The study by Mawarikado et al. (2025) investigated the use of infrared thermography (IRT) to monitor body surface temperatures in people with hemophilia (PwH) and to detect possible compensatory overload in areas distant from the primary site of pain or impairment.

To this end, the authors recruited 24 people with hemophilia (PwH) aged 6 to 76 years who were experiencing pain due to recent bleeding, post-orthopedic surgery, or hemophilic arthropathy. Whole-body thermal images were taken and analyzed using ThermoHuman software, which calculates the difference in skin temperature between a region of interest (ROI) and its contralateral side to determine asymmetries. A difference of 0.3°C or more was considered significant.

The thermographic analysis allowed the authors to evaluate temperature in the affected areas. Most participants showed an increase in asymmetry greater than 0.3°C in the affected area. According to the group, the increases were:

• After bleeding: 3 of 4 participants (median: +0.62°C).
• Post-orthopedic surgery: all 4 participants (median: +0.80°C).
• Hemophilic arthropathy: 10 of 13 participants (median: +0.91°C).

In addition, the primary objective was to observe temperature increases indicative of load in areas different from the affected/painful site. The subjects exhibited two main patterns:

• Vertical Pattern: Ipsilateral temperature elevation (same side), either proximal or distal to the affected area.
• Diagonal Pattern: Contralateral temperature elevation (opposite side), either proximal or distal to the affected area.

Results

These results lay the foundation for describing detection patterns of compensatory overload in adjacent, asymptomatic areas, which may suggest overload or secondary inflammation.

• Patients with Hemophilic Arthropathy (14 participants) showed a vertical pattern (13 of 14 participants) and a diagonal pattern (all participants).
• Post-surgery patients (4 participants) showed both vertical and diagonal patterns.
• Patients after bleeding (6 participants) showed a vertical pattern (4 of 6 participants) and a diagonal pattern (5 of 6 participants).

Conclusion

Increased temperature occurred in areas beyond the painful region, indicating that asymptomatic zones may be under overload. This may be due to changes in gait and/or posture induced by pain.

The authors’ key contribution is extending the use of thermography beyond the detection of inflammation or acute bleeding at the affected site to identify compensatory overload. IRT is proposed as a tool to visualize these areas of excessive load. Furthermore, the description of the "Vertical" (same side, proximal/distal) and "Diagonal" (opposite side, proximal/distal) patterns provides a framework for interpreting thermography results in contexts of pain and functional limitation.

Finally, the study positions IRT not only as a diagnostic tool but also as an indicator of risk for secondary injury and functional impairment in asymptomatic areas that require monitoring and potential intervention.

Reference

Mawarikado, Y., Sakata, A., Shima, M., Hosoda, C., Matsumoto, N., Kawasaki, R., ... & Nogami, K. (2025). Infrared thermography for detecting compensatory load in people with haemophilia: a cross-sectional study. Thrombosis Journal, 23(1), 112.