Correlation between Hemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) score and Hemophilia Joint Health Score (HJHS) in patients with hemophilic arthropathy

Abstract

Background Hemophilic arthropathy, a condition manifested as joint destruction due to spontaneous joint bleeding, is one complication of hemophiliac patients. Early detection and intervention may improve the outcome, in which ultrasonography can be an ideal modality with the introduction of HEAD-US (Hemophilia Early Arthropathy Detection with Ultrasound) protocol. Studies have shown US benefit in hemophiliac patients, including its potential as an alternative for the Hemophiliac Joint Health Score (HJHS) system. However, many of the studies were conducted in countries with better management of hemophilia using prophylaxis treatment. It is unclear whether HEAD-US has a correlation with HJHS in countries using episodic treatment only, like in Indonesia. Purpose This study aimed to explore the correlation between HEAD-US and HJHS in hemophiliac patients with joint problems in Indonesia. Materials and methods A cross-sectional correlation study between HEAD-US and HJHS was performed with primary data collected from 120 hemophilic patients. US examination was performed on elbow, knee and ankle joints using the HEAD-US scoring method by a musculoskeletal radiologist. HJHS examination was conducted by a trained physiotherapist and a medical rehabilitation specialist. All examiner is member of multidisciplinary Hemophiliac Management Team in Cipto Mangunkusumo General Hospital in Jakarta, Indonesia. Results The mean age of the participant was 9.3 (5–14) years old. The median score of HEAD-US was 8 (1–28) with most of the joint abnormalities found on the ankles. The median score of HJHS was 3 (0–35), with most joint abnormalities found on the knees. There was a moderate correlation between HEAD-US and HJHS score (p < 0.05, r = 0.65). Conclusion HEAD-US shows a moderate correlation to HJHS in hemophiliac patients who received episodic treatment. HEAD-US can provide additional value in the anatomical evaluation of the joint and could be complementary to HJHS in assessing the joint status in hemophilic patient

Screening for subclinical synovial proliferation in haemophilia: A systematic review and meta‐analysis comparing physical examination and ultrasound

“…In addition, the majority of studies were not specifically designed to compare physical examination and ultrasound for detection of synovial proliferation specifically, resulting in potential selection and/or information bias in 9 of 15 studies. While 12 of 15 included studies reported on the correlation between HJHS and ultrasound 11,12,46,47,24,29,[39][40][41][42]44,45 and 7 of 10 aimed at investigating the correlation between HJHS and ultrasound, 11,29,39,40,44,45,47 only De la Corte-Rodriguez et al 29 aimed at comparing the separate items of the HEAD-US and HJHS.…”

How to assess, detect, and manage joint involvement in the era of transformational therapies: Role of point‐of‐care ultrasound

“…A post hoc analysis of data from several cohort studies using the HJHS that included 62 patients with moderate or severe haemophilia found that joint health was more likely to deteriorate over 5–10 years in patients with severe disease 62 . The HJHS correlates with the HEAD‐US, and both are complementary to each other in detecting joint damage 63 . It has been suggested that early use of HJHS and ultrasound may reveal initial joint changes that often escape clinical diagnosis, 21,24,33,64–66 although prospective studies are needed to compare the outcomes and significance of early detection versus incidental findings of abnormal joint activity in the general population.…”

“…62 The HJHS correlates with the HEAD-US, and both are complementary to each other in detecting joint damage. 63 It has been suggested that early use of HJHS and ultrasound may reveal initial joint changes that often escape clinical diagnosis, 21,24,33,[64][65][66] although prospective studies are needed to compare the outcomes and significance of early detection versus incidental findings of abnormal joint activity in the general population.…”

Hemosiderin deposition evaluation in hemophilic ankle joints: association between US finding and gradient-recalled echo MR imaging sequence

“…Many studies have proposed the use of US in evaluating HA [4][5][6][7][8][10][11][12][13][14][15][16][17]. However, there was some disagreement regarding US ability in detecting hemosiderin deposition in hemophilic joint.…”