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Ray A, Rowbotham E. Radiosynovectomy in haemophilic synovitis and arthropathy of the knee: A scoping review. Haemophilia 2024; 30:617-627. [PMID: 38439131 DOI: 10.1111/hae.14966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Radiosynovectomy is an established treatment for chronic synovitis in patients with haemophilia. Although its role in rheumatological diseases has diminished, it remains an accepted therapy for haemophilic synovitis. AIM The aim of this scoping review was to map and summarise the evidence surrounding radiosynovectomy in haemophilic knees, identify gaps in the literature and inform future research. RESULTS Forty-three manuscripts and abstracts were identified for this review. Evidence was limited to observational studies and Yttrium-90 was the most studied licensed radioisotope. Radiosynovectomy was associated with a reduction in bleeding frequency and pain, improvements in range of motion and a reduction in the use of factor replacement. CONCLUSION The literature reviewed lacks studies of sufficient methodological quality to permit systematic review and meta-analysis. Systematic review using risk of bias assessment for observational studies should be undertaken to better evaluate the efficacy and safety of radiosynovectomy. A causal relationship between RSV and key clinical outcomes remains undetermined.
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Affiliation(s)
- Aaron Ray
- Department of Radiology, York Hospital, York and Scarborough Teaching Hospitals NHS Trust, York, UK
| | - Emma Rowbotham
- Musculoskeletal Radiology Department, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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2
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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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The use of radiosynovectomy in patients with juvenile idiopathic arthritis. Assessment of treatment efficacy and safety. Reumatologia 2021; 59:219-229. [PMID: 34538952 PMCID: PMC8436796 DOI: 10.5114/reum.2021.108450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives The aim of the study was to evaluate the usefulness of knee joint radiosynovectomy (RS) in patients suffering from juvenile idiopathic arthritis (JIA). Material and methods One hundred RS procedures performed in 58 patients with JIA in average age 10.4 years were evaluated. Results After 6 weeks, a decrease in the number of cases with joint pain from 90.3% to 29%, with joint oedema from 100% to 74.5%, with joint exudate from 100% to 60.6%, with gait disorders from 19.4% to 3.2%, with joint mobility disorders from 51.1% to 26.6% in the RS cases was observed. A reduction of the score in the Colorado scale from 10.9 to 4.66, in the pain visual analogue scale (VAS) from 50 to 10, in the illness VAS assessed by the patient/parent from 69.9 to 32.4, in the illness VAS assessed by the physician from 68.8 to 36.9 was observed. Six months after the RS procedure, a reduction in the number of cases with joint pain from 89.5% prior to the procedure to 29.5%, with oedema from 100% to 58.3%, with exudate from 100% to 46.9%, with gait disorders from 20% to 2.1%, with joint motility disorders from 51.1% to 26.1% was achieved. The score in the Colorado scale was reduced from 10.9 to 4.04, in the pain VAS from 40 to 0, in the illness VAS assessed by the patient/parent from 69.7 to 27.9, in the illness VAS assessed by the physician from 68.8 to 32.4. In ultrasound examinations, the greatest improvement compared to the initial condition was recorded in the 6th month after the RS. Radiosynovectomy was positively evaluated by parents and patients in 34 anonymous surveys. Early and late observations (average 1473 days) did not show lesions at the isotope injection site, and no neoplastic lesions were observed. Conclusions Radiosynovectomy is a valuable therapeutic option for local treatment in patients with JIA.
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Abstract
BACKGROUND The risk of developing cancer increases with age and also adverse environmental conditions. The same holds true in the aging people with hemophilia (PwH). Furthermore, cancer is an important challenge for physicians working in multidisciplinary hemophilia care centers. AIM Here, the authors report 7 hemophiliacs with malignancies diagnosed and managed at our center. STUDY DESIGN Hemophilia A and B were included. METHOD Patients with mild, moderate, or severe hemophilia A or B, who were followed-up in our center between January 1999 and December 2018 were included in the study. A total of 470 PwH (391 Hemophilia A and 79 Hemophilia B) were followed in this time period. RESULTS With a minimum 1 and maximum 20 years (median: 11.5 y) of the following time, 7 of 470 (1.48%) PwH were diagnosed with cancer. The diagnosed cancer types were acute lymphoblastic leukemia, acute myeloid leukemia, thyroid cancer, rectum cancer, malign melanoma, basal cell carcinoma, and gastric cancer. All patients except patients with leukemia had major surgical intervention and the hemostasis control was provided on the basis of institutional protocols. At the end of the study, all of the patients were alive besides the patient with acute myeloid leukemia. CONCLUSIONS Nowadays, the management of PwH has improved immensely and the life span has progressively become similar to healthy male individuals. For accurate improvement and standardizing care, prospective data collection on the epidemiology of cancer in PwH is an important tool.
