A team from Ege University Medical Faculty Hospital in Turkey recommends the use of the hemophilia early arthropathy detection with ultrasound (HEAD-US) procedure and scoring method to detect early signs of arthropathy in patients with hemophilia.

“Although a correlation was detected between HJHS [hemophilia joint health score] and HEAD-US scores, which are used to evaluate joint health in hemophilic patients, HEAD-US is accepted to be more sensitive than HJHS in detecting early signs of arthropathy,” said the authors of the new study published in the Journal of Clinical Ultrasound.

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Ultrasonographic examination of the joints identified early arthropathic changes in 4 cases that showed normal HJHS scores at clinical examination. Mean HEAD-US and HJHS scores were 15.6±12.6 and 14.94±15.18, respectively. A positive correlation was detected between HJHS and HEAD-US scores (r =0.847, P <.001).

“Early diagnosis of subclinical joint changes and bleeding will provide more benefits to the protecting joint functions in hemophilia patients,” the authors said.

The study enrolled 50 patients (mean age, 26.38±13.77 years, age range, 5-66 years) with moderate or severe hemophilia A (n=40) or hemophilia B (n=10). The authors analyzed a total of 294 joints (elbow n=100, knee n=94, ankle n=100) by ultrasonography.

Patients With Hemophilia Exhibit Joint Changes Despite Low Joint Bleeding Rates

They evaluated signs of synovial hypertrophy (an indicator of disease activity in hemophilic joints) and osteochondral damage of articular cartilage and subchondral bone for each joint. Both conditions are frequently asymptomatic. In this cohort, most (n=156) joints were classified as grade 0 hypertrophic synovium, followed by grade 1 (n=86) and grade 2 (n=52).


Tamsel İ, Kavakli K, Özbek SS, et al. The value of ultrasonography in detecting early arthropathic changes and contribution to the clinical approach in patients of hemophilia. J Clin Ultrasound. Published online March 2, 2022. doi:10.1002/jcu.23164