Even children with hemophilia who are on routine prophylactic treatment can have joint pathology, according to a study published in Thrombosis Research.
Repetitive joint bleeding in hemophilia can cause significant joint damage, resulting in chronic pain and loss of range of motion. Prophylaxis has long been seen as the best method to alleviate hemophilic arthropathy; however, some studies suggest that joint changes still occur even when prophylactic adherence is high.
Any joint pathology in children is alarming, given that it will likely progress to severe disability in adulthood. Scientists theorize that repetitive bleeding episodes, perhaps less conspicuous than before, still occur in children with hemophilia on prophylaxis treatment.
The authors of the study sought to investigate joint pathology among children with hemophilia who were on prophylaxis treatment. They conducted an observational, analytical, cross-sectional study between May 2019 and December 2021 at the Hemophilia Foundation in Buenos Aires, Argentina. One hundred six patients with severe hemophilia on prophylaxis between 2 and 18 years of age were recruited for the study; this translated to the evaluation of 636 joints.
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The research team took note of key details in the participants’ clinical history: their age, hemophilia type, onset of prophylaxis, presence of inhibitors, and joint bleeding history. The researchers assessed 6 joints per patient via ultrasound—bilateral elbows, knees, and ankle joints.
Of the 636 joints examined, 140 had ultrasound abnormalities. Synovitis was a notable feature among some patients with hemophilia, the most affected (18%-23%) being children over 10 years of age. These findings are significant because synovitis is often a precursor to severe joint damage.
“Consequently, it is relevant to carry out a routine joint status evaluation (physical examination and ultrasound) to monitor joint damage progression over time,” the authors concluded.
Daffunchio C, Galatro G, Faurlin V, Neme D, Caviglia H. The hidden joint in children with haemophilia on prophylaxis. Thromb Res. Published online April 26, 2023. doi:10.1016/j.thromres.2023.04.012