Merging into the mainstream: the evolution of the role of point-of-care musculoskeletal ultrasound in hemophilia

Abstract

Bleeding with resultant hemophilic arthropathy constitutes the largest cause of morbidity in patients with hemophilia. It results from repeated bleeding episodes in the joint and is characterized by synovial hypertrophy and cartilage and bony destruction. Hemophilic arthropathy assessment is a continually evolving process and is particularly challenging in children and young adults in whom joint disease may be missed or underestimated as obtaining serial “baseline” magnetic resonance imaging scans of multiple clinically asymptomatic or nearly asymptomatic joints may be unjustifiable and cost-ineffective. Musculoskeletal ultrasound—particularly, point-of-care musculoskeletal ultrasound—has emerged as a promising imaging modality for the early detection and management of hemophilic arthropathy, and for the evaluation of hemarthrosis and painful musculoskeletal episodes in patients with hemophilia. This review summarizes currently available data on the emerging role of this new imaging modality, its limitations, and gaps in knowledge. The review also raises unanswered questions, highlights the need for consolidated research efforts, and delineates future directions expected to advance this technology and optimize its use in this patient population.

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

“…If clinically relevant, MRI can be used subsequently to differentiate the nature of the tissue. Over the past years, ultrasound is increasingly used as point‐of‐care addition to the existing check‐up routine 22,23 …”

“…Over the past years, ultrasound is increasingly used as point-of-care addition to the existing check-up routine. 22,23 Several studies have compared the accuracy of ultrasound and physical examination for detecting (early) joint abnormalities in people with haemophilia during routine assessment. Most literature on this topic has focused on detecting haemophilia arthropathy as a whole and less on detecting specific parameters such as synovial proliferation.…”

Teleguidance for Patient Self‐Imaging of Hemophilic Joints Using Mobile Ultrasound Devices

“…Over the past decade, point‐of‐care (POC) MSKUS, performed mostly with stationary or laptop machines, has been introduced into many clinics managing PWH 6 . POC MSKUS in the setting of hemophilia care should answer questions regarding musculoskeletal abnormalities in a “yes/no” fashion (for instance, is this joint experiencing a hemarthrosis?)…”

Treatment Individualization Using Pharmacokinetic Studies and Joint Ultrasound Imaging in Pediatric Patients With Hemophilia

“…5 Plain radiography is widely available but can only capture advanced changes, mainly involving bony changes. 14 Magnetic resonance imaging (MRI) can detect early soft-tissue and osteochondral changes and remains the gold standard for assessing hemophilic arthropathy. Serial MRI monitoring, however, is time consuming, expensive, and not always readily available.…”

“…Serial MRI monitoring, however, is time consuming, expensive, and not always readily available. 5,14,15 Given the limitations of plain radiography and MRI, interest is now focusing on ultrasound and the possibilities it offers as a tool for detecting and monitoring joint disease in hemophilia. 15 Prophylactic treatment has long aimed at maintaining factor levels above 1% at all times to minimize bleeding, whereas recent guidelines recommend much higher troughs that aim, if possible, at 0 bleeds.…”