Purpose or Case Report: Haemophilic arthropathy is caused by recurrent bleeding into joint. The first bleeding episodes usually occurs in knee and ankles between 1 and 3 years old. In the pediatric patients with haemophilia, it is important to detect the joint damage as soon as possible because appropriate prophylaxis is provided. Ultrasonography is increasingly used for joint assessment recently. The purpose of this study is to present clinical importance of joint evaluation by the ultrasonography in the pediatric patients with haemophilia.
Methods & Materials: We reviewed the 38 patients (median age 10.5 years, range 2-28 years) with haemophilia who underwent both ultrasonography and radiograph of bilateral knee and ankles in 2015. We compared ultrasonography findings with radiographic findings. In addition, we performed MRI in 4 patients and compared ultrasonography findings with MRI findings.
Results: Over all, 152 joints were evaluated. 11 of 152 joints were pointed out the abnormal findings by joint radiograph. The abnormal findings that could be pointed out by joint radiograph were as follows: joint space narrowing, osteophyte, subchondral bone irregularity. On the other hand, in joint ultrasonography, the abnormal findings were pointed out in 31 of 152 joints. The abnormal findings that could be pointed out by joint ultrasonography were as follows: intraarticular effusion or hematoma, synovial thickening, cartilage thinning, cartilage surface irregularity, subchondral bone irregularity, osteophyte. The joint ultrasonography is superior in evaluation of cartilage, synovium and intraarticular fluid than joint radiograph. In addition, the ultrasonography can evaluate bone surface including osteophyte and the subchondral bone. In 4 patients underwent MRI, the abnormal findings on MRI could be detected easily and clearly also on a joint ultrasonography. Although MRI is very useful for assessment of haemophilic arthropathy, use of MRI is limited because very of its high cost and time-consuming examinations, and requirement of sedation in small children. Compared with MRI, ultrasonography is easily available and can evaluate multiple joints without sedation.
Conclusions: In the pediatric patients with haemophilia, ultrasonography is the most useful modality as screening to detect initial intraarticular abnormalities to lead to haemophilic arthropathy.