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Rodriguez-Merchan EC. Synovitis in hemophilia: preventing, detecting, and treating joint bleeds. Expert Rev Hematol 2023:1-10. [PMID: 37119182 DOI: 10.1080/17474086.2023.2209717] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Most bleeding events in individuals with hemophilia occur within the ankle, knee, and elbow joints. Should the bleeding persist, the synovial membrane starts to hypertrophy and a vicious cycle of chronic hemophilic synovitis (CHS) occurs, leading to joint destruction. AREAS COVERED This article covers the prompt diagnosis of CHS by point-of-care ultrasonography (POC-US) and its treatment by means of several types of synovectomy. EXPERT OPINION It is essential to prevent, detect and treat hemophilic synovitis, because it indicates that the joint has bled and is at risk of bleeding further. Prophylaxis with standard half life (SHL) factor VIII (FVIII) concentrate is the standard of care for individuals with severe hemophilia A and can also be considered for selected patients with moderate disease. Several years of real-world experience with extended half life (EHL) FVIII, emicizumab, and other drugs in development will be needed to ascertain their final effect on bleeding and its complications. We must look for synovitis in individuals declaring joint pain and in asymptomatic patients, and POC-US is the most reasonable imaging instrument with which to carry out periodic joint screening. Radiosynovectomy, chemical synovectomy, and arthroscopic synovectomy markedly reduce bleeding events.
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Song HQ, Wu GF, Qi WZ, Lin LJ. Diffuse pigmented villonodular synovitis treated with arthroscopic total synovial peel. BMC Surg 2023; 23:12. [PMID: 36647094 PMCID: PMC9841682 DOI: 10.1186/s12893-023-01906-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Diffuse pigmented villonodular synovitis (PVNS) is prone to recurrence after surgery, and it is difficult to achieve a long-term complete cure. OBJECTIVE To reduce the recurrence rate of PVNS, the author pioneered the arthroscopic total synovial peel (ATSP). METHODS From March 2014 to July 2020, a total of 19 patients (6 males and 13 females) with diffuse PVNS of the knee were treated in our department and underwent ATSP. It's 'peel' rather than simple excision. This method is similar to peeling bark. Relapse rates and functional scores were determined, with follow-ups ranging from 12 to 72 months, on average 36 months. RESULTS Treatment efficacy was assessed by imaging and functional scores. Imaging results indicated a recurrence rate of 10.5%. In patients without recurrence, the visual analog score (VAS) decreased from 4.76 ± 2.02 preoperatively to 1.56 ± 1.15 postoperatively. The Tegner-Lysholm knee function score (TLS) score increased from 67.76 ± 15.64 preoperatively to 90.32 ± 8.32 postoperatively. Compared with the literature, ATSP significantly reduces the postoperative recurrence rate of diffuse PVNS. The preliminarily findings suggest that this approach could greatly reduce the recurrence rate of postoperative PVNS in follow-up studies. CONCLUSION This approach may be a viable option for treating diffuse PVNS via arthroscopy and is worthy of clinical consideration.
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Affiliation(s)
- Hao-Qiang Song
- grid.284723.80000 0000 8877 7471Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Guo-Feng Wu
- Department of Orthopedics, South University of Science and Technology Hospital, Shenzhen, China
| | - Wei-Zhong Qi
- grid.284723.80000 0000 8877 7471Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Li-Jun Lin
- grid.284723.80000 0000 8877 7471Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
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Le Quellec A, Edouard T, Audebert-Bellanger S, Pouzet A, Bourdet K, Colson C, Oriot C, Poignant S, Saraux A, Devauchelle-Pensec V. Joint involvement in Noonan syndrome. A retrospective paediatric descriptive study. Joint Bone Spine 2021; 89:105270. [PMID: 34534690 DOI: 10.1016/j.jbspin.2021.105270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Noonan syndrome is a rare genetic disorder characterized mainly by congenital heart disease, occasional intellectual disability, and varied orthopaedic, rheumatological and haematologic anomalies. Despite potentially serious functional consequences, joint involvement has been rarely studied in the literature. Our objective was to perform a retrospective study evaluating the prevalence and characteristics of joint involvement in Noonan syndrome. METHODS We recorded articular symptoms, including their type and frequency, in patients with Noonan syndrome followed up in French hospitals. Patients were included if the diagnosis was confirmed before the age of 20 based on the van der Burgt criteria or genetic analysis. Data are presented as frequencies or medians (ranges), and patient groups were compared using chi-square or Fisher tests. RESULTS Seventy-one patients were included from 4 centres. The average age was 12.5 years (range: 2-36). Musculoskeletal pain was found in 18 patients (25%) and joint stiffness in 10 (14%) located in the wrists, elbows, ankles, knees and hips, which was usually bilateral. Only one destructive form was described (multiple villonodular synovitis and a giant cell lesion of the jaw). There were no cases of systemic lupus erythaematosus (SLE) or other autoimmune arthritis. Raynaud's phenomenon was observed in 3 patients. Only 50% of joint complaints led to additional exploration. SOS1 mutations (P<0.05) and treatment with growth hormone (GH) (P<0.05) were the only factors significantly related to musculoskeletal pain. Patients treated with GH did not have more SOS1 mutations. Patients experiencing pain were not more likely to experience stiffness, joint hypermobility, or coagulation abnormalities. CONCLUSION Joint manifestations were frequent in Noonan syndrome, predominant in large joints, and rarely explored. Multiple villonodular synovitis is characteristic but rare. Auto-immune disorders were not described in this cohort. A more multidisciplinary approach could be recommended for the early detection of possibly disabling rheumatologic manifestations.
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Affiliation(s)
- Aurore Le Quellec
- Rheumatology department, Center of Autoimmune Rare Diseases (CERAINO), CHU Cavale Blanche, Brest, France
| | - Thomas Edouard
- Endocrinology, bone diseases and genetics unit, hôpital des Enfants, CHU de Toulouse, France
| | | | - Antoine Pouzet
- Pediatric and genetic department, CHU Morvan, Brest, France
| | | | | | | | | | - Alain Saraux
- Rheumatology department, Center of Autoimmune Rare Diseases (CERAINO), CHU Cavale Blanche, Brest, France; Endocrinology, bone diseases and genetics unit, hôpital des Enfants, CHU de Toulouse, France; Pediatric and genetic department, CHU Morvan, Brest, France; Pediatric department, CHU Morvan, Brest, France; Genetic department, CHU de Caen, France; Pediatric and genetic department, CHU de Nantes, France; UMR1227, Inserm, université de Bretagne Occidentale, Brest, France
| | - Valérie Devauchelle-Pensec
- Rheumatology department, Center of Autoimmune Rare Diseases (CERAINO), CHU Cavale Blanche, Brest, France; Endocrinology, bone diseases and genetics unit, hôpital des Enfants, CHU de Toulouse, France; Pediatric and genetic department, CHU Morvan, Brest, France; Pediatric department, CHU Morvan, Brest, France; Genetic department, CHU de Caen, France; Pediatric and genetic department, CHU de Nantes, France; UMR1227, Inserm, université de Bretagne Occidentale, Brest, France.
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