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Koc B, Kılıcoglu O, Turkmen C, Zulfikar B. Prognostic factors of radiosynovectomy in haemophilia patients with inhibitors: Survival analysis in a 19-year period. Haemophilia 2020; 26:855-860. [PMID: 32666645 DOI: 10.1111/hae.14091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/29/2020] [Accepted: 06/09/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION People with haemophilia (PwH) with inhibitors have an increased risk of bleeding and early development of progressive arthropathy. Radiosynovectomy (RS) has been effective in dramatically reducing the frequency of haemarthroses. In the present study, the mid- and long-term results of the efficacy of RS in PwHs with inhibitors and prognostic factors that influence success and failure of RS were presented. MATERIAL AND METHOD Radiosynovectomy was performed in 51 joints of 22 PwHs with inhibitors diagnosed with chronic haemophilic synovitis between January 2000 and December 2018. Two patients were lost to follow-up and four joints were excluded. Number of bleeding episodes within the pre- and post-treatment 6 months were documented. Treatment failure was defined as need for repeat RS injection. RESULTS Results of 47 RS were analysed. The mean bleeding frequency of the joints was 11.2 ± 6.2 (median 9) within the last 6 months in the pre-treatment evaluation. After the treatment, the mean bleeding frequency of the joints decreased to 1.2 ± 2.8 (median 0) for first 6 months (P < .0001). The cumulative survival rate at 12 months was 87% and 78% at 36 months. The receiver operating characteristic (ROC) curve analysis revealed that cut-off points of 12 bleeding episodes within the last 6 months (sensitivity, 71.4; specificity, 81.8 P = .0022) and an inhibitor titre of 63.4 BU (sensitivity, 57.1; specificity, 75.8; P = .31) were threshold levels for a predisposition for failure. CONCLUSION Radiosynovectomy is an effective and safe intervention in PwHs with inhibitors. Bleeding frequency is a prognostic marker for the success of RS treatment. Patients who have more than 12 bleeding episodes within the last 6 months before the RS treatment have a higher rate of failure.
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Affiliation(s)
- Basak Koc
- Department of Pediatric Haematology/Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Onder Kılıcoglu
- Department of Orthopedics and Traumatology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cuneyt Turkmen
- Department of Nuclear Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Bulent Zulfikar
- Department of Pediatric Haematology/Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey
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Danielson H, Lassila R, Ylinen P, Yrjönen T. Total joint replacement in inhibitor-positive haemophilia: Long-term outcome analysis in fifteen patients. World J Orthop 2017; 8:777-784. [PMID: 29094008 PMCID: PMC5656493 DOI: 10.5312/wjo.v8.i10.777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 07/22/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To collect data from joint replacement in inhibitor patients, evaluate haemostatic and patient outcomes, and analyse the costs.
METHODS We report our 21-year, single-centre cumulative experience of 15 joint arthroplasties in six inhibitor patients.
RESULTS Two low responder inhibitor patients were in the early days treated with FVIII, whereas bypassing agents were used in the rest of the high responder patients. The primary haemostatic outcome was good in 8/15, fair in 4/15 and poor in 3/15 operations. The overall patient outcome, including joint health and patient satisfaction, was good in 10/15, fair 4/15 and poor in 1/15. No deep infections were observed. Cost analysis was most beneficial in low responders and in two immune-tolerized, high responder patients. In all cases, factor replacement comprised the main treatment costs.
CONCLUSION Our experience supports the initial use of bypassing agents as well as preoperative immune-tolerance induction when possible. Despite the challenges of haemostasis and severe joint disease, total joint arthroplasty can reach a good outcome, even in inhibitor patients. The risk for deep infection might be smaller than previously reported. Individual planning, intense multidisciplinary teamwork and execution of operations should be centralised in a professional unit.
