and Damage Examination (JADE), was developed for soft tissue and osteochondral measurements, including power Doppler, using nominal group techniques. To study intra‐ and inter‐rater reliability, 8 musculoskeletal US–experienced hemophilia providers performed anatomic landmark recognition and tissue measurements on 86 images with arthropathic changes, with repetition 1 month later. Twenty‐three musculoskeletal US–inexperienced providers performed similar assessments. Inter‐operator reliability was established by 6 musculoskeletal US–experienced hemophilia providers, each acquiring images and JADE assessments of 3 hemophilic arthropathic joints. A radiologist and musculoskeletal sonographer functioned as adjudicators. The statistical analysis was performed with the intraclass correlation coefficient (ICC), Fleiss κ, and Cohen κ where appropriate. Results The musculoskeletal US–experienced providers showed excellent intra‐and inter‐rater reliability for tissue measurements (ICCs, 0.94–0.96). Agreement was good to excellent for landmark recognition (Fleiss κ, 0.87‐0.94). Inter‐operator reliability was excellent for measurements and landmark recognition (ICC, 0.90; Fleiss κ, 1.0). Agreement with adjudicators was mostly good to excellent. Musculoskeletal US–inexperienced providers showed excellent inter‐rater reliability for measurements (ICC, 0.96) and moderate agreement for landmark recognition (Fleiss κ, 0.58). Conclusions The JADE protocol appears feasible for quantifying hemophilic intra‐articular abnormalities. Musculoskeletal US–trained hemophilia providers showed high intra‐rater, inter‐rater, and inter‐operator reliability, supporting JADE as a protocol for clinical management and research.

Introduction Point-of-care (POC) musculoskeletal ultrasound (MSKUS) is increasingly used by hemophilia providers to guide management, however, pathologic tissue differentiation with US is uncertain. We sought to determine the extent to which POC MSKUS can identify and discriminate pathologic soft tissue changes in hemophilic arthropathy. Materials and Methods 36 adult patients with hemophilia A/B were prospectively enrolled. POC MSKUS was performed on arthropathic joints (16 knees, 10 ankles, and 10 elbows) using standard views by a MSKUS-trained and certified hematologist, who recorded abnormal intra-articular soft tissue accumulation. Within three days, magnetic resonance imaging (MRI) was performed using conventional and multi-echo ultrashort echo time (UTE) sequences. Soft tissue identification (synovial proliferation with or without hemosiderin, fat, and/or blood products) was performed by a musculoskeletal radiologist. Findings obtained with both imaging modalities were compared and correlated in a blinded fashion. Results There was perfect agreement between the modalities on the presence of abnormal soft tissue (34/36 cases). However, MSKUS was unable to discriminate between coagulated blood, synovium, intra- or extra-synovial fat tissue, or hemosiderin deposits due to wide variation in echogenicity. Conclusion MSKUS is valuable for POC imaging to determine the presence of soft tissue accumulation in discrete areas. However, due to limitations in MSKUS in discriminating the nature of pathological soft tissues and detecting hemosiderin, MRI will be required if such discrimination is clinically important.

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Introduction Haemophilia patients experience painful joint episodes which may or may not be associated with haemarthrosis. We sought to validate a questionnaire developed by the Canadian Haemophilia Society using point‐of‐care musculoskeletal ultrasound (POC MSKUS) to confirm haemarthrosis. Methods The questionnaire comprised of 20 questions (10 each associated with haemarthrosis and arthritis pain) and was administered to adult haemophilia patients reporting to the Haemophilia Treatment Centre (University of California San Diego). We confirmed the presence (or absence) of haemarthrosis using POC MSKUS [Joint Activity and Damage Exam (JADE)]. We fitted univariate and multivariate generalized estimating equations to identify symptoms associated with haemarthrosis. Results We evaluated 79 painful episodes in 32 patients [median age = 38 years (range 21–74)]. POC MSKUS detected haemarthrosis in 36 (46%) episodes. The strongest predictor for haemarthrosis pain was ‘like a balloon swelling with water’ (odds ratio [OR] 2.88 [CI .68;12.10]); ‘no feeling of sponginess with movement’ (OR .24[CI .07;.76]) was the strongest for arthritic pain. We identified four questions with the strongest OR for differentiating haemarthrosis pain from arthritic pain to develop an algorithm for haemarthrosis prediction. Answering these questions in “yes/no” fashion yielded estimates of the probability of haemarthrosis Conclusion Objective diagnosis of haemarthrosis by MSKUS facilitated the development of a symptom‐based prediction tool for diagnosis of haemarthrosis. The tool requires further validation and will be particularly helpful in situations where MSKUS is not readily available.