Development and definition of a simplified scanning procedure and scoring method for Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US)

Summary

The aim of this study was to develop a simplified ultrasound scanning procedure and scoring method, named Haemophilia Early Arthropathy Detection with UltraSound [HEAD-US], to evaluate joints of patients with haemophilic arthropathy. After an initial consensus-based process involving a multidisciplinary panel of experts, three comprehensive and evidence-based US scanning procedures to image the elbow, knee and ankle were established with the aim to increase sensitivity in detection of early signs of joint involvement while keeping the technique easy and quick to perform. Each procedure included systematic evaluation of synovial recesses and selection of a single osteochondral surface for damage analysis. Based on expert consensus, a simplified scoring system based on an additive scale was created to define the joint status and, in perspective, to offer a tool to evaluate disease progression and monitor the result of treatment in follow-up studies.

Keywords

Haemophilic arthropathy - joints - scoring systems - ultrasonography - synovitis - osteochondral damage

• References

• 1 Manco-Johnson MJ, Abshire TC, Schapiro AD. et al. Prophylaxis versus episodic treatment to prevent joint disease in boys with severe hemophilia. N Engl J Med 2007; 9357: 535-544.
• 2 Jones J, Hunter D. Consensus methods for medical and health services research. Br Med J 1995; 311: 376-380.
• 3 Landis JR, Kock GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174.
• 4 Bland JM, Altman DG. Statistics notes: Cronbach’s alpha. Br Med J 1997; 314: 572.
• 5 Bianchi S, Martinoli C, Bianchi-Zamorani MP. al Ultrasound of the joints. Eur Radiol 2002; 12: 56-61.
• 6 Lafeber FPJG, Miossec P, Valentino LA. Physiopathology of haemophilic arthro-pathy. Haemophilia 2008; 14: 3-9.
• 7 Maclachlan J, Gough-Palmer A, Hargunani R. et al. Haemophilia imaging: a review. Skeletal Radiol 2009; 38: 949-957.
• 8 Melchiorre D, Linari S, Innocenti M. et al. Ultrasound detects joint damage and bleeding in haemophilic arthropathy: a proposal of a score. Haemophilia 2011; 17: 112-117.
• 9 Zukotynski K, Jarrin SJ, Babyn PS. et al. Sonography for assessment of haemophilic arthropathy in children: a systematic protocol. Haemophilia 2007; 13: 293-304.
• 10 Acharya SS, Schloss R, Dyke JP. et al. Power Doppler sonography in the diagnosis of hemophilic synovitis: a promising tool. J Thromb Haemost 2008; 06: 2055-2061.
• 11 Naredo E, Bonilla G, Gamero F. et al. Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis 2005; 64: 375-381.
• 12 Naredo E, Möller I, Cruz A. et al. Power Doppler ultrasonographic monitoring of response to anti-tumor necrosis factor therapy in patients with rheumatoid arthritis. Arthritis Rheum 2008; 58: 2248-2256.
• 13 Kamishima T, Tanimura K, Henmi M. et al. Power Doppler ultrasound of rheumatoid synovitis: quantification of vascular signal and analysis of interobserver variability. Skeletal Radiol 2009; 38: 467-472.
• 14 Roosendaal G, Van Rinsum AC, Vianen ME. et al. Haemophilic arthropathy resembles degenerative rather than inflammatory joint disease. Histopathology 1999; 34: 144-153.
• 15 Valentino LA, Hakobyan N. Histological changes in murine haemophilic syn-ovitis: a quantitative grading system to assess blood-induced synovitis. Haemophilia 2006; 12: 654-662.
• 16 Roosendaal G, Lafeber FPJG. Blood-induced joint damage in hemophilia. Semin Thromb Hemost 2003; 29: 37-42.
• 17 Roosendaal G, Lafeber FPJG. Pathogenesis of haemophilic arthropathy. Haemophilia 2006; 12: 117-121.
• 18 Keshava S, Gibikote S, Mohanta A. et al. Refinement of a sonographic protocol for assessment of haemophilic arthropathy. Haemophilia 2009; 15: 1168-1171.