A European e-Delphi consensus study was performed to develop expert recommendations on the definition, physiology, and natural course of synovitis in patients with hemophilia. The study, published in Haemophilia, found a lack of research on these topics, highlighting knowledge gaps that remain to be addressed.

“Owing to the knowledge gap on synovitis in hemophilia but considering its great relevance for joint health in patients with hemophilia, the aim of this study was to develop an expert consensus regarding the definition, pathophysiology, diagnosis, prevention, follow-up and treatment of synovitis through the Delphi methodology, which is often used to produce best-practice guidelines where evidence is missing,” the authors wrote.

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The research team designed and performed the study between March 2021 and March 2022 with a panel of 5 experts in hemophilia—4 hematologists and 1 physiotherapist. The panel identified 5 domains related to synovitis in patients with hemophilia: 1) its definition, 2) diagnosis, 3) impact on joint health, 4) follow-up, and 5) prevention and treatment.

All meetings to formulate and discuss the consensus statements were conducted virtually due to the COVID-19 pandemic.

Based on the available literature, the panel proposed a series of statements regarding synovitis that was assessed by each panel member for their level of agreement, resulting in a set of 22 statements that was sent to an external expert panel of 38 European hemophilia healthcare providers.

The results revealed significant gaps in knowledge regarding best practices for synovitis in hemophilia due to a lack of studies in this area and heterogeneity in the approaches to its diagnosis and treatment. However, the authors found the Delphi approach to be successful in that retention of the expert panelists throughout the course of the study was high and consensus was achieved on all statements after 3 rounds of voting.

One area of significant consensus was in the preference for musculoskeletal ultrasound over magnetic resonance imaging to investigate synovitis in patients.


Mancuso ME, Holstein K, O‘Donnell JS, Lobet S, Klamroth R; FVIII Think Tank Study Group. Synovitis and joint health in patients with haemophilia: statements from a European e-Delphi consensus study. Haemophilia. Published online January 9, 2023. doi:10.1111/hae.14734