Skip to main content

Advertisement

SpringerLink
Log in

Assessing joint involvement in haemophilia by clinical rheumatologic scores. A pilot study on similarities with subjects with psoriatic arthritis

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Because of joint haemorrhages, severe haemophilia subjects often have limitations in their daily activities. Current orthopaedic scores (OJS) in haemophilia miss mild joint impairments and only pick up severe alterations. Twelve young severe haemophiliacs (20.25 ± 1.9 years of age), were evaluated for OJS as well as for indices employed in rheumatoid arthritis [28-joint Disease Activity Score (DAS-28), Ritchie index, Health Assessment Questionnaire (HAQ), visual analogue scale (VAS)], spondyloarthritis [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), HAQ, VAS] and osteoarthritis [Knee injury and Osteoarthritis Outcome Score (KOOS), VAS]. Twenty-four matched apparently healthy subjects and 29 subjects with psoriatic arthritis (PsA) with oligoarticular involvement (one to three swollen joints) served as controls. In addition to the impairment of target joints (elbow, in five of five in those on-demand treatment; three, elbows; four, knee in those on secondary prophylaxis), HAQ (mean 0.71 ± 0.95) and VAS (3.12 ± 2.36) documented a quality of life and a perception of pain in haemophiliacs similar to that of PsA subjects (p = 0.061 and p = 0.063, respectively). Their Ritchie index did not differ from that of subjects with psoriatic arthritis (5.75 ± 8.1 vs 7.73 ± 9.22; p = 0.408), nor did the BASDAI score with respect to psoriatic arthritis patients (p = 0.105). Six of 12 haemophiliacs (50%) had KOOS values from 70 to 50 (significant function joint impairment); 3 of 12 (25%) showed DAS-28 values >3.2 (moderate disease activity), 2 of 12 (16.6%) severe disease activity (>5.1). All these indices significantly correlated with VAS and HAQ in haemophilia subjects. A rheumatologic assessment may help identify early polyarticular disease and subclinical abnormalities involving joints not usually studied (not target joint) in haemophiliacs. These pilot data provide the rationale for testing a systemic involvement in haemophiliacs by means of high-tech imaging and to start early-onset prophylaxis/treatment in this setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stein H, Duthie RB (1981) The pathogenesis of chronic haemophilic arthropathy. J Bone Joint Surg Br 63B:601–609

    PubMed  CAS  Google Scholar 

  2. Madhok R, York J, Sturrock RD (1991) Haemophilic arthritis. Ann Rheum Dis 50:588–591

    Article  PubMed  CAS  Google Scholar 

  3. Zeman DH, Roberts ED, Shoji H, Miwa T (1991) Experimental haemarthrosis in rhesus monkeys: morphometric, biochemical and metabolic analyses. J Comp Pathol 104:129–139

    Article  PubMed  CAS  Google Scholar 

  4. Roy S, Ghadially FN (1966) Pathology of experimental haemarthrosis. Ann Rheum Dis 25:402–415

    PubMed  CAS  Google Scholar 

  5. Gilbert MS (1993) Prophylaxis: musculoskeletal evaluation. Semin Hematol 30(suppl 2):3–6

    PubMed  CAS  Google Scholar 

  6. Poonnoose PM, Manigandan C, Thomas R et al (2005) Functional independence score in haemophilia (FISH): a new performance-based instrument to measure disability. Haemophilia 11:598–602

    Article  PubMed  CAS  Google Scholar 

  7. Hacker MR, Funk SM, Manco-Johnson MJ et al (2007) The Colorado haemophilia paediatric joint physical examination scale: normal values and interrater reliability. Haemophilia 13:71–78

    Article  PubMed  CAS  Google Scholar 

  8. Di Minno MND, Iervolino S, Peluso R, Scarpa R, Di Minno G; on behalf of the CaRRDs study group (2011) Carotid intima-media thickness in psoriatic arthritis: differences between tumor necrosis factor-{alpha} blockers and traditional disease-modifying antirheumatic drugs. Arterioscler Thromb Vasc Biol (in press)

  9. Taylor WJ, Harrison AA (2004) Could the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) be a valid measure of disease activity in patients with psoriatic arthritis? Arthritis Rheum 51:311–315

    Article  PubMed  Google Scholar 

  10. Gladman DD, Mease PJ, Healy P, Helliwell PS, Fitzgerald O, Cauli A, Lubrano E, Krueger GG, van der Heijde D, Veale DJ, Kavanaugh A, Nash P, Ritchlin C, Taylor W, Strand V (2007) Outcome measures in psoriatic arthritis. J Rheumatol 34(5):1159–1166

    PubMed  Google Scholar 

  11. Ritchie DM, Boyle JA, McInnes JM et al (1968) Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med 37:393–406

    PubMed  CAS  Google Scholar 

  12. Van der Heijde DMFM, Johannes WG, Jacobs JWG (1998) The original “DAS” and the “DAS28” are not interchangeable: comment on the article by Prevoo et al. Arthritis Rheum 41(5):942–950

