الفهرس 
HEMOPHILIA AND HEMOPHILIC ARTHROPATHYOnly 14 pages are availabe for public view
 |  | from | 122 |  |  |
| | | from | 122 | | |
Abstract
ABSTRACT
Background: Hemophilic arthropathy represents a major health concern in resource-limited settings, despite the major advances in the management of hemophilia worldwide. TNF-α has a role in the pathophysiology of chronic hemophilic arthropathy.
Aim: To evaluate levels of TNF-α and ferritin in patients with hemophilia in relation to joint arthropathy.
Methodology: we conducted a 6-months comparative cross-sectional study including hemophiliacs with arthropathy (HA+) and without arthropathy (HA⁻); as well as age- and sex-matched healthy control. Patients with a history of acute bleeding or inflammatory conditions in the previous four weeks were excluded from the study. We measured serum ferritin and TNF-α using enzyme linked immune-sorbent assay. Joints assessment was done clinically by the Hemophilia joint health score (HJHS), and radiologically by the six major joints ultrasound (US).
Results: The median (IQR) age in the hemophilia group was 11.8 (9-16.1) years. Most patients (97.3%) received regular low dose prophylaxis. The median (IQR) HJHS among (HA⁻) was 0 (0 - 1) versus 18 (9 - 22) in (HA+) group, and HJHS correlated well with the US score (p<0.001, p <0.001 and p=0.005 for knee, ankle and elbow joints respectively). The annual bleeding rate was comparable between both hemophilia groups with median (IQR) 0.88 (0- 2.25) in HA⁻ group versus 1.25 (0.5- 1.75) in HA+ patients. There was no significant difference in ferritin levels among hemophiliacs with median (IQR) in (HA+) and (HA-) of 40 (35-70) ng/ml and 30 (30-50) ng/ml respectively. TNF-α levels was significantly higher in hemophiliacs compared to control (p<0.001); with median (IQR) 500 (390 -780) in HA⁻ patients, 485 (385 -580) in HA+ group and 65 (50 - 95) for healthy controls. In a post-hoc analysis TNF-α levels were comparable among patients with and without arthropathy (p=0.56).
Conclusion: Hemophiliacs display higher TNF-α levels when compared to healthy controls, which may be a useful surrogate biomarker for bleeding episodes.