CO028 | ASSOCIATION BETWEEN BONE MARROW EDEMA AND JOINT PAIN IN HEMOPHILIC ARTHROPATHY: A RETROSPECTIVE SINGLE-CENTER STUDY
R. Gualtierotti1|2, E. Guido3, J. Acquati Lozej4, A. Giachi1, M. Fassi1, M.L. Franzone5, L.M. Gentile5|6, S.M. Siboni1, L.P. Solimeno4, F. Peyvandi1|2 | 1Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milano, Italy; 2Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy; 3Università degli Studi di Milano, Dipartimento di Oncologia ed EmatoOncologia, Milano, Italy; 4Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Orthopaedic Surgery and Traumatology, Milano, Italy; 5Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Radiology, Milano, Italy; 6Università degli Studi di Milano, Dipartimento di Oncologia ed Emato-Oncologia, Milano, Italy
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Background. Bone marrow edema (BME) on magnetic resonance imaging (MRI) is a common finding in osteoarthritis and may reflect osteochondral damage or microfractures. However, its presence in hemophilic arthropathy and its relationship with joint pain is often overlooked.
Aims. To assess the prevalence of BME in hemophilic joints of consecutive patients undergoing MRI for different reasons and to evaluate its association with joint pain, age, and global joint health scores.
Methods. We retrospectively reviewed 55 joint MRI examinations performed between 2013 and 2024 in 32 persons with hemophilia. For each examination we recorded the presence/absence of BME, joint involved, BME grade, age, Haemophilia Joint Health Score (HJHS), Haemophilia Early Arthropathy Detection with Ultrasound (HEAD-US), home treatment category, indications for MRI, presence and type of pain (acute spontaneous, acute post‑traumatic, or chronic), and prosthesis status.
Results. BME was present in 35/55 joints (63.6%). Median age at MRI was 37.1 years in joints with BME and 32.6 years without (p = 0.56). Patients with joints with BME had higher HJHS (median 13 vs 5; p = 0.03) and HEAD‑US scores (median 11.5 vs 3; p = 0.001). Pain was reported in 14/35 (40%) joints with BME and 2/20 (10%) without BME; Fisher’s exact test showed a significant association (p = 0.03) between pain and BME. Among painful joints, acute spontaneous pain predominated in the BME group (11 vs. 2 cases), whereas post‑traumatic pain was uncommon (2 vs. 0), and only one case of chronic pain was observed. Most joints with BME were ankles and elbows, and severe grades of edema were seen in 40% of BME joints. Home therapy was heterogeneous: FVIII standard (48.6%), FVIII EHL (8.6%), FIX EHL (11.4%), emicizumab (14.3%), concizumab (2.9%), DDAVP (5%), and other regimens.
Conclusions. In this cohort, BME was frequent and associated with higher HJHS and HEAD‑US scores. A significant association was found between BME and joint pain, particularly spontaneous acute pain. These findings suggest that BME contributes to symptomatic arthropathy. Prospective studies are needed to clarify the clinical and prognostic significance of BME in persons with hemophilia
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