The Impact of HEAD-US Scoring System for Observing the Protective Effect of Prophylaxis in Hemophilia Patients: A Prospective, Multicenter, Observational Study.

Objective To observe preventive effect of prophylactic treatment on joint health in people with hemophilia (PwH) and to investigate the importance of integration of ultrasonographic examination into clinical and radiological evaluation of the joints. Material and Methods This national, multicenter, prospective, observational study included male patients aged ≥6 years with the diagnosis of moderate or severe hemophilia A or B from 8 centers across Turkey between January 2017-March 2019. Patients were followed-up for 1 year by 5 visits (baseline, 3rd, 6th, 9th, and 12th month visits). The Hemophilia Joint Health Score (HJHS) was used for physical examination of joints; the Pettersson Scoring was used for radiological assessment; Point-of-care (POC) ultrasonography was used for bilateral examinations of joints; and the Hemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) was used for evaluation of ultrasonography results. Results Seventy-three hemophilic patients, of whom 62 had hemophilia A and 11 had hemophilia B, were included and 24.7% had target joints at baseline. The HJHS and HEAD-US scores were significantly increased at the 12th month in all patients. These scores were also higher in the hemophilia A subgroup than the hemophilia B subgroup. However, in childhood group increment of scores were not significant. The HEAD-US total score was significantly correlated with both the HJHS total score and Pettersson total score at the baseline and 12th month. Conclusion The HEAD-US and HJHS scoring systems are valuable tools during follow-up examinations of PwH and they complement each other. We suggested that POC Ultrasonographic evaluation and the HEAD-US scoring system may be integrated into differential diagnosis of bleeding and long-term monitoring for joint health as a routine procedure.