Home‐delivered ultrasound monitoring for home treatment of haemarthrosis in haemophilia A

Aznar, José A.; Pérez‐Alenda, Sofía; Jaca, M.Aguirre; García-Dasí, M.; Vila, Carmen; Moret, A.; Querol, Felipe; Bonanad, Santiago

doi:10.1111/hae.12622

Cited by 19 publications

(39 citation statements)

References 9 publications

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“…Point‐of‐care ultrasound is increasingly used in haemophilia patients to obtain direct information of joint status . Operators should have received proper training before implementation of POC‐US in haemophilia care in order to avoid incorrect diagnosis and misuse.…”

Section: Discussionmentioning

confidence: 99%

“…Point-of-care ultrasound is increasingly used in haemophilia patients to obtain direct information of joint status. [25][26][27][28] Operators should have received proper training before implementation of POC-US in haemophilia care in order to avoid incorrect diagnosis and misuse. Recommendations and guidelines on training standards, appropriate use and quality assurance have therefore been described.…”

Section: Clinical Applicationmentioning

confidence: 99%

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Diagnostic accuracy of point‐of‐care ultrasound for evaluation of early blood‐induced joint changes: Comparison with MRI

et al. 2018

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Introduction Recurrent joint bleeding is the hallmark of haemophilia. Synovial hypertrophy observed with Magnetic Resonance Imaging (MRI) is associated with an increased risk of future joint bleeding. Aim The aim of this study was to investigate whether point‐of‐care ultrasound (POC‐US) is an accurate alternative for MRI for the detection of early joint changes. Methods In this single centre diagnostic accuracy study, bilateral knees and ankles of haemophilia patients with no or minimal arthropathy on X‐rays were scanned using POC‐US and 3 Tesla MRI. POC‐US was performed by 1 medical doctor, blinded for MRI, according to the “Haemophilia Early Arthropathy Detection with Ultrasound” (HEAD‐US) protocol. MRIs were independently scored by 2 radiologists, blinded for clinical data and ultrasound results. Diagnostic accuracy parameters were calculated with 95% confidence intervals (CI). Results Knees and ankles of 24 haemophilia patients (96 joints), aged 18‐34, were studied. Synovial hypertrophy on MRI was observed in 20% of joints. POC‐US for synovial tissue was correct (overall accuracy) in 97% (CI: 91‐99) with a positive predictive value of 94% (CI: 73‐100) and a negative predictive value of 97% (CI: 91‐100). The overall accuracy of POC‐US for cartilage abnormalities was 91% (CI: 83‐96) and for bone surface irregularities 97% (CI: 91‐99). Conclusion POC‐US could accurately assess synovial hypertrophy, bone surface irregularities and cartilage abnormalities in haemophilia patients with limited joint disease. As POC‐US is an accurate and available alternative for MRI, it can be used for routine evaluation of early joint changes.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Applicationmentioning

confidence: 99%

Diagnostic accuracy of point‐of‐care ultrasound for evaluation of early blood‐induced joint changes: Comparison with MRI

et al. 2018

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“…In an effort to improve time to diagnosis, some clinics have started mobile programmes where a physical therapist visits the patient's home to perform ultrasound during painful episodes. 8 Despite its usefulness in the clinical set-…”

Section: Use Of Ultrasound For Evaluation Of Painful Joint Episodes Pmentioning

confidence: 99%

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

et al. 2018

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“…This prompted investigation into alternative new imaging modalities, which led to the adoption of musculoskeletal ultrasound (MSKUS) for the imaging of hemophilic joints and its recent introduction into clinical practice. 25–28 Continued innovative development and wide-spread utilization for HA care are expected over the next few years. Advances in ultrasound technology permit high resolution imaging for detailed visualization of anatomy and pathology of the musculoskeletal system, including tendons, muscles, ligaments and fluid.…”

Section: Novel Imaging Modalitiesmentioning

confidence: 99%

“…MSKUS is also mobile, with a potential for use in patients’ homes or work place, and it can monitor resolution of hemarthrosis or inflammation. 27, 28 …”

Section: Novel Imaging Modalitiesmentioning

confidence: 99%

Advances and challenges in hemophilic arthropathy

Wyseure

Mosnier

Drygalski

2016

Seminars in Hematology

106

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Hemophilic arthropathy is a form of joint disease that develops in secondary to joint bleeding and presents with synovial hypertrophy, cartilage and bony destruction. The arthropathy can develop despite clotting factor replacement and is especially disabling in the aging population. Pathobiological tissue changes are triggered by release of hemoglobin and iron deposition in the joint, but the sequence of events and the molecular mechanisms resulting in joint deterioration are incompletely understood. Treatment options other than clotting factor replacement are limited. Improvements in the treatment of hemophilia necessitate a better understanding of the processes that lead to this disabling condition and better diagnostic tools. Towards that end, studies of the molecular mechanisms leading to the arthropathy, as well as the development of sensitive imaging techniques and biomarkers are needed. These will pave the way to identify the cause of acute pain such as joint bleeding or synovitis, detect early, potentially reversible structural changes, and predict progression of disease. This review describes current imaging techniques and the development of high resolution musculoskeletal ultrasound with power Doppler to afford point-of-care diagnosis and management, the potential utility of diagnostic biomarkers, and summarizes our current knowledge of the pathobiology of hemophilic arthropathy.

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Home‐delivered ultrasound monitoring for home treatment of haemarthrosis in haemophilia A

Cited by 19 publications

References 9 publications

Diagnostic accuracy of point‐of‐care ultrasound for evaluation of early blood‐induced joint changes: Comparison with MRI

Diagnostic accuracy of point‐of‐care ultrasound for evaluation of early blood‐induced joint changes: Comparison with MRI

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

Advances and challenges in hemophilic arthropathy

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