    Article  PubMed  Google Scholar 

  13. Garrett S, Jenkinson T, Kennedy G, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Activity index. J Rheumatol 21:2286–2291

    PubMed  CAS  Google Scholar 

  14. Myles PS, Troedel S, Boquest M, Reeves M (1999) The pain visual analog scale: is it linear or nonlinear? Anesth Analg 89:1517–1520

    PubMed  CAS  Google Scholar 

  15. Bruce B, Fries JF (2003) The Stanford Health Assessment Questionnaire: a review of its history, issues, progress, and documentation. J Rheumatol 30:167–178

    PubMed  Google Scholar 

  16. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS) development of a self-administred outcome measure. J Orthop Sports Phys Ther 28(2):88–96

    PubMed  CAS  Google Scholar 

  17. Scarpa R, Oriente P, Pucino A, Vignone L, Cosentini E, Minerva A, Biondi Oriente C (1988) The clinical spectrum of psoriatic spondylitis. Br J Rheumatol 27(2):133–137

    Article  PubMed  CAS  Google Scholar 

  18. Roosendaal G, Lafeber FP (2006) Pathogenesis of haemophilic arthropathy. Haemophilia 12(suppl 3):117–121

    Article  PubMed  Google Scholar 

  19. Wen FQ, Jabbar AA, Chen YX, Kazarian T, Patel DA, Valentino LA (2002) c-myc proto-oncogene expression in hemophilic synovitis: in vitro studies of the effects of iron and ceramide. Blood 100:912–916

    Article  PubMed  CAS  Google Scholar 

  20. Valentino LA, Hakobyan N, Kazarian T, Jabbar KJ, Jabbar AA (2004) Experimental haemophilic synovitis: rationale and development of a murine model of human factor VIII deficiency. Haemophilia 10:280–287

    Article  PubMed  CAS  Google Scholar 

  21. Hakobyan N, Kazarian T, Valentiono LA (2005) Synovitis in a murine model of human factor VIII deficiency. Haemophilia 11:227–232

    Article  PubMed  CAS  Google Scholar 

  22. Hakobyan N, Kazarian T, Jabbar AA, Jabbar KJ, Valentiono LA (2004) Pathobiology of hemophilic synovitis: overexpression of mdm2 oncogene. Blood 104:2060–2064

    Article  PubMed  CAS  Google Scholar 

  23. Roosendaal G, Vianen ME, Marx JJM, van den Berg HM, Lafeber FPJG, Bijlsma JWJ (1999) Blood induced joint damage: a human in vitro study. Arthritis Rheum 42:1025–1032

    Article  PubMed  CAS  Google Scholar 

  24. Hooiveld MJJ, Roosendaal G, van den Berg HM, Bijlsma JWJ, Lafeber FPJG (2003) Blood-induced joint damage: long-term effects in vivo and in vitro. J Rheumatol 30:339–344

    PubMed  Google Scholar 

  25. Roosendaal G, Van Rinsum AC, Vianen ME, van den Berg HM, Lafeber FPJG, Bijlsma JWJ (1999) Haemophilic arthropathy resembles degenerative rather than inflammatory joint disease. Histopathology 34:144–153

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosures

All the authors have revised and approved the present manuscript.

Professor Giovanni Di Minno, Professor Raffaele Scarpa and Doctor Antonio Coppola did not receive specific funding for the preparation of this manuscript. During the last 5 years, they served on advisory boards and received honoraria and grants for research unrelated to this study. The other authors have nothing to declare.

Author information

Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, Regional Reference Centre for Coagulation Disorders, Federico II University, Naples, Italy

    Matteo Nicola Dario Di Minno, Anna Russolillo, Antonio Coppola, Anna Guida & Giovanni Di Minno

  2. Department of Clinical and Experimental Medicine, Rheumatology Research Unit, Federico II University, Via Sergio Pansini 5, 80131, Naples, Italy

    Salvatore Iervolino, Rosario Peluso, Antonio del Puente & Raffaele Scarpa

  3. Department of Surgery, Orthopedic Surgery and Trauma, Federico II University, Naples, Italy

    Carlo Ruosi

Authors
  1. Matteo Nicola Dario Di Minno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Salvatore Iervolino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rosario Peluso
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio del Puente
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anna Russolillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio Coppola
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carlo Ruosi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anna Guida
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Raffaele Scarpa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Giovanni Di Minno
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rosario Peluso.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Di Minno, M.N.D., Iervolino, S., Peluso, R. et al. Assessing joint involvement in haemophilia by clinical rheumatologic scores. A pilot study on similarities with subjects with psoriatic arthritis. Clin Rheumatol 30, 915–919 (2011). https://doi.org/10.1007/s10067-011-1707-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-011-1707-4

Keywords

Search

Navigation