A physical examination of joints in patients with hemophilia without imaging studies may be inadequate, but an ultrasound exam may generate important information regarding synovial changes that may be difficult to detect otherwise, according to a study published in Haemophilia. 

The authors of the study conducted a systematic review to assess whether the use of ultrasound in assessing the joints of patients with hemophilia may complement physical examination. They sought observational studies with data from routine physical examinations and ultrasound scans of joints in patients with hemophilia A or B. Eleven studies were included in the final analysis. 

The team found that ultrasound-detected synovial proliferation during routine screening showed low sensitivity but high specificity of swelling. This means that the physical examination of joints without ultrasound usually shows no signs of swelling, even when swelling may be present, something that can be remedied by the adjunctive use of ultrasound imaging in assessing joint health. 

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“These summary estimates indicate fair evidence for the added value of ultrasound in screening for subclinical synovial proliferation,” the authors of the study wrote. “Future studies may identify patient subgroups in which ultrasound examination is most clinically relevant.” 

Read more about hemophilia etiology

Hemophilic arthropathy is a significant disease burden in patients with hemophilia. Studies suggest synovial proliferation may drive increased bleeding and worsen arthropathy. Hence, the early detection and treatment of synovial proliferation may help prevent disease progression.

Upon physical examination, physicians typically assess the joints by looking out for signs of swelling and limited ranges of motion. Nevertheless, physical examinations are thought to be relatively insensitive to the detection of early joint changes, including synovial proliferation. 

Many physicians make use of imaging modalities to better visualize joint pathology. MRI is the gold standard in assessing joints, but it is expensive and takes a relatively long time for an assessment to be completed, and healthcare centers tend to have a very limited number of them.

An ultrasound scan, on the other hand, is a cheaper imaging modality that provides real-time information regarding the joint that is being examined. An illuminating study confirmed that many of the soft tissue abnormalities detected in the joints of patients with hemophilia via ultrasound correspond with findings acquired via MRI scans. 


van Leeuwen FHP, Timmer MA, de Jong PA, Fischer K, Foppen W. Screening for subclinical synovial proliferation in haemophilia: a systematic review and meta-analysis comparing physical examination and ultrasoundHaemophilia. Published online January 3, 2023. doi:10.1111/hae.14737