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
