OC 01.3 - Use of the Joint Activity Damage Exam (JADE) ultrasound protocol for hemophilic joint assessment enables determination of annual rate changes of intraarticular tissue measurements

Saturday, June 22, 2024

13:30 – 13:45 ICT

Room: Ballroom B1

Presenting Author(s)

Parthiv V. Sheth, MD

Fellow
University of California San Diego
San Diego, California, United States

Co-Author(s)

PA

Peter Aguero

Physical Therapist
University of California San Diego
San Diego, California, United States
MG

Michael Glenzer

Statistician & Research Coordinator
University of California San Diego
San Diego, California, United States
IN

Isaac Nwi-Mozu

Statistician
University of California San Diego
San Diego, California, United States
BS

Bruno Steiner

Physical Therapist
Washington Center for Bleeding Disorders
Seattle, Washington, United States
CB

Cindy Bailey

Physical Therapist
Orthopaedic Hemophilia Treatment Center at Orthopaedic Institute for Children Los Angeles
Los Angeles, California, United States
Doris V. Quon

Medical Director
Orthopaedic Hemophilia Treatment Center at Orthopaedic Institute for Children Los Angeles
Los Angeles, California, United States
Rebecca Kruse-Jarres

Medical Director
Washington Center for Bleeding Disorders
Seattle, Washington, United States
Annette von Drygalski, MD, PharmD, RMSK

Professor of Clinical Medicine
University of California San Diego
San Diego, California, United States

Background: Ultrasonographic assessment of hemophilic joints has allowed for rapid evaluation of intra-articular abnormalities. The Joint Activity Damage Exam (JADE) is a validated ultrasound protocol to measure cartilage thickness, osteochondral alterations, and soft tissue expansion. JADE measurements correlate well with Hemophilia Joint Health Scores (HJHSs), but longitudinal rates of tissue measurement changes have not yet been studied.

Aims: Determine rate changes in JADE tissue measurements of both healthy and unhealthy joints in persons with hemophilia.

Methods: We prospectively studied adults (n = 44) with hemophilia (A or B) of any severity and arthropathy at 3 North American sites. We assessed HJHS and JADE measurements (osteochondral alterations, cartilage thickness, and soft tissue expansion) in bilateral elbows, ankles, and knees at study entry, at ≈12–18 months, and at ≈24–36 months, and used musculoskeletal ultrasound to verify bleeding episodes between study visits. The annual rate change of tissue thickness was calculated. We analyzed associations between the rate changes of healthy (HJHS 0-3) and unhealthy (HJHS ≥4) joints.

Results: Median age was 36 [IQR 28,49] years and median total HJHS was 27 [IQR 18,42]. Evaluation included 264 joints (139 healthy; 125 unhealthy at baseline). The annual bleed rate was low ( < 1). Median rate changes for most JADE measurements were not statistically significantly different between healthy and unhealthy joints. Among 50 joints with zero cartilage thickness at baseline (5 healthy; 45 unhealthy), 11 demonstrated positive measurements at study exit.

Conclusion(s): The fact that unhealthy tissues did not deteriorate faster than healthy tissues, and that cartilage could regain thickness was unexpected. These are encouraging observations, enabled by precise ultrasonographic measurements, suggesting unanticipated plasticity of cartilage and bone in arthropathic joints. Therefore, incorporating JADE into joint health studies will be highly valuable to ascertain subclinical effects of new therapies by objective imaging.