Department of Medicine, Division of Hematology/Oncology, University of California San Diego, 9333 Genesee Avenue, St 310, San Diego, CA, 92122, USA.
Department of Physical Medicine and Rehabilitation, University of California San Diego, San Diego, CA, USA.
BMC Musculoskelet Disord. 2023 Apr 15;24(1):299. doi: 10.1186/s12891-023-06419-5.
The Joint Activity and Damage Exam (JADE) is a point-of-care (POC) musculoskeletal ultrasound (MSKUS) protocol for non-radiologists to evaluate hemophilic arthopathy. Our aim was to determine the consistency of cross-sectional analyses of direct tissue measurements (JADE protocol) and clinical Hemophilia Joint Health Score [HJHS] and functional joint assessments (arc) at three clinic visits.
We prospectively studied adults (n = 44) with hemophilia (A or B) of any severity and arthropathy at 3 North American sites. We assessed HJHS, total arc, and JADE parameters (bilateral elbows, ankles, and knees) at study entry, at ≈12-18 months, and at ≈24-36 months, and used MSKUS to evaluate painful episodes between study visits. JADE measurements included osteochondral alterations, cartilage thickness, and soft tissue expansion at sentinel positions. Associations between joint HJHS and total arc with each JADE variable were examined with random intercept models.
At each visit increasing HJHS and decreasing total arc were associated in the expected direction with increasing length of OAs and soft tissue expansion in all joints, and decreasing cartilage thickness in the knee. However, HJHS associations with cartilage thickness were U-shaped for elbow and ankle (i.e. cartilage thinning and thickening). Associations between total arc and cartilage thickness followed a similar curve. (Near) normal levels of both joint parameters (HJHS and total arc) were associated with normal ranges of cartilage thickness. JADE views were also helpful to detect hemarthrosis in association with joint pains.
POC MSKUS applying direct tissue measurements using the JADE protocol provided reproducible cross-sectional associations with joint health outcomes on three visits. These findings advance protocol validation and enable iterative adaptations resulting in JADE protocol version 2.
联合活动和损伤检查 (JADE) 是一种非放射科医生用于评估血友病性关节炎的即时护理 (POC) 肌肉骨骼超声 (MSKUS) 方案。我们的目的是确定直接组织测量的横断面分析（JADE 方案）与临床血友病关节健康评分 [HJHS] 和功能关节评估（弧）在三次就诊时的一致性。
我们前瞻性研究了北美三个地点的任何严重程度和关节炎的成人（n=44）血友病（A 或 B）患者。我们在研究开始时、约 12-18 个月时和约 24-36 个月时评估了 HJHS、总弧和 JADE 参数（双侧肘部、踝关节和膝关节），并在研究访问之间使用 MSKUS 评估疼痛发作。JADE 测量包括在哨兵位置的骨软骨改变、软骨厚度和软组织扩张。使用随机截距模型检查关节 HJHS 和总弧与每个 JADE 变量之间的关联。
在每次就诊时，预期方向上的 HJHS 增加和总弧减少与所有关节的 OA 长度和软组织扩张增加以及膝关节的软骨厚度减少相关。然而，肘关节和踝关节的 HJHS 与软骨厚度的相关性呈 U 形（即软骨变薄和增厚）。总弧与软骨厚度之间的相关性遵循类似的曲线。（接近）正常的关节参数（HJHS 和总弧）与正常的软骨厚度范围相关。JADE 视图也有助于检测与关节疼痛相关的关节积血。
使用 JADE 方案进行直接组织测量的 POC MSKUS 提供了在三次就诊时与关节健康结果的可重复的横断面关联。这些发现推进了方案验证，并使 JADE 方案版本 2 的迭代适应成为可能。
