The Effect of Overweight and Obesity on Joint Damage in Patients with Moderate or Severe Hemophilia.

Abstract

Abstract Hemophilia is due to a lack of a clotting factor, usually factor 8 or 9, and confers an increased tendency to bleed. Repeated joint bleeds lead to bone and joint damage, and ultimately to joint deformity and significant morbidity. Overweight and obesity have been found to have major impact on the health of children and adolescents. Concern about weight gain among children has been high due to negative health outcomes in addition to the increasing prevalence of the problem. To evaluate the impact of overweight and obesity on joint damage in patients with hemophilia, we conducted a retrospective evaluation of males aged 6 to 25 years with moderate or severe hemophilia who presented to our treatment center from 1/1998 to 12/2005. Of 197 patients initially identified from our hemophilia population as eligible for the study, 56 met the inclusion criteria of having a diagnosis of moderate or severe hemophilia, and available measurements for height, weight and joint range of motion (ROM). Patients were scored based upon ROM for weight bearing joints (ankle, knee, and hip). We assigned a score of 1 for each ROM measured outside of the range of normal. Each joint possessed the possibility of two scores, one each for flexion and extension, resulting in joint scores ranging from 0–6. Patients were divided into two categories: those with a score of < 1 and those with scores from 1–6 and/or a target joint. Forty-four subjects had additional information about the number of bleeding episodes from the beginning of the time of the study until the time of their ROM measurements. We then compared patients with a normal BMI to those with BMI ≥ 85%ile for age. For the 44 subjects in whom bleeding data was available, the rate of recorded joint bleeding of those with BMI ≥ 85%ile did not significantly increase compared to those with a lower BMI over the time of the study (odds ratio(OR) = 1.44, 95%CI 0.4 – 5.1). In addition, we found no difference between the groups when comparing the amount of bleeding over the year prior to the ROM measurements (OR 0.6, 95% CI 0.2 – 1.9). However, we found that for patients with BMI ≥ 85%ile, the OR of having a joint score ≥ 1 or a target joint was 3.4 (95% CI 1.1 – 10.7). Despite the fact that we demonstrated no significant difference in bleeding in the two populations, it would appear that patients with hemophilia and BMI ≥ 85%ile experience decreased ROM in weight-bearing joints. These findings suggest that overweight and obesity may influence the joint health of patients with hemophilia, and that further studies are indicated to fully comprehend the impact of these common health issues on this disease. We would also recommend consideration of a prospective trial examining joint health and bleeding episodes in overweight patients with hemophlia. Patient Demographics BMI ≥ 85%ile BMI < 85%ile Gender (%) male 100 100 Ethnicity (%) Black 4 0 White 16 40 Hispanic 80 60 Hemophilia A 24 15 Hemophilia B 1 5 Mean Age 15 15 Median Age 15 19 Age Range 5–24 5–23 Joint Scores and BMI Joint Score ≥ 1 plus target Joint Score < 1 BMI ≥ 85%ile 25 8 BMI < 85%ile 11 12