Humanistic burden of problem joints for children and adults with haemophilia

Haemophilia. 2023 Mar;29(2):608-618. doi: 10.1111/hae.14731. Epub 2022 Dec 27.


Introduction: The "problem joint" (PJ) concept was developed to address patient-centric needs for a more holistic assessment of joint morbidity for people with haemophilia (PwH).

Aim: To quantify the humanistic burden of PJs in PwH to further support validation of the PJ outcome measure.

Methods: Multivariable regression models evaluated the relationship between PJs and health-related quality of life (HRQoL, EQ-5D-5L) and overall work productivity loss (WPL) using data from the 'Cost of HaEmophilia: a Socioeconomic Survey' population studies (adults: CHESS II, CHESS US+; children/adolescents: CHESS-Paeds). Covariates included were haemophilia severity, age, comorbidities and education.

Results: The CHESS II sample included 292 and 134 PwH for HRQoL and WPL analyses, mean age 38.6 years (39% ≥1 PJ, 61% none). CHESS US+ included 345 and 239 PwH for HRQoL and WPL, mean age 35 years (43% ≥1 PJ, 57% none). CHESS-Paeds included 198 PwH aged 4-17 (HRQoL only), mean age 11.5 years (19% ≥1 PJ, 81% none). In CHESS II and CHESS US+, presence of PJs was associated with worse HRQoL (Both p < .001). Few CHESS-Paeds participants had PJs, with no significant correlation with HRQoL. In CHESS II, upper body PJs were significantly correlated to WPL (p < .05). In CHESS US+, having ≥1 PJ or upper and lower body PJs were significantly correlated to WPL (vs. none; both p < .05).

Conclusion: This study has shown a meaningful burden of PJs on PwH, which should be considered in clinical and health policy assessments of joint health.

Keywords: haemarthrosis; haemophilia; humanistic burden; problem joint; productivity impairment; quality of life.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Comorbidity
  • Educational Status
  • Hemophilia A* / epidemiology
  • Humans
  • Quality of Life
  • Surveys and Questionnaires