Comparison of joint status in children with haemophilia A using ultrasound and physical examination

Purpose: This study aimed to compare assessments of joint status conducted by a physiotherapist using a clinical scoring system, Haemophilia Joint Health Score (HJHS 2.1), and an ultrasound-based scoring system, Haemophilia Early Arthropathy Detection with UltraSound (HEAD-US), for detecting early signs of haemophilic arthropathy. Materials and methods: The study group comprised 32 patients aged 6-17 years with a moderate or severe bleeding disorder, haemophilia A. The elbow, ankle and knee joints were evaluated using HJHS 2.1 and HEAD-US. Results: There was a strong correlation between total scores of the clinical scoring system and the ultrasound scoring system (rS =0.66, p<.01) for elbows and knees (rS = 0.57, p<.01 and rS = 0.76, p<.01, respectively). The correlation for ankles was substantially weaker (rS = 0.36, p = .04). The clinical scores correlated also with annual bleeding rate. Conclusions: The total and individual joint scores, especially for knees and elbows, using "Haemophilia Early Arthropathy Detection with UltraSound" correlated well with "Haemophilia Joint Health Score". The clinical score, also measuring function, correlated better with bleeding rate. The relevance of HEAD-US as a prognostic tool is still unclear.