الفهرس 
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Abstract
Despite major advances in the management of patients with hemophilia worldwide, hemophilic arthropathy still represents a major concern especially in resource-limited settings. TNF-α has been implicated in the pathophysiology of chronic hemophilic arthropathy.
We aimed to evaluate serum levels of TNF-α and ferritin in patients with hemophilia in relation to joint arthropathy in patients with hemophilia as compared to healthy controls.
We conducted a 6-months comparative cross-sectional study including 38 hemophiliacs with arthropathy (HA+) and without arthropathy (HA⁻), as well as 53 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 levels of ferritin and TNF-α by using ELISA. Joint status was assessed clinically using the HJHS, and radiologically by the six major joints ultrasound (US).
Summary of our results:
• In the current study, regarding severity of disease, 4 (10.5%) had mild disease, 2 (5.3%) had moderate disease, and 32 (84.2%) had severe disease.
• In this study, the median (IQR) ABR was 1.25 (0.5 – 1.75) and ranged from 0 – 5.
• In this study, regarding target joint was positive in 34 (89.50%), 10 (29.4%) was in Elbow, 21 (61.8%) in Knee, 11 (32.4%) in Ankle, 1 (2.9%) in Hip and 1 (2.9%) in shoulder. Regarding disease Inhibitor status, 3 (7.9%) were positive inhibitors. The median (IQR) no. of joint bleeding in last 6m was 5.5 (3 – 8) and ranged from 1 – 20. The Muscle bleeds in last 6m was positive in 5 (13.2%).
• In our study, regarding age at diagnosis (mo), severity, no. of joint bleeding in last 6m, ABR, muscle bleeds in last 6m, and target joint were insignificantly different between both patient groups. Inhibitor disease status was significantly different between both patient groups. Inhibitor disease status was significantly higher in group without arthropathy compared to group with arthropathy. Regarding site of target joint was insignificantly different between both patient groups except as regard knee, group with arthropathy was significantly higher compared to group without arthropathy. Regarding site of hemarthrosis was insignificantly different between both patient groups except as regard hip was higher in patient group without arthropathy compared to group with arthropathy.
• The present study revealed that, ferritin was significantly lower in both without arthropathy group and with arthropathy group compared to control group and was significantly lower in without arthropathy group compared to with arthropathy group.
• The current study revealed that TNF-α was significantly higher in both without arthropathy group and with arthropathy group compared to control group and was significantly higher in without arthropathy group compared to with arthropathy group.
• Regarding ultrasound score (Knee, Ankle, elbow, HJHS), there was a significant difference between the group without arthropathy and group with arthropathy. Ultrasound score was significantly higher in with arthropathy group compared to without arthropathy group.
• The current study showed that, there was a positive significant correlation between HJHS and other U/S score (Knee, Ankle, and Elbow).
• There was an insignificant correlation between TNF-α level and no. of previous bleeding in last 6m and ABR.
• There was an insignificant relation between TNF-α results with the other detailed criteria and hemophilia disease phenotype, inhibitor status, hemoarthrosis and severity between patient group.