The longitudinal effect of body adiposity on joint mobility in young males with Haemophilia A

Abstract

Although body adiposity and disease severity in haemophilia have been found in cross-sectional studies to be negatively associated with joint mobility, it is not clear how these two factors affect the rate of joint mobility loss over time. Over a 10-year period, repeated measures of joint range of motion (ROM) were collected annually using universal goniometers on bilateral hip, knee, ankle, shoulder and elbow joints in 6131 young males with haemophilia A aged ≤ 20 years. Body mass index (BMI) was calculated using data on weight and height during follow up. The effect of body adiposity, adjusted for disease severity, on the rate of joint mobility loss over time was assessed using a longitudinal model. Compared with haemophilia males with normal BMI, those who were obese had lower ROM at initial visit and a faster rate of joint mobility loss in the lower limbs. Overweight subjects experienced similar loss in ROM, although to a lesser degree. A decline in ROM with age was also observed in upper limb joints but the rate was not significantly affected by body adiposity. Haemophilia severity, joint bleeding and the presence of an inhibitor were other significant contributors to joint mobility loss in both upper and lower limb joints. Excess body adiposity accelerates joint mobility loss in weight bearing joints particularly among those with severe haemophilia. Our findings suggest that body weight control and effective treatment of bleeds should be implemented together to achieve better joint ROM outcomes in males with haemophilia.

Physical Functioning in Boys with Hemophilia in the U.S.

“…[15][16][17][18] Reports on the impact of race and ethnicity in hemophilia have been limited to the higher prevalence of African Americans who develop inhibitors, 19,20 septic arthritis, 21 and joint ROM limitations. 7 There are no comprehensive reports on the impact of race and ethnicity on the pediatric U.S. hemophilia population.…”

“…22,23 As an example, increased BMI is associated with greater degrees of loss of joint ROM in boys with hemophilia, as noted in the previous text. 7 In the general population (aged 2-19 years), Mexican-American boys and non-Hispanic African-American boys are each more likely than non-Hispanic white boys to have a BMI above the 97th percentile. 24 Obesity in African-American and Hispanic boys was signifıcantly more prevalent than in non-Hispanic white and Asian preschoolers.…”

Prophylaxis usage, bleeding rates, and joint outcomes of hemophilia, 1999 to 2010: a surveillance project

“…6,7 Factors previously determined to predict joint disease and poor physical function in boys with hemophilia include joint hemorrhage, increasing age, obesity, African American race, and inhibitor formation. [8][9][10] In 1997, the Centers for Disease Control and Prevention (CDC) in collaboration with the US Hemophilia Treatment Center Network (USHTCN), a specialty health care network primarily housed in academic centers, initiated a prospective surveillance system called the Universal Data Collection (UDC) system for outcomes of hemophilia, directed and funded by a US Congressional mandate, with a goal of developing preventive strategies; the structure, organization, and participants of the UDC have been previously described. 11 The outcomes of interest included bloodborne pathogens, mortality, joint disease, inhibitor formation, health insurance and employment status, obesity, and bleeding rate.…”

Association of overweight and obesity with the use of self and home‐based infusion therapy among haemophilic men

“…Persons with bleeding disorders and elevated BMI may face unique health complications in addition to those faced by the general population. Above-normal BMI has been associated with reduced ROM in haemophilic persons in American and European studies and can increase the cost of care, as dosing of factor concentrate is based on actual body weight [11–13,24]. …”