Serum Vascular Endothelial Growth Factor and C-reactive Protein Serve As Biomarkers of Joint Health in Severe Haemophilia A: A Cross-Sectional Study From India

ObjectivesIn low-and middle-income countries (LMICs), people living with haemophilia (PWH) remain on on-demand factor replacement therapy and present with haemophilic arthropathy.This two-arm cross-sectional study compared serum vascular endothelial growth factor (VEGF) and C-reactive protein (CRP) levels between patients with severe haemophilia A and healthy controls and explored their association with clinical indices of joint health. Materials and methodsWe measured serum VEGF and CRP in 50 male patients with severe haemophilia A and 50 age-matched healthy male controls.Joint status was assessed by the Haemophilia Joint Health Score (HJHS), Functional Independence Score in Haemophilia (FISH), and annual bleed rate (ABR).Comparisons used nonparametric tests; diagnostic performance was evaluated using receiver operating characteristic (ROC) curves; and correlations were analysed with Spearman's rho. ResultsMedian age of the patient cohort was 11.5 years (range 4-25 years).Mean VEGF (85.11 ± 9.01 pg/mL) and CRP (1032.58± 242.88 pg/mL) levels were significantly higher in PWH than in controls (VEGF 56.9 ± 17.1 pg/mL, CRP 140.26 ± 37.24 pg/mL; both p<0.001).ROC analysis showed fair discrimination between cases and controls for VEGF (area under the curve or AUC 0.792) and CRP (AUC 0.775); optimal cut offs were 68.85 pg/mL for VEGF and 210.03 pg/mL for CRP.VEGF and CRP correlated significantly with FISH and CRP correlated positively with ABR. ConclusionSerum VEGF and CRP are elevated in severe haemophilia A and show fair ability to distinguish PWH from healthy controls.Longitudinal studies can help establish the feasibility of these biomarkers in predictive models for joint bleeding.