Background
Recurrent intra-articular
bleedings in patients
with haemophilia result in inflammation,
exudate and consequently in damage to
the cartilage, bones and functional
restrictions. The bleeding can occur
as early as the first decade of life, often with subclinical or asymptomatic course.
Early detection of arthropathy features could result in modification of treatment or implementation of procedures preventing progression of the disease.
Aims and methods
The aim of the study
is the evaluation of HEAD-US protocol usefulness
in children. The Haemophilia Early Arthropaty Detection with Ultrasound
(HEAD-US) is a scoring method of joints assessment described by
Martinoli et al. in 2013. Our study included paediatric
patients with a diagnosis of haemophilia
A and B, regardless of severity of the
disease. In each patient elbows, knees
and ankles were examined. In
addition, patients or their parents were asked to evaluate joint
function in the four-level scale.
Results and conclusion
Up to date 180 joints in 30 patients
have been examined. The patients were aged 4 months to 18 years, mean 9 years (med 8,35y, SD 5,8), 22
with haemophilia A: 15 severe (2
inhibitors), 4 moderate, 3 mild and 8 with haemophilia B: 1 severe, 4 moderate,
3 mild. In patients with mild forms changes in ankles were found in one case (HEAD-US
3/2). In patients with moderate form of A type synovial hypertrophy of elbows and knees was found in one individual (HEAD-US 1/1). In 3 out of 15
patients with severe form of haemophilia A there were features of synovial
hypertrophy, in 2 there were changes in articular surfaces cartilage and in 2
changes in bones were found (HEAD-US up to 7). Further studies are conducted.
