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Editorial
. 2024 Jan 3;8(1):102314.
doi: 10.1016/j.rpth.2023.102314. eCollection 2024 Jan.

Ultrasound evaluation of hemophilic arthropathy: a proposal of definitions in a changing landscape

Roberta Gualtierotti  1   2 , Luigi Piero Solimeno  3 , Flora Peyvandi  1   2 ; Ultrasound in hemophilic arthropathy study group
Collaborators, Affiliations
Editorial

Ultrasound evaluation of hemophilic arthropathy: a proposal of definitions in a changing landscape

Roberta Gualtierotti et al. Res Pract Thromb Haemost. .

Abstract

The advent of novel effective treatments and the identification of the need to achieve a higher trough level for persons with hemophilia A and B have changed the landscape of management of these patients, allowing to change the target from survival and prevention of life-threatening complications to prevention of musculoskeletal complications and improvement of quality of life. Point-of-care musculoskeletal ultrasound imaging has also improved the early recognition of joint bleeding and the differential diagnosis of acute joint pain. In addition, joint ultrasound allows the evaluation of the severity of hemophilic arthropathy in terms of synovitis and cartilage and bone damage. However, a lack of standardization in the definition of ultrasound elementary lesions of hemophilic arthropathy may lead to confusion and an incorrect evaluation of the presence and progression of joint damage. Here, we propose to start a standardization and validation process for ultrasound definitions of hemophilic arthropathy that has been planned to become a project within the Factor VIII/IX Standardization Subcommittee of the International Society on Thrombosis and Haemostasis Scientific and Standardization Committee.

Keywords: cartilage; hemophilia; joints; synovitis; ultrasonography.

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Figures

Figure
Figure
Longitudinal scan of the posterior recess of the elbow. (A) A normal elbow. (B) Joint bleeding in the posterior recess of the elbow of an adult person with severe hemophilia and hemophilic arthropathy: the joint capsule is distended (arrowheads) by an inhomogeneous isoechoic corpusculated fluid (asterisk) with speckles that swirl at dynamic maneuvers. (C) Synovial hyperplasia (arrow) with power Doppler signal in the posterior recess of the elbow of a different adult patient with hemophilic arthropathy in a longitudinal scan and (D) in a transversal scan. The presence of a Doppler signal in (C and D) suggests that the capsule distension is due to solid and vascularized synovial tissue and, therefore, allows for the exclusion of joint bleeding.
See this image and copyright information in PMC

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