Diagnosis and treatment of chronic synovitis in patients with haemophilia: consensus statements from the Italian Association of Haemophilia Centres

Abstract

Although synovitis is recognized as a marker of joint disease activity, its periodic assessment is not included in routine clinical surveillance of patients with haemophilia (PwH). In order to evaluate the current knowledge and to identify controversial issues, a preliminary literature search by the Musculoskeletal Committee of the Italian Association of Haemophilia Centres (AICE) has been conducted. Statements have been established and sent to the Italian AICE members to collect their level of agreement or disagreement by a Delphi process. Thirty-seven consensus recommendations have been drafted. We found a general agreement on the indication to consider the presence of synovitis as a marker of joint disease activity in PwH. Accordingly, there was agreement on the indication to search for synovitis both in patients reporting joint pain and in asymptomatic ones, recognizing ultrasound as the most practical imaging technique to perform periodic joint screening. Interestingly, after detection of synovitis, there was agreement on the indication to modify the therapeutic approach, suggesting prophylaxis in patients treated on demand and tailoring treatment in patients already under prophylaxis. Whereas the need of an early consultation with a physiotherapist is recommended for PwH affected by chronic synovitis, the exact timing for an orthopaedic surgeon consultation is currently unknown.

Synovitis and joint health in patients with haemophilia: Statements from a European e‐Delphi consensus study

“…The World Federation of Haemophilia (WFH) and the German Society for Thrombosis and Haemostasis (GTH) define chronic synovitis as synovial inflammation persisting over and beyond 3 months 14,18 . Elsewhere in the literature, the presence of chronic synovitis has been related to multiple bleeds over 6 months and thus to the presence of target joints 20,21 . Likewise, although there are multiple publications discussing chronic synovitis, its definition is unclear and, when defined, it is not based on clinical data.…”

The role of point-of-Care Musculoskeletal Ultrasound for Routine Joint evaluation and management in the Hemophilia Clinic - A Real World Experience

“…On the other hand, PT plans uninformed by POC-MSKUS provided a more general approach to exercise, wellness and pain mitigation. In this context it is important to state that PT interventions in hemophilia are highly effective [ 10 ] and that MSKUS examinations in conjunction with functional/physical assessments are very useful to address synovitis [ 45 ].…”

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

“…Assessments of the elbow were excluded but are important, as this joint is frequently affected. Medical organizations have recommended ultrasound evaluation as a useful component in assessments of synovial hypertrophy, 32,35,36 in addition to assessments of effusion/haemarthrosis, 32,35 in patients with haemophilia. POCUS was deemed clinically useful by the majority of survey respondents to confirm or rule out acute joint bleeding or the presence of clinically significant synovial hypertrophy; almost half of clinicians used either power Doppler or colour Doppler signal to diagnose synovitis 35 …”