AB1389 VALUE OF MUSCULOSKELETAL ULTRASOUND IN DETECTING ASYMPTOMATIC JOINT CHANGES IN PATIENTS WITH HEMOPHILIA (PWH) USING THE HEMOPHILIA EARLY ARTHROPATHY DETECTION WITH ULTRASOUND SCORING(HEAD-US).
Authors: T. Abe, Y. Inagaki, C. Ogita, Y. Minagawa, K. Noguchi, Y. Ohtsuka, T. Tokugawa, A. Sawada, N. Azuma, K. Matsui
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Hemophilic arthropathy (HA), is characterized by synovitis and cartilage and bony destruction, which ultimately results from repeated joint bleeding episodes in patients with hemophilia (PwH). Early detection of HA is crucial to prevent joint damage. In daily clinical practice, the standard of joint evaluation is based on the patient's symptoms and physical examination such as tender joint, swollen joint, and the specific scales as Hemophilia Joint Health Score (HJHS). Synovitis can be asymptomatic, going unnoticed on physical examination, especially in patients on prophylaxis. Therefore, the use of imaging tools such as magnetic resonance imaging (MRI) and musculoskeletal ultrasound (MSKUS) for the assessment of the most frequently affected joints in PWH is increasingly being promoted. For polyarticular and repeated assessment, performing MSKUS seems the most practical option among patients with Hemophilia (PwH). Recently, HEAD-US (Hemophilia Early Arthropathy Detection with Ultrasound) protocol has been established as a simplified US scale used to evaluate joint health and could be useful to individualize treatment. It is underexploring about the efficacy of MSKUS in assessing asymptomatic joint damage by joint level among PwH. <h3>Objectives:</h3> This study aimed to explore the value of MSKUS beyond clinical joint parameters in assessing asymptomatic joints in PwH. <h3>Methods:</h3> We analyzed PwH under 35 years of age with mild joint damage who had examined MSKUS at our department. Prior to the MSKUS examination, clinical joint parameters such as an episode of joint bleeding within a month, tender joint, swollen joint, and HJHS, radiographic assessment (Petterson score) were evaluated. MSKUS was performed according to HEAD-US protocol, with bilateral ankle, knee joints, and elbow joints. Synovial hypertrophy, disease damage of cartilage and bone surface were independently scored and each HEAD-US score ≧1 was defined as the presence of synovitis, cartilage damage, and bone damage. Additionally, the presence of joint effusion and positive rate of the power doppler signal in synovitis were assessed. For each joint with synovitis, clinical joint parameters were compared independently. We compared the differences of clinical joint parameters and MSKUS findings between the asymptomatic joints with synovitis and without synovitis. <h3>Results:</h3> Of the total 168 joints in 28 PwH (median age 15 years), 147 (88%) asymptomatic joints were enrolled. The frequency of synovitis/cartilage damage/bone damage/joint effusion in each joint is shown below: Elbow (51 joints);33%/6%/8%/27%, Knee (53 joints); 40%/8%/8%/38%, Foot (43 joints);19%/51%/49%/7%. The score of HEAD-US synovial hypertrophy in each joint was shown in Figure 1. A comparison of joint parameters and US findings between asymptomatic joints with synovitis and without synovitis is shown in Table 1. Peterson's score was significantly higher in the synovitis group. Of the 45 asymptomatic joints with synovitis, 2% had tenderness, 2% had swelling, 13% had HJHS score ≥1, and 11% had Petterson score ≥1. <h3>Conclusion:</h3> Among asymptomatic joints, synovitis was more common in elbow and knee joints, and cartilage and bone damage were more common in ankle joints. Although the frequency of bone damage detected by XR or MSKUS was higher in the joint with synovitis, even in cases where radiographic bone damage was absent, synovitis was confirmed in approximately 90% of instances. From these findings, we conclude that predicting synovitis solely based on the presence of bone damage is challenging. Therefore, when considering early diagnosis for synovitis, a more comprehensive MSKUS approach beyond the presence of joint parameters is deemed necessary. <b>REFERENCES: NIL.</b> <b>Table 1.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>