title: Correlating clinical and radiological assessment of joints in haemophilia: results of a cross sectional study.
abstract: OBJECTIVE
  This study was undertaken to determine the correlation between the radiological changes in haemophilic arthropathy [X-ray, Ultrasound (US) and MRI] and clinical assessment as determined by the Hemophilia Joint Health Score (HJHS); and to document the US and MRI changes in joints that appear normal on plain X-ray and clinical evaluation.
  
  
  METHODS
  Of 55 study joints (22 knees and 33 ankles) in 51 patients with haemophilia/von Willebrand disease, with a median age of 15 years (range: 5-17) were assessed using X-rays (Pettersson score) and clinical examination (HJHS) at two centres (Toronto, Canada; Vellore, India). MRI and ultrasonographic scoring was done through a consensus assessment by imagers at both centres using the IPSG MRI and US scores.
  
  
  RESULTS
  The HJHS had a good correlation with the Pettersson score (rs= 0.66). Though the HJHS had moderate correlation with the osteochondral component of the MRI and US scores (rs0.51, 0.45 respectively), its correlation with the soft tissue component was poor (rs0.19; 0.26 respectively). Of the 18 joints with a Pettersson score of zero, 88.9% had changes that were detected clinically by the HJHS. Osteochondral abnormalities were identified in 38.9% of these joints by the MRI, while US images of the same joints were deemed abnormal in 83.3% by the current criteria. US identified haemosiderin and other soft tissue changes in all of the joints, while the same changes were noted in 94.4% of these joints on MRI. There were four joints with a HJHS of zero, all of which had soft tissue changes on MRI (score 1-7) and US (score 2-7). Osteochondral changes were detected in three of these joints by US and in 2 by MRI. There were four joints with an MRI score of 0-1 that had significant US scores (3-5) and HJHS scores (0-6).
  
  
  CONCLUSIONS
  US and MRI are able to identify pathological changes in joints with normal X-ray imaging and clinical examination. However, further studies are required to be able to differentiate early abnormalities from normal. Clinical (HJHS) and radiological assessment (US/MRI) provide complimentary information and should be considered conjointly in the assessment of early joint arthropathy.
authors.affiliation: Department of Orthopaedics, Christian Medical College, Vellore, India.
authors.forename: P M
authors.initials: PM
authors.lastname: Poonnoose
authors.affiliation: Department of Rehabilitation, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Hilliard
authors.affiliation: Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: A S
authors.initials: AS
authors.lastname: Doria
authors.affiliation: Department of Radiology Christian Medical College, Vellore, India.
authors.forename: S N
authors.initials: SN
authors.lastname: Keshava
authors.affiliation: Department of Radiology Christian Medical College, Vellore, India.
authors.forename: S
authors.initials: S
authors.lastname: Gibikote
authors.affiliation: Department of Haematology, Christian Medical College, Vellore, India.
authors.forename: M L
authors.initials: ML
authors.lastname: Kavitha
authors.affiliation: Division of Rheumatology, Departments of Paediatrics, The Hospital for Sick Children, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: B M
authors.initials: BM
authors.lastname: Feldman
authors.affiliation: Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Blanchette
authors.affiliation: Department of Haematology, Christian Medical College, Vellore, India.
authors.forename: A
authors.initials: A
authors.lastname: Srivastava
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D014463:Ultrasonography / Q000379:methods*
keywords: haemophilia joint health score (HJHS); haemophilic arthropathy; magnetic resonance imaging; musculoskeletal assessment/outcome; ultrasonography