Beyond the Surface: Bone Marrow Oedema as a Hidden Marker of Pain in Haemophilic Ankles

Magnetic resonance imaging (MRI) is the gold standard for assessing haemophilic arthropathy using the IPSG scale. However, MRI-detected abnormalities often correlate poorly with pain, suggesting that structural damage alone cannot explain symptoms. Assessing additional features such as bone marrow oedema (BME) may better capture disease activity and pain in people with haemophilia (PwH).

This study aimed to evaluate the presence and extent of bone BME in the ankles of PwH, assess the reproducibility of MRI scoring for BME and IPSG, and examine correlations between MRI findings, clinical parameters, pain, and ultrasound results.

A prospective study was conducted on 56 PwH, assessing 108 ankle joints via MRI using a 3T scanner. IPSG and BME scores were independently assessed by two blinded radiologists. Statistical analyses assessed inter-reader agreement, correlations between MRI scores, and their associations with ultrasound (HEAD-US), joint health (HJHS), and pain intensity over the past 24 h and 4 weeks.

BME was observed in 45% of left and 34% of right ankles. Both IPSG and BME scores showed high reproducibility. BME scores correlated strongly with pain (ρ = 0.61-0.68) and moderately with joint health (HJHS, ρ = 0.56), whereas IPSG total scores showed moderate correlations with pain (ρ = 0.46-0.51). Resampling analyses confirmed stronger BME-pain associations.

This study shows that BME is common in haemophilic ankles and more strongly associated with pain and joint health than IPSG scores. Integrating BME into MRI assessments may enhance evaluation and monitoring of haemophilic joint disease.