title: Value of routine ultrasound in detecting early joint changes in children with haemophilia using the 'Haemophilia Early Arthropathy Detection with UltraSound' protocol.
abstract: BACKGROUND
  Patients with haemophilia tend to bleed in large joints even during prophylactic replacement therapy. Detection of early blood-induced joint changes may improve monitoring of treatment. The aim of this study was to explore the value of routine ultrasound in detecting early joint abnormalities in children with haemophilia on prophylaxis.
  
  
  METHODS
  Sixty-four joints in 32 children with haemophilia were examined by one operator using the Haemophilia Early Arthropathy Detection with UltraSound protocol during annual multidisciplinary follow-up. Based on reported bleeding, the joint with the highest risk of blood-induced joint damage and the contralateral joint were examined. At the same day, clinical function was assessed according to the Haemophilia Joint Health Score (HJHS).
  
  
  RESULTS
  Median age was 11.5 years (range = 5.5-16.4). Out of the 64 examined joints, one ankle was excluded because of previous surgery. Median lifetime joint bleeds/joint was three (interquartile ranges = 1-5). Clinical function of most joints was perfect: only 7/49 joints with reported bleeds scored positive due to swelling, muscle atrophy and/or range of motion loss (HJHS range = 1-2 points). Ultrasound showed abnormalities in 5/49 joints with reported bleeding, and 4/5 showed positive HJHS scores. Ultrasound abnormalities were present in 1/56 joints (1.8%, CI: 0.1-9.6%) without loss of clinical function.
  
  
  CONCLUSIONS
  Ultrasound abnormalities were found during routine evaluation of joints in children with haemophilia on prophylaxis. Most joints with ultrasound abnormalities showed low HJHS scores too. Ultrasound could be used to evaluate whether minimal losses of clinical function might be caused by anatomical changes.
authors.affiliation: Department of Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Foppen
authors.affiliation: Department of Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
authors.forename: I C
authors.initials: IC
authors.lastname: van der Schaaf
authors.affiliation: Van Creveldkliniek, Department of Hematology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.|Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Fischer
mesh_terms: D000293:Adolescent; D002648:Child; D042241:Early Diagnosis; D006467:Hemophilia A / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007592:Joint Diseases / Q000150:complications* / Q000000981:diagnostic imaging*; D012189:Retrospective Studies
keywords: arthropathy; clinical function; haemarthrosis; haemophilia; ultrasound