title: Joint Function and Arthropathy Severity in Patients with Hemophilia.
abstract: BACKGROUND
  The Arnold-Hilgartner classification is one of the most popular evaluation systems for the progression hemophilic arthropathy. A previous study reported an association between arthropathy severity and arc range of motion (ROM). However, associations between arthropathy severity and angular ROM and muscle strength remain unclear.
  
  
  OBJECTIVE
  The purpose of this study was to clarify the association between joint function and arthropathy severity in hemophilia.
  
  
  METHODS
  We studied the knee, ankle, and elbow joints of 31 patients with hemophilia (PWH). The condition of the affected joints was evaluated on the basis of the interview data, joint function measurements, and roentgenography of the affected joints. In assessment of joint function, we evaluated knee strength (flexor, extensor) and grip strength as well as the passive ROM of the elbow, knee, and ankle. During the interview, all patients were asked about the history of intra-articular bleeding over the past year and pain.
  
  
  RESULTS
  As arthropathy severity worsened, knee flexor strength, knee extensor strength, grip strength, and ROM (elbow flexion, elbow extension, knee flexion, knee extension, and ankle extension) significantly decreased. Even patients with mild arthropathies experienced knee extensor weakness and extension limitation. In addition, joint function of severe ankle arthropathy was significantly related to the history of intra-articular bleeding and pain.
  
  
  CONCLUSIONS
  Our results suggest that physical therapy is necessary to improve joint function in PWH and mild or no arthropathy. Pain control and prophylactic hematological management are necessary for patients with severe arthropathy because intra-articular bleeding and pain significantly decrease joint function.
authors.affiliation: The University of Tokyo Hospital.
authors.forename: Miwa
authors.initials: M
authors.lastname: Goto
authors.affiliation: IMSUT Hospital of the Institute of Medical Science, The University of Tokyo.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Takedani
authors.affiliation: Tokyo Metropolitan University.
authors.forename: Osamu
authors.initials: O
authors.lastname: Nitta
authors.affiliation: University of Tsukuba.
authors.forename: Kennosuke
authors.initials: K
authors.lastname: Kawama
keywords: Arnold-Hilgartner classification; Muscle strength; Range of motion