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Affiliation(s)
- Heidi Danielson
- Orton Orthopaedic Hospital, Invalid Foundation, Helsinki 00280, Finland
| | - Riitta Lassila
- Helsinki University and Coagulation Disorders unit, Department of Haematology and Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki 00029, Finland
| | - Pekka Ylinen
- Orton Orthopaedic Hospital, Invalid Foundation, Helsinki 00280, Finland
| | - Timo Yrjönen
- Orton Orthopaedic Hospital, Invalid Foundation, Helsinki 00280, Finland
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Querol-Giner M, Pérez-Alenda S, Aguilar-Rodríguez M, Carrasco JJ, Bonanad S, Querol F. Effect of radiosynoviorthesis on the progression of arthropathy and haemarthrosis reduction in haemophilic patients. Haemophilia 2017; 23:e497-e503. [PMID: 28891593 DOI: 10.1111/hae.13326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2017] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Repeated haemarthrosis is widely accepted as the triggering cause of synovitis and haemophilic arthropathy. A first-line treatment of chronic synovitis is radiosynoviorthesis (RS). The aim of this study was to evaluate the RS effects on the progression of arthropathy and on a reduction in bleeding in patients with haemophilia. METHODS An observational-retrospective study was performed. Bleeding episodes in the 12 months following and in the 12 months preceding RS was compared. The arthropathy was clinically and radiologically analysed by age range, joint and subject, comparing those undergoing RS (Radiosynoviorthesis Group, RSG) against those not undergoing this treatment (Non-Radiosynoviorthesis Group, Non-RSG). RESULTS One hundred and seventy-four RS were performed in 71 patients (90 Y in Knees and 186 Re in elbows/ankles/shoulder). RS resulted in significant reduction in bleeding (582 preintervention and 168 postintervention, P < .001). In general, the level of arthropathy measured clinically and radiologically was greater with age increase in both groups (RSG and Non-RSG), especially in the 25-40 age range. A significant increase (P < .05) in the progression of arthropathy was also observed, both globally by patient and specifically for each joint, in non-RSG and RSG group. CONCLUSION RS is an effective method to reduce the number of haemarthrosis episodes in chronic synovitis. Moreover, RS can positively affect arthropathy by slowing down its progression. However, the results obtained suggest that arthropathy may be conditioned by the subject's age, regardless of whether or not the joint has undergone RS.
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Affiliation(s)
- M Querol-Giner
- Servicio de Rehabilitación, Hospital de Sagunto, Valencia, Spain.,Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - S Pérez-Alenda
- Department of Physiotherapy, University of Valencia, Valencia, Spain.,Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - M Aguilar-Rodríguez
- Department of Physiotherapy, University of Valencia, Valencia, Spain.,Rehabilitation Service, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - J J Carrasco
- Department of Physiotherapy, University of Valencia, Valencia, Spain.,Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - S Bonanad
- Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - F Querol
- Department of Physiotherapy, University of Valencia, Valencia, Spain.,Haemostasis and Thrombosis Unit, University and Polytechnic Hospital La Fe, Valencia, Spain
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McGuinn C, Cheng D, Aschman D, Carpenter SL, Sidonio R, Soni A, Tarantino MD, Wheeler AP, Dunn AL. Radionuclide synovectomy/synoviorthesis (RS) in patients with bleeding disorders: A review of patient and procedure demographics and functional outcomes in the ATHNdataset. Haemophilia 2017; 23:926-933. [DOI: 10.1111/hae.13318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- C. McGuinn
- Weill Cornell Medical College; New York NY USA
| | - D. Cheng
- American Thrombosis and Hemostasis Network; Riverwoods IL USA
| | - D. Aschman
- American Thrombosis and Hemostasis Network; Riverwoods IL USA
| | | | - R. Sidonio
- Emory University/Children's Healthcare of Atlanta Comprehensive Bleeding Disorder Clinic; Atlanta GA USA
| | - A. Soni
- Center for Comprehensive Care and Diagnosis of Inherited Blood Disorders; Orange CA USA
| | - M. D. Tarantino
- Bleeding and Clotting Disorders Institute; University of Illinois College of Medicine-Peoria; Peoria IL USA
| | - A. P. Wheeler
- Vanderbilt University Medical Center; Nashville TN USA
| | - A. L. Dunn
- Nationwide Children's Hospital/Ohio State University; Columbus OH USA
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9
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Rodriguez-Merchan EC. Platelet-rich plasma intra-articular injections for haemophilic synovitis: Scientific knowledge does not support its use. Haemophilia 2017; 23:e486-e487. [DOI: 10.1111/hae.13328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2017] [Indexed: 12/31/2022]
