Serological biomarkers in hemophilic arthropathy: Can they be used to monitor bleeding and ongoing progression of blood-induced joint disease in patients with hemophilia?

In patients with hemophilia, levels of uCTX-II and sCS846 increase 5 days after joint hemorrhage with respect to the initial value. In other words, in patients with established hemophilic arthropathy, the aforesaid biomarkers of joint tissue damage augment shortly after the first joint hemorrhage. In patients with hemophilia treated on demand, a correlation has been found between magnetic resonance imaging scores and the CS846 biomarker. Patients with hemophilia having more than one joint with advanced arthropathy have shown high levels of circulating soluble vascular cell adhesion molecule-1 (sVCAM-1). In addition, sVCAM-1 levels in these patients are associated with the severity of hemophilic arthropathy. In patients with hemophilia, cartilage degradation is increased by 25% compared with controls, as measured by some biomarkers (C2M, CTX-II and COMP). Levels of the cartilage degradation enzyme, ADAMTS5, are 10% lower in patients with hemophilia. Bone formation (PINP) is 25% lower in patients with hemophilia, whereas bone resorption (CTXI) is 30% greater. Acute inflammation (hsCRP) is 50% greater, whereas chronic inflammation (CRPM) is 25% lower. The hsCRP/CRPM ratio is 60% higher in patients with hemophilia than in controls. A panel of biomarkers that combines C2M, CRPM and ADAMTS5 can distinguish patients with hemophilia from controls with 85.3% accuracy. No strong correlation between biomarkers and the radiological and physical examination of the joint has been found.