Females with FVIII and FIX deficiency have reduced joint range of motion

Abstract

Little is known about rates of joint bleeding among females with FVIII/FIX deficiency or hemophilia carriers. In a cross-sectional study, we tested the hypothesis that females with FVIII or FIX deficiency enrolled in the Universal Data Collection (UDC) project had a reduced mean overall joint range of motion (ROM) compared with historic controls from the Normal Joint Study. Demographics, clinical characteristics, and joint ROM measurements on 303 females without a bleeding disorder and 148 females with FVIII and FIX deficiency, respectively, between the ages of 2-69 years and a body mass index (BMI) ≤ 35 were compared. Multivariate linear regression was performed with the overall joint ROM (sum of the right and left ROM measurements of five joints) as the dependent variable and FVIII or FIX activity as the independent variable adjusting for age, race, BMI, and number of joint bleeds reported over the last 6 months. As FVIII and FIX activity decreased, the mean overall joint ROM became reduced and in most cases was significantly lower than that of the controls regardless of age and clinical hemophilia severity. Further investigation of reduced joint ROM as evidence of subclinical joint bleeding in females with FVIII and FIX deficiency is warranted.

Figure 1

Predicted mean overall range of motion (ROM) by age and clinical severity, for 2- to 69-year old females with FVIII deficiency. Graph was created using separate linear regression models for normal FVIII activity, and for mild, moderate, and severe FVIII deficiency adjusted for race and body mass index (BMI). Mean overall ROM was calculated by setting categorical variables equal to the reference value and by using the severity group mean for the continuous variable BMI. Normal activity (>40% FVIII); Mild deficiency (>5%–40%); Moderate deficiency (1%–5%); Normal Study (normal females from Normal Joint Study).