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10
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Al-Mayouf SM, Almutairi N, Alismail K. The Efficacy of Yttrium-90 Radiosynovectomy in Patients with Camptodactyly-Arthropathy-Coxa Vara-Pericarditis Syndrome. Mol Imaging Radionucl Ther 2017; 26:33-37. [PMID: 28291008 PMCID: PMC5350503 DOI: 10.4274/mirt.29484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Camptodactyly-arthropathy-coxa-vara-pericarditis (CACP) syndrome is an autosomal recessive disorder caused by mutations in PRG4 gene that encodes for proteoglycan 4, the main lubricant for joints and tendon surfaces. It is a non-inflammatory arthropathy, characterized by joint effusions and synovial hypertrophy. So far, there is no effective treatment for this disorder. To evaluate the effectiveness of yttrium-90 radiosynovectomy in arthropathy of patients with CACP syndrome. METHODS Consecutive patients with CACP syndrome were prospectively evaluated at the enrollment and 3 months after the right knee injection with yttrium-90. The outcome variables were patient/parent and physician's global assessment measured by a 3-point scale, right knee swelling and range of motion on a 3-point scale, in addition to magnetic resonance imaging (MRI) assessment of the right knee for bone, cartilage, fluid, synovial hypertrophy and soft tissue changes. RESULTS Six (three boys, three girls) patients with a mean age of 12 years and mean follow-up duration of 8.5 years completed a single right knee intra-articular yttrium-90 injection with 5 mCi. The procedure was well tolerated without adverse events apart from mild and transient joint pain in two patients. There was a minimal radioisotope leakage to soft tissue in two patients. During the 3-month follow-up interval, there was no improvement in the outcome variables. Patients and parents did not notice favorable therapeutic effects and global physician assessment was unsatisfactory. There was no difference in knee joint swelling or range of motion. Furthermore, MRI findings were unchanged. However, there was a minimal increase in synovial fluid post injection. CONCLUSION Yttrium-90 radiosynovectomy seems to be a safe and well tolerated procedure, however, it did not show a beneficial therapeutic effect in arthropathy of CACP syndrome with the given dosage and interval. Studies including a larger number of patients and probably repeated injections are needed to derive satisfactory results about the effectiveness of yttrium-90 in CACP syndrome patients.
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Affiliation(s)
- Sulaiman Mohammed Al-Mayouf
- King Faisal Specialist Hospital and Research Center, Clinic of Pediatric Rheumatology, Riyadh, Saudi Arabia Phone: +996114427761 E-mail:
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Lim MY, Cheng D, Aschman D, Dunn A. Radionuclide synovectomy in patients with bleeding disorders: a review of malignancy and myeloproliferative neoplasms from the ATHNdataset. Haemophilia 2017; 23:e160-e162. [PMID: 28111845 DOI: 10.1111/hae.13179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/01/2022]
Affiliation(s)
- M Y Lim
- Comprehensive Hemophilia Diagnostic and Treatment Center, University of North Carolina, Chapel Hill, NC, USA
| | - D Cheng
- American Thrombosis and Hemostasis Network, Riverwoods, IL, USA
| | - D Aschman
- American Thrombosis and Hemostasis Network, Riverwoods, IL, USA
| | - A Dunn
- Nationwide Children's Hospital/Ohio State University, Columbus, OH, USA
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Affiliation(s)
| | - Alexander D. Liddle
- NIHR Clinical Lecturer, University College London Institute of Orthopaedics and Musculoskeletal Science, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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Radionuclide synovectomy - essentials for rheumatologists. Reumatologia 2016; 54:108-16. [PMID: 27504020 PMCID: PMC4967977 DOI: 10.5114/reum.2016.61210] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/30/2016] [Indexed: 01/09/2023] Open
Abstract
Radionuclide synovectomy is a minimally invasive method of treating persistent joint inflammation. It involves intra-articular injection of radioactive colloids which induce necrosis and fibrosis of hypertrophic synovial membrane. The most common indication for radiosynovectomy is rheumatoid arthritis, although patients with seronegative spondyloarthropathies, unclassified arthritis, haemophilic arthropathy and other less common arthropathies can also benefit from this method. Radiosynovectomy is safe, well tolerated and efficacious. About 70–80% of patients respond well to the therapy. However, the therapeutic effects are considerably worse in patients with co-existent osteoarthritis and advanced joint degeneration. Despite its advantages, radionuclide synovectomy is not performed as often as it could be, so greater knowledge and understanding of this method are needed. The authors present the most important facts about radiosynovectomy that may help rheumatologists in their daily clinical practice.
