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The hidden joint in children with haemophilia on prophylaxis
Carla Daffunchio1, Gustavo Galatro1, Virginia Faurlin2
1Haemophilia Foundation, Buenos Aires, Argentina; Department of Orthopaedics and Traumatology, Juan A. Fernández Hospital, Buenos Aires, Argentina.
Insights
Subclinical bleeding in children with haemophilia on prophylaxis can cause hidden joint damage, particularly in the ankle. Early detection using HEAD-US imaging is crucial for timely intervention and preventing arthropathy.
Area of Science:
- Paediatric Rheumatology
- Haematology
- Medical Imaging
Background:
- Prophylaxis is the standard treatment for children with haemophilia (CWH).
- Subclinical bleeding can lead to joint damage despite prophylaxis.
- Early detection of joint damage is vital to prevent arthropathy in CWH.
Purpose of the Study:
- To identify "hidden joints" in children with haemophilia on prophylaxis (CWHP).
- To analyze age-related joint involvement in CWHP.
- To determine the most affected joint in CWHP.
Main Methods:
- Observational, analytical, cross-sectional study.
- 106 CWH on prophylaxis were evaluated.
- Joint damage defined as HEAD-US score ≥ 1.
Main Results:
- 22% of joints showed damage (HEAD-US score ≥ 1), with 12.7% having no history of bleeding.
- Cartilage damage was most frequent, followed by synovitis and bone damage.
- The ankle was the most affected joint, identified as the "hidden joint".
Conclusions:
- Prophylaxis is effective but does not eliminate joint bleeding risk in CWH.
- Routine joint evaluation, especially of the ankle, is recommended.
- HEAD-US imaging can detect early arthropathy in CWH based on age and prophylaxis type.
Abstract:
Prophylaxis is the gold standard treatment for children with haemophilia (CWH). MRI studies revealed joint damage, even with this treatment; this suggests the presence of subclinical bleeding. In the case of children with haemophilia, it is relevant to detect early signs of joint damage, as this allows the medical team to provide the appropriate treatment and follow-up, in order to avoid arthropathy development and its consequences. The aim of this study is to detect the hidden joint in children with haemophilia on prophylaxis (CWHP) and analyse, by age group, which joint is the most affected. We define the hidden joint in CWH on prophylaxis as the joint that presents joint damage secondary to repetitive bleeding episodes and is detected in the joint evaluation, despite being asymptomatic or with mild symptoms. It is most commonly caused by repetitive subclinical bleeding.
Methods:
This was an observational, analytical, cross-sectional study of 106 CWH on prophylaxis treated in our centre. Patients were divided according to age and type of treatment. Joint damage was defined as a HEAD-US score ≥ 1.
Results:
Patients' median age was 12 years. All had severe haemophilia. The median age of onset of prophylaxis was 2.7. Forty-seven (44.3 %) patients received primary prophylaxis (PP) and 59 (55.7 %), secondary prophylaxis. Six hundred and thirty-six joints were analysed. Type of prophylaxis and joint involvement showed statistically significant differences (p < 0.001). However, patients on PP had a greater number of damaged joints at older ages. Twenty-two % (140) of the joints scored ≥1 on HEAD-US. Cartilage was most frequently involved, followed by synovitis, and bone damage. We observed a greater frequency and degree of arthropathy in subjects aged 11 and above. Sixty (12.7 %) joints showed a HEAD-US score ≥ 1, with no history of bleeding. The ankle was the most affected joint, representing the hidden joint according to our definition.
Conclusion:
Prophylaxis is the best treatment for CWH. However, symptomatic or subclinical joint bleeding may occur. The routine evaluation of joint health is relevant, particularly, of the ankle. In our study, early signs of arthropathy according to age and type of prophylaxis were detected by HEAD-US.
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