Use of ultrasound for assessment of musculoskeletal disease in persons with haemophilia: Results of an International Prophylaxis Study Group global survey

Abstract

Aim: The objective of this survey was to understand the global trends of imaging assessments in persons with haemophilia, focusing on point-of-care ultrasound (POCUS). Insights into the barriers impeding its widespread proliferation as a frontline imaging modality were obtained. Methods: The survey opened in September of 2017 and closed in May of 2018. Haemophilia Treatment Centres (HTCs) treating both paediatric/adult patients were the population of interest. A REDCap survey of 25 questions was disseminated to 232 clinical staff in 26 countries. Results: The majority of respondents (88.3%, 91/103) reported that POCUS is most useful to confirm or rule out a presumed acute joint bleed. European HTCs reported the highest routine use of POCUS at 59.5% (22/37) followed by HTCs in the "Other" countries of the world at 46.7% (7/15) and North American HTCs at 43.9% (25/57). At the time of the survey, physiotherapists were identified as the clinical staff who perform POCUS 52.8% (28/53) of the time, in contrast with nurses/nurse practitioners who represent only 5.7% (3/53) of users. The greatest perceived barriers to the implementation of POCUS are the lack of trained healthcare professionals who

Systemic vascular basement membrane markers linked to synovial vascular remodeling are biomarkers of hemarthrosis in patients with hemophilia

“…This was accomplished by joint examinations with point-of-care MSKUS/PD, increasingly evolving as a tool to detect hemarthrosis in hemophilia. 16,31,32 Although we found no convincing evidence that any of the 10 biomarkers characterized longitudinal joint health changes in our cohort, we did identify several markers that fluctuated in association Among the 10 joint-specific collagen turnover markers measured in our study, we found that a distinct set of biomarkers related to basement membrane and endothelial cell turnover increased specifically during acute hemarthrosis, and distinguished hemarthrosis from other painful episodes. Both type IV collagen synthesis and degradation markers were found to be elevated in association with joint bleeding and not during nonbleeding painful episodes, adding to the mounting evidence that hemarthrosis and synovial vascular remodeling are linked.…”

“…To examine the utility of biomarkers for assessing joint health in the context of arthropathy and fluctuating joint pains, it was critical to objectively establish the presence of hemarthrosis. This was accomplished by joint examinations with point‐of‐care MSKUS/PD, increasingly evolving as a tool to detect hemarthrosis in hemophilia 16,31,32 …”

The Role of Physiotherapy in the New Treatment Landscape for Haemophilia

“…Point-of-care ultrasound can be considered for early detection of synovial changes, cartilage lesions and diagnosis of acute bleeding [6], although survey findings suggest that it is used routinely in only 60%, 43%, and 47% of haemophilia treatment centres in Europe, North America, and the rest of the world, respectively [40]. In addition, only a quarter of physiotherapists report being able to independently use the technology [36].…”

Feasibility and Toxicity of Intra-Articular 188Re-tin Colloid Injection in Patients with Rheumatoid Arthritis with Three-Phase Positive Bone Scan and Refractory Knee Pain, a pilot study

“…A France group demonstrated that the finger pulp had the highest radiation exposure, especially at the left thumb and forefinger. The radiation effects can be avoided by fixing the injection needle [18].…”