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Rodriguez-Merchan EC. Musculo-skeletal manifestations of haemophilia. Blood Rev 2016; 30:401-9. [PMID: 27166435 DOI: 10.1016/j.blre.2016.04.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/24/2016] [Accepted: 04/26/2016] [Indexed: 01/15/2023]
Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Paseo de la Castellana 261, 28046 Madrid, Spain.
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Rodriguez-Merchan EC, Valentino LA. Safety of radiation exposure after radiosynovectomy in paediatric patients with haemophilia. Haemophilia 2015; 21:411-8. [PMID: 25854422 DOI: 10.1111/hae.12668] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2015] [Indexed: 11/29/2022]
Abstract
Many paediatric patients with haemophilia who might benefit from radiosynovectomy (RS) for the control of synovitis do not undergo the procedure as there is controversy in the literature regarding the safety of radiation exposure after two cases of acute lymphocytic leukaemia in children with haemophilia treated with (32) P RS were reported. The purpose of this review was to analyse the safety of RS in paediatric patients with haemophilia and provide a risk-benefit assessment, which practitioners could apply to their patients. Children undergoing knee RS receive a radiation dose of approximately 0.74 mSv (90 megabecquerels-MBq) and elbow and ankle RSs a dose of approximately 0.32 mSv (30-40 MBq). The radiation dose from natural sources is approximately 2 mSv and the recommended limit for patients (apart from natural sources) is 1 mSv per year. The lifetime cancer risk increases about 0.5% per 100 mSv per year. Considering the risks and benefits of RS, the authors recommend that clinicians consider this procedure in children with inhibitors or in patients without inhibitors when bleeding is recurrent and persistent despite aggressive factor replacement.
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Rodriguez-Merchan EC, De la Corte-Rodriguez H, Jimenez-Yuste V. Radiosynovectomy in haemophilia: long-term results of 500 procedures performed in a 38-year period. Thromb Res 2014; 134:985-90. [PMID: 25240555 DOI: 10.1016/j.thromres.2014.08.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 08/19/2014] [Accepted: 08/23/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radiosynovectomy (RS) can reduce the number of haemarthroses in chronic haemophilic synovitis. The purpose of this study was to assess the effectiveness of RS in terms of the objective improvement of five parameters (number haemarthroses, articular pain, degree of clinical synovitis, clinical score of the World Federation of Haemophilia (WFH), and radiological score of the WFH. METHODS In a 38-year period (1976-2013), five hundred radiosynovectomies were performed in 443 joints of 345 patients with haemophilia diagnosed with chronic synovitis. The mean patient age was 23.7 years (range, 6-53). The mean follow-up was 18.5 years (range: 6 months-38 years). The RS was carried out with either yttrium-90 or rhenium-186. We performed 1 to 3 injections (RS-1, RS-2, RS-3), with a 6-month interval between them. RESULTS RS resulted in significant improvement in all the parameters studied, except in the WFH radiologic score that showed no improvement. On average, the number of haemarthroses decreased by 64.1% and articular pain decreased by 69.4%. The degree of synovitis showed a reduction of 31.3%. The WFH clinical score revealed an improvement of 19%. The WFH radiological score showed no improvement. There were four complications (0.9%) of RS. Twenty-eight (6.3%) joints eventually had to be subjected to arthroscopic synovectomy or total knee replacement (TKR). No cancer was observed in this group of patients during the 38-year period. CONCLUSIONS Radiosynovectomy (RS) is an effective, safe, minimally invasive, well tolerated procedure in the long-term for the treatment of chronic haemophilic synovitis. Moreover, it is very easy to perform. The knee required more injections than the elbow or the ankle and more severe synoviums required a higher number of RS procedures.
