Patients with hemophilia often use a symptom-based algorithm to self-diagnose hemarthrosis to initiate timely and appropriate management. A new study published in Haemophilia validated these questionnaires by using objective point-of-care musculoskeletal ultrasound imaging modalities.

This study evaluated a “painful episode questionnaire” which was developed by the Canadian Haemophilia Society as a tool to distinguish acute episodes of hemarthrosis from arthritic pain. Answers could be grouped into 5 categories: pain, range of motion, swelling, heat, and “other.”

In univariate analysis, the strongest predictor for arthritic pain was “no feeling of sponginess with movement” and the strongest predictor for hemarthrosis pain was “like a balloon swelling with water.”

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The comparison of musculoskeletal ultrasound findings of hemarthrosis (“bleeding” or “pain only”) against the questionnaire elucidated that not all questions accurately identified hemarthrosis or arthritic pain. The results of this study highlight the importance of objectively validating symptom-based questionnaires before adopting them as a tool to aid clinical decision-making.

The accuracy of such a constellation of symptoms was fine-tuned using an objective point of care musculoskeletal ultrasound, which led to the development of an “in-home” prediction tool which is essential in detecting hemarthrosis as it guides clotting factor administration, unlike symptomatic management of arthritic flares.

While the results of this study are a significant advancement toward early and accurate self-diagnosis of hemarthrosis, the researchers encourage refinement and validation in larger patient cohorts. The potential use of artificial intelligence can also be explored to increase diagnostic accuracy and utilize available resources in a cost-effective manner.


Gopal S, Barnes RFW, Volland LM, Page D, von Drygalski A. Patient-derived assessment tool using musculoskeletal ultrasound for validation of haemarthrosis. Haemophilia. Published online June 2, 2022. doi:10.1111/hae.14591