Diagnosis and treatment of chronic synovitis in patients with haemophilia: consensus statements from the Italian Association of Haemophilia Centres.
Matteo Nicola Dario Di MinnoMariasanta NapolitanoAnna Chiara GiuffridaErminia BaldacciChristian CarulliElena BoccalandroClarissa BrunoEleonora FornerisIrene RiccaWalter PasseriMarco MartinelliGianna Franca RivoltaLuigi Piero SolimenoCarlo MartinoliAngiola RocinoGianluigi Pastanull nullPublished in: British journal of haematology (2021)
Although synovitis is recognized as a marker of joint disease activity, its periodic assessment is not included in routine clinical surveillance of patients with haemophilia (PwH). In order to evaluate the current knowledge and to identify controversial issues, a preliminary literature search by the Musculoskeletal Committee of the Italian Association of Haemophilia Centres (AICE) has been conducted. Statements have been established and sent to the Italian AICE members to collect their level of agreement or disagreement by a Delphi process. Thirty-seven consensus recommendations have been drafted. We found a general agreement on the indication to consider the presence of synovitis as a marker of joint disease activity in PwH. Accordingly, there was agreement on the indication to search for synovitis both in patients reporting joint pain and in asymptomatic ones, recognizing ultrasound as the most practical imaging technique to perform periodic joint screening. Interestingly, after detection of synovitis, there was agreement on the indication to modify the therapeutic approach, suggesting prophylaxis in patients treated on demand and tailoring treatment in patients already under prophylaxis. Whereas the need of an early consultation with a physiotherapist is recommended for PwH affected by chronic synovitis, the exact timing for an orthopaedic surgeon consultation is currently unknown.
Keyphrases
- disease activity
- systemic lupus erythematosus
- rheumatoid arthritis
- rheumatoid arthritis patients
- ankylosing spondylitis
- clinical practice
- juvenile idiopathic arthritis
- end stage renal disease
- palliative care
- magnetic resonance imaging
- newly diagnosed
- ejection fraction
- systematic review
- chronic kidney disease
- public health
- healthcare
- chronic pain
- pain management
- emergency department
- computed tomography
- mass spectrometry
- patient reported outcomes
- minimally invasive
- photodynamic therapy
- patient reported
- electronic health record
- fluorescence imaging
- robot assisted
- sensitive detection
- label free