Commentary Open Access
Volume 3 | Issue 6 | DOI: https://doi.org/10.33696/immunology.3.124

Joint Health Markers in Hemophilia: The State of the Art

  • 1Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584C CX Utrecht, the Netherlands
  • 2Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
+ Affiliations - Affiliations

Corresponding Author

E.D.P. van Bergen, e.d.p.vanbergen@umcutrecht.nl

Received Date: August 20, 2021

Accepted Date: November 21, 2021


Introduction: Recurrent joint bleeds in hemophilia lead to (irreversible) joint damage, so-called hemophilic arthropathy causing major morbidity amongst hemophilia patients. Progression of arthropathy is monitored by clinical examination and imaging, but sensitive joint outcome measurements detecting early and subclinical joint damage are lacking. Biochemical markers reflecting joint tissue turnover can potentially provide this significant information about the joint status.

Aim: To provide an update on our systematic review about blood and urinary biochemical markers in patients with HA and give an overview of the challenges in biomarker research.

Methods: We updated our systematic search in PubMed/EMBASE and selected all publications between September 9, 2019 and June 23, 2021. All articles were screened and eligible publications were allocated to one or several BIPED-categories.

Results: We found 220 new articles/abstracts of which twelve were eligible for inclusion. The results were in line with our previous review.Again, many studies focused on the differences between patients with hemophilia and (healthy) control groups. Cartilage markers (e.g. COL- 18N, PRO-C4, PRO-C8, C4M) were most promising for detecting joint damage progression or acute hemarthrosis.

Conclusion: Biomarkers may reflect pathophysiological processes and are theoretically useful in clinical practice and trials to accurately monitor joint damage progression. However, biomarker research comes with multiple pitfalls and challenges. Translation into daily practice is not yet achieved.


Biochemical marker research, BIPED, Hemophilic arthropathy, Joint damage, Joint tissue turnover

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