Abstract
Introduction: Monitoring joint health is essential for identifying joint health deterioration and adjusting treatment to limit further decline. The aim of the present study was to describe changes in clinical joint health over a 5-10 years follow-up and identify factors associated with joint health deterioration in adult patients with hemophilia.
Methods: A post-hoc analysis was performed in patients with moderate or severe hemophilia, ≥16 years at T0, using data collected for previous cohort studies. Joint health of ankles, knees and elbows was measured with the Hemophilia Joint Health Score (HJHS) from 2006-2008 (T0) to 2011-2016 (T1). Analyses were performed on patient level (ΔHJHS total score) and joint level (ΔHJHS joint score). Factors associated with deterioration in ΔHJHS scores were determined with univariate and multivariate linear regression analyses; single level for ΔHJHS total score and two-level for ΔHJHS joint score.
Results: Sixty-two patients (median age 25.1, 72.6% severe hemophilia, median 0.0 [25th-75th percentile: 0.0;2.0] joint bleeds between T0-T1) were included. After median 8.0 years HJHS total score and HJHS joint score deteriorated in
37.1% (ΔHJHS ≥4) and 17.5% (ΔHJHS ≥2), respectively. Ankle joints (30.6%) showed more deterioration than the elbows (18.5%) and knees (3.2%). Severe hemophilia (β [95% CI]: 0.31 [0.07;0.54)]) was the only factor associated with
ΔHJHS total score. ΔHJHS joint score was associated with a higher number of joint bleeds between T0-T1 (β [95% CI]: 0.34/joint bleed [0.16;0.51), lower HJHS at baseline (β [95% CI]: -0.34/point [-0.49;-0.19]), presence of synovitis (β [95%
CI]: 0.81 [0.24;1.37]) and more limitations in activities measured with the Hemophilia Activities List (β [95% CI]: -0.21/point [-0.32;-0.10]). Of the joints without joint impairment at baseline and with ≤1 joint bleed and no synovitis during follow-up, the majority (91.9%) showed no deterioration during five to ten years follow-up.
Discussion/Conclusion: In 37.1% of patients with moderate/severe hemophilia and low joint bleeding rates joint health deteriorated over 5.1-10.1 years. Ankle and elbow joints showed most deterioration. Joint health deterioration was
associated with increased joint bleeding, lower HJHS at baseline, presence of synovitis and limitations in activities. Factors found in the current study may be useful to identify which patients or joints need more/less frequent joint
monitoring.
Methods: A post-hoc analysis was performed in patients with moderate or severe hemophilia, ≥16 years at T0, using data collected for previous cohort studies. Joint health of ankles, knees and elbows was measured with the Hemophilia Joint Health Score (HJHS) from 2006-2008 (T0) to 2011-2016 (T1). Analyses were performed on patient level (ΔHJHS total score) and joint level (ΔHJHS joint score). Factors associated with deterioration in ΔHJHS scores were determined with univariate and multivariate linear regression analyses; single level for ΔHJHS total score and two-level for ΔHJHS joint score.
Results: Sixty-two patients (median age 25.1, 72.6% severe hemophilia, median 0.0 [25th-75th percentile: 0.0;2.0] joint bleeds between T0-T1) were included. After median 8.0 years HJHS total score and HJHS joint score deteriorated in
37.1% (ΔHJHS ≥4) and 17.5% (ΔHJHS ≥2), respectively. Ankle joints (30.6%) showed more deterioration than the elbows (18.5%) and knees (3.2%). Severe hemophilia (β [95% CI]: 0.31 [0.07;0.54)]) was the only factor associated with
ΔHJHS total score. ΔHJHS joint score was associated with a higher number of joint bleeds between T0-T1 (β [95% CI]: 0.34/joint bleed [0.16;0.51), lower HJHS at baseline (β [95% CI]: -0.34/point [-0.49;-0.19]), presence of synovitis (β [95%
CI]: 0.81 [0.24;1.37]) and more limitations in activities measured with the Hemophilia Activities List (β [95% CI]: -0.21/point [-0.32;-0.10]). Of the joints without joint impairment at baseline and with ≤1 joint bleed and no synovitis during follow-up, the majority (91.9%) showed no deterioration during five to ten years follow-up.
Discussion/Conclusion: In 37.1% of patients with moderate/severe hemophilia and low joint bleeding rates joint health deteriorated over 5.1-10.1 years. Ankle and elbow joints showed most deterioration. Joint health deterioration was
associated with increased joint bleeding, lower HJHS at baseline, presence of synovitis and limitations in activities. Factors found in the current study may be useful to identify which patients or joints need more/less frequent joint
monitoring.
| Original language | English |
|---|---|
| Article number | P084 |
| Pages (from-to) | 78-79 |
| Journal | Haemophilia |
| Volume | 23 |
| Issue number | S2 |
| DOIs | |
| Publication status | Published - Feb 2017 |