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Affiliation(s)
| | - H De la Corte-Rodriguez
- Department of Rehabilitation and Physical Therapy, La Paz University Hospital, Madrid, Spain
| | - V Jimenez-Yuste
- Department of Haematology, La Paz University Hospital, Madrid, Spain
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The knee in severe haemophilia with special emphasis on surgical/invasive procedures. Thromb Res 2014; 134:545-51. [DOI: 10.1016/j.thromres.2014.05.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/23/2014] [Accepted: 05/26/2014] [Indexed: 12/17/2022]
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Rodriguez-Merchan EC. Hemophilic synovitis of the knee: radiosynovectomy or arthroscopic synovectomy? Expert Rev Hematol 2014; 7:507-11. [DOI: 10.1586/17474086.2014.926809] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Calegaro J, Silveira C, Hage D, Sayago M, de Landa D, Mengatti J, de Paula AP. Comparison of the effect of knee synovectomy in haemophilic patients with153Sm- and90Y -labelled hydroxyapatite 1 year after. Haemophilia 2014; 20:873-8. [DOI: 10.1111/hae.12453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2014] [Indexed: 12/01/2022]
Affiliation(s)
- J. Calegaro
- Hospital de Base; Nuclear Medicine Service; São Paulo Brazil
| | - C. Silveira
- Hospital de Base; Haematology Service; São Paulo Brazil
| | - D. Hage
- Hospital de Base. Orthopedic Service; São Paulo Brazil
| | - M. Sayago
- IHTC Brasília; Physiotherapy; São Paulo Brazil
| | - D. de Landa
- Hospital de Base; Nuclear Medicine Service; São Paulo Brazil
| | - J. Mengatti
- IPEN-CNEN; Radiopharmacy Center; São Paulo Brazil
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Ozcan Z. Radiosynovectomy in hemophilic synovitis. Mol Imaging Radionucl Ther 2014; 23:1-4. [PMID: 24653927 PMCID: PMC3957964 DOI: 10.4274/mirt.49369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 12/23/2013] [Indexed: 12/01/2022] Open
Abstract
Radisosynovectomy (RS) is a local form of radionuclide therapy used in various forms of arthritis characterized by synovitis. In hemophilic arthropathy, RS provides removal of inflamed synovium and prevents further joint damage. This review focuses on the practical aspects of radionuclide synovectomy in hemophilic patients and describes the issues both related to the methodology and post-therapeutic follow-up. Conflict of interest:None declared.
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Affiliation(s)
- Zehra Ozcan
- Ege University Faculty of Medicine, Department of Nuclear Medicine, İzmir, Turkey
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Turkmen C, Kilicoglu O, Dikici F, Bezgal F, Kuyumcu S, Gorgun O, Taser O, Zulfikar B. Survival analysis of Y-90 radiosynovectomy in the treatment of haemophilic synovitis of the knee: a 10-year retrospective review. Haemophilia 2013; 20:e45-50. [DOI: 10.1111/hae.12252] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
Affiliation(s)
- C. Turkmen
- Department of Nuclear Medicine; Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
| | - O. Kilicoglu
- Department of Orthopedics and Traumatology; Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - F. Dikici
- Department of Orthopedics and Traumatology; Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - F. Bezgal
- Hemophilia Society of Turkey; Istanbul Turkey
| | - S. Kuyumcu
- Department of Nuclear Medicine; Istanbul Medical Faculty; Istanbul University; Istanbul Turkey
| | - O. Gorgun
- Department of Pediatric Hematology and Oncology; Institute of Oncology; Istanbul University; Istanbul Turkey
| | - O. Taser
- Hemophilia Society of Turkey; Istanbul Turkey
| | - B. Zulfikar
- Department of Pediatric Hematology and Oncology; Cerrahpasa Medical Faculty; Institute of Oncology; Istanbul University; Istanbul Turkey
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Rodriguez-Merchan EC. Haemophilic synovitis of the elbow: radiosynovectomy, open synovectomy or arthroscopic synovectomy? Thromb Res 2013; 132:15-8. [PMID: 23786892 DOI: 10.1016/j.thromres.2013.05.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/21/2013] [Accepted: 05/26/2013] [Indexed: 11/26/2022]
Abstract
Arthroscopic synovectomy (AS) of the elbow, while providing similar pain relief to open synovectomy (OS), may place patients at higher risk for recurrence. The primary predictor of outcome is degree of pre-existing degenerative changes within the joint. Regarding haemophilia patients, radiosynovectomy (RS) is the best choice for patients with persistent synovitis of the elbow. In the elbow we recommend a dose of 30-40 megabecquerels (mBq) in children and a dose of 56-74 mBq in adults. If three consecutive RSs with 6 months intervals are ineffective, an AS or OS must be indicated. Synovectomy (by any method) significantly reduces bleeding episodes. Although the dose of radiation of RS is minimal, 0.32 millisieverts (mSv) in children, 0.54 mSv in adults, and neither articular nor systemic neoplastic changes related to RS have been reported so far, all patients must be given opportunity to consider risk/benefit ratios. Radiation dose due to natural sources is 2 mSv per year and the recommended limit for patients (apart from natural sources is 1 mSv per year). My current recommendation is to use RS in children older than 12 years of age. Therefore, in children younger than 12 years of age an AS should be indicated. OS should be reserved for adults requiring radial head excision (due to a severe limitation of pronation-supination) and synovectomy in the same surgical session.
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