Ağır Hemofili Hastalarında Hemofilik Artropatisinin Ultrasonla Hemofili Erken Artropati Tespiti (HEAD-US) Skoru ve Hemofili Eklem Sağlığı Skoru (HJHS) kullanılarak farklı kullanıcılar tarafından değerlendirilmesi

Abstract

Amaç: Hemofilik artropatinin ultrasonla hemofili erken artropati tespiti (HEAD-US) ve hemofili eklem sağlığı (HJHS) skorları kullanılarak değerlendirilmesine ilişkin az sayıda çalışma vardır. Bu çalışmanın amacı ağır hemofili hastalarında hemofilik artropatinin HEAD-US ve HJHS skorları kullanılarak radyolog ve romatologlar tarafından eş zamanlı değerlendirilmesini karşılaştırmaktır. Gereç ve Yöntemler: Altı aylık aralıklarla, ağır hemofili A ve B'li 28 hastanın 168 eklemi 2021 ve 2022 yılları arasında iki farklı zaman noktasında (TP1 ve TP2) incelendi. Tüm hastaların HJHS skorları kaydedildi. Her hemofilik hastanın altı eklemindeki (dirsek, diz ve ayak bileği) HEAD-US skorları radyologlar ve romatologlar tarafından değerlendirildi. Bulgular: HEAD-US ile yapılan ayak bileği değerlendirmesi, HJHS skoru 0 olan hastalarda TP1'de en yüksek sinovit oranı (%34) radyolog değerlendirmesi ile saptandı. HEAD-US ile yapılan diz değerlendirmesi, HJHS skoru 0 olan hastalarda TP1'de en yüksek sinovit ve kemik hasarı oranı (%56) romatolog değerlendirmesi ile bulundu. HEAD-US ayak bileği ve diz muayenesinde, HJHS skoru 0 olan hastalarda TP2'de en yüksek sinovit oranı (%34) radyolog değerlendirmesi ile tespit edildi. HEAD-US diz değerlendirmesi, HJHS skoru 0 olan hastalarda TP2'de en yüksek sinovit oranı (%44) romatolog değerlendirmesi ile saptandı. Dirsek ve diz eklemlerinin değerlendirilmesinde HJHS ile HEAD-US arasında orta ile iyi derece korelasyon tespit edildi (p< 0.05). Sonuç: Bulgularımız HJHS skorlamada patoloji saptanmayan ağır hemofili hastalarında radyologlara benzer şekilde romatologlar tarafından yapılan HEAD-US skorlama ile subklinik hemofilik artropatinin erken teşhisinde klinisyenlerin de önemli rolü olduğunu göstermektedir.

Keywords

• HEAD-US
• HJHS
• radyolog
• romatolog

ASSESSMENT OF HAEMOPHILIC ARTHROPATHY IN PATIENTS WITH SEVERE HEMOPHILIA USING THE HEMOPHILIA EARLY ARTHROPATHY DETECTION WITH ULTRASOUND (HEAD-US) SCORE AND THE HEMOPHILIA JOINT HEALTH SCORE (HJHS) BY DIFFERENT CAREGIVERS

Abstract

Objective: There are few studies on the assessment of hemophilic arthropathy using the hemophilia early arthropathy detection with ultrasound (HEAD-US) and hemophilia joint health score (HJHS) scores.This study aimed to examine how radiologists and rheumatologists could evaluate hemophilic arthropathy in individuals with severe hemophilia using HEAD- US and HJHS scores simultaneously. Material and Methods: Between 2021 and 2022, 168 joints from 28 individuals with severe hemophilia A and B were investigated at six-month intervals (TP1 and TP2). The HJHS scores of all patients were recorded. The HEAD-US in each hemophilic patient's six joints (elbow, knee, and ankle) were evaluated by radiologists and rheumatologists. Results: The ankle assessment by HEAD-US showed the highest rate (34%) of synovitis by radiologist evaluation at TP1 in patients with an HJHS score of 0. The knee assessment by HEAD-US showed the highest rate (56%) of synovitis and bone damage by rheumatologist evaluation at TP1 in patients with an HJHS score of 0. HEAD-US ankle and knee examinations revealed the highest rate of synovitis (34%) by radiologist evaluation at TP2 in patients with an HJHS score of 0. The HEAD-US knee assessment revealed the highest rate of synovitis (44%) by rheumatologist evaluation at TP2 in patients with an HJHS score of 0. In the assessment of elbow and knee joints, there was a moderate to good correlation between HJHS and HEAD-US scores by different caregivers at different time points (p< 0.05). Conclusion: Our findings indicate that clinicians play a crucial role in the early diagnosis of subclinical hemophilic arthropathy, with HEAD-US scoring conducted by rheumatologists similar to radiologists in severe hemophilia patients without pathology in HJHS scoring.

Keywords

• HEAD-US
• HJHS
• radiologist
• rheumatologist

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