23. Assessment of Joint Involvement in Hemophilia

  1. Emérito-Carlos Rodríguez-Merchán MD, PHD2,3 and
  2. Leonard A. Valentino MD4
  1. Erik Berntorp

Published Online: 12 MAY 2011

DOI: 10.1002/9781119979401.ch23

Current and Future Issues in Hemophilia Care

Current and Future Issues in Hemophilia Care

How to Cite

Berntorp, E. (2011) Assessment of Joint Involvement in Hemophilia, in Current and Future Issues in Hemophilia Care (eds E.-C. Rodríguez-Merchán and L. A. Valentino), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119979401.ch23

Editor Information

  1. 2

    Department of Orthopedic Surgery and Hemophilia Unit, La Paz University Hospital, Spain

  2. 3

    School of Medicine, Autonomous University, Madrid, Spain

  3. 4

    Hemophilia and Thrombophilia Center, Rush University Medical Center, Chicago, IL, USA

Author Information

  1. Skåne University Hospital, Malmö, Sweden

Publication History

  1. Published Online: 12 MAY 2011
  2. Published Print: 13 MAY 2011

ISBN Information

Print ISBN: 9780470670576

Online ISBN: 9781119979401



  • hemophilia;
  • prophylaxis;
  • hemarthrosis;
  • arthropathy;
  • radiography;
  • MRI;
  • ultrasonography


Assessment of joint involvement in hemophilia is based on physical examination, radiography, magnetic resonance imaging (MRI), and, recently, ultrasonography. Scales for the scoring of hemophilic arthropathy have been developed and used in clinical trials to evaluate different treatment protocols such as prophylaxis versus treatment on demand and also different prophylactic regimens. During the 1980s, the World Federation of Hemophilia (WFH) endorsed a physical examination (PE) scale and a radiographic (Pettersson) scale. Improved hemophilia treatment has resulted in less pronounced hemophiliac arthropathy, which has prompted updating of the PE scale in terms of its sensitivity and suitability for children. The new scale is named the Hemophilia Joint Health Score (HJHS). The advent of MRI has increased the ability to detect early joint disease, and an international MRI scale has been developed. These new scales have the potential to contribute to the development and evaluation of better prophylactic protocols, but further prospective studies are needed.