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Semin Thromb Hemost 2016; 42(05): 541-549
DOI: 10.1055/s-0036-1579640
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Assessment of Hemophilic Arthropathy by Ultrasound: Where Do We Stand?

Matteo Nicola Dario Di Minno
1   Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy
2   Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy
,
Pasquale Ambrosino
1   Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy
,
Gabriele Quintavalle
3   Regional Reference Centre for Inherited Bleeding Disorders, University-Hospital of Parma, Parma, Italy
,
Antonio Coppola
1   Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy
,
Annarita Tagliaferri
3   Regional Reference Centre for Inherited Bleeding Disorders, University-Hospital of Parma, Parma, Italy
,
Carlo Martinoli
4   Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
,
Gianna Franca Rivolta
3   Regional Reference Centre for Inherited Bleeding Disorders, University-Hospital of Parma, Parma, Italy
› Author Affiliations
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Publication History

Publication Date:
28 April 2016 (online)

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Abstract

Joint hemorrhages represent the most common type of bleeding episode in persons with hemophilia, and recurrent hemarthrosis triggers chronic arthropathy, which is the most frequent chronic complication in these patients. In recent years, in the frame of a comprehensive care approach, a growing attention has been given to the periodic assessment of the joint status in hemophilia patients with the aim to identify early arthropathic changes and to prevent the development of a clinically overt arthropathy. Besides clinical examination, X-ray and magnetic resonance imaging (MRI) are currently used to evaluate joint status and to monitor the disease progression in hemophilia. Considering the limitations of X-ray and MRI, growing interest has been given to ultrasound (US) as a possible tool to assess joint status and identify early arthropathic changes in hemophilia patients. In the present review, we summarize major literature evidence on the use of joint US for the evaluation of markers of disease activity (joint effusion and synovial hypertrophy) and of degenerative damages (osteochondral changes) in patients with hemophilia. On the whole, being able to identify the presence of intra- or extra-articular fluid, US examination is the fastest and most reliable technique to identify acute conditions, such as hemarthrosis. In addition, the information on joint involvement provided by US in the patient follow-up may influence treatment decisions on a personalized basis. The use of US as part of a routine clinical examination by hemophilia experts may optimize the diagnostic workflow, avoiding additional costs and long waiting lists for patients referred to imaging departments. In the frame of a comprehensive care approach, US might represent a strategy to early detect and monitor synovial hypertrophy and osteochondral changes in hemophilia, thus extending the clinical examination and helping identify joints to be studied with a second-level examination such as MRI.

Keywords

hemophilia - hemophilic arthropathy - ultrasound - imaging
 

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