Risk Factors for the Progression of Haemophilic Arthropathy – The PUSH-Study

Introduction Haemophilic arthropathy (HA) is a progressive joint disorder resulting from recurrent haemarthroses, typically affecting the same joint over time. In its early stage, HA is characterized by signs of increased joint activity (Act), such as synovial hypertrophy and hypervascularization. If not effectively managed, these changes can lead to irreversible structural joint damage (Dam), including cartilage degeneration and bone erosions. This prospective study aimed to identify risk factors associated with progression of Act and Dam in patients with haemophilia (PwH). Method This prospective observational study followed 74 patients with moderate or severe haemophilia A or B over three years. Ankle, knee, and elbow joints of PwH were assessed at baseline and at follow-up utilizing the Haemophilic Early Arthropathy Detection with Ultrasound scoring system. Progression of Act and Dam was defined as follow-up score minus baseline score>0.A multivariable regression analysis was used to analyse potential risk factors, including age (>30 years), body-mass-index (BMI;>24.9 kg/m²), pain (numerical rating scale>0), pain medication use (yes vs. no), occurrence of joint bleeds (>0 bleeds), presence of Act or Dam at baseline (Act>0 / Dam>0), factor concentrate switch (yes vs. no), haemophilia severity (severe vs. non-severe), treatment regimen (on-demand vs. prophylaxis), low treatment adherence, and lower extremity joints (lower extremities vs. upper extremities). Each risk factor was dichotomized, with the lower-risk category serving as the reference group. A significance level of p≤0.05 was used for the multivariable analyses. Fig. 1 Multivariable analysis of risk factors for the progression of joint activity in joints of Results Act and Dam progression were observed in 31.8% and 18.5% of joints, respectively. Act progression was independently associated with Dam at baseline (OR=2.320 [95%-CI: 1.053, 5.110], p=0.037) and treatment adherence (OR=0.351 [95%-CI: 0.173, 0.712], p=0.004), while a trend was found for BMI (OR=1.993 [95%-CI: 0.939, 4.229], p=0.073) and pain (OR=0.515 [95%-CI: 0.249, 1.065], p=0.073). Dam progression was independently linked to Act (OR=6.463 [95%-CI: 2.140, 19.524], p