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Haemophilia. 2016 Nov;22(6):925-933. doi: 10.1111/hae.13023. Epub 2016 Jul 7.

Correlating clinical and radiological assessment of joints in haemophilia: results of a cross sectional study.

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Department of Orthopaedics, Christian Medical College, Vellore, India.
Department of Rehabilitation, The Hospital for Sick Children, Toronto, ON, Canada.
Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
Department of Radiology Christian Medical College, Vellore, India.
Department of Haematology, Christian Medical College, Vellore, India.
Division of Rheumatology, Departments of Paediatrics, The Hospital for Sick Children, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.



This study was undertaken to determine the correlation between the radiological changes in haemophilic arthropathy [X-ray, Ultrasound (US) and MRI] and clinical assessment as determined by the Hemophilia Joint Health Score (HJHS); and to document the US and MRI changes in joints that appear normal on plain X-ray and clinical evaluation.


Of 55 study joints (22 knees and 33 ankles) in 51 patients with haemophilia/von Willebrand disease, with a median age of 15 years (range: 5-17) were assessed using X-rays (Pettersson score) and clinical examination (HJHS) at two centres (Toronto, Canada; Vellore, India). MRI and ultrasonographic scoring was done through a consensus assessment by imagers at both centres using the IPSG MRI and US scores.


The HJHS had a good correlation with the Pettersson score (rs = 0.66). Though the HJHS had moderate correlation with the osteochondral component of the MRI and US scores (rs 0.51, 0.45 respectively), its correlation with the soft tissue component was poor (rs 0.19; 0.26 respectively). Of the 18 joints with a Pettersson score of zero, 88.9% had changes that were detected clinically by the HJHS. Osteochondral abnormalities were identified in 38.9% of these joints by the MRI, while US images of the same joints were deemed abnormal in 83.3% by the current criteria. US identified haemosiderin and other soft tissue changes in all of the joints, while the same changes were noted in 94.4% of these joints on MRI. There were four joints with a HJHS of zero, all of which had soft tissue changes on MRI (score 1-7) and US (score 2-7). Osteochondral changes were detected in three of these joints by US and in 2 by MRI. There were four joints with an MRI score of 0-1 that had significant US scores (3-5) and HJHS scores (0-6).


US and MRI are able to identify pathological changes in joints with normal X-ray imaging and clinical examination. However, further studies are required to be able to differentiate early abnormalities from normal. Clinical (HJHS) and radiological assessment (US/MRI) provide complimentary information and should be considered conjointly in the assessment of early joint arthropathy.


haemophilia joint health score (HJHS); haemophilic arthropathy; magnetic resonance imaging; musculoskeletal assessment/outcome; ultrasonography

[Indexed for MEDLINE]

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