Radionuclide Synovectomy for Hemophilic Arthropathy: A Comprehensive Review of Safety and Efficacy and Recommendation for a Standardized Treatment Protocol

Keywords

Radionuclide - synovectomy - synoviorthesis - hemophilia - phosphorus-32 chromic phosphate

The following authors provided significant intellectual contributions to this review and are listed in alphabetical order after acknowledgment of the senior leadership of Frederick R. Rickles; Henry Goodgold, Margaret A. Heisel, J. Heinrich Joist, James V. Luck, Marilyn Manco-Johnson, Rachelle Nuss, Georges E. Rivard, Michael E. Siegel

• References

• 1 Ansell BM, Crook A, Mallard JR, Bywaters EGL. Evaluation of intraarticular colloidal gold 198 Au in the treatment of persistent knee effusions. Ann Rheum Dis 1963; 22: 435-9.
• 2 Sokoloff L. Biochemical and physiological aspects of degenerative joint diseases with special references to hemophilic arthropathy. Ann NY Acad Sci 1975; 240: 285-90.
• 3 Morris CJ, Wainwright AC, Steven MM, Blake DR. The nature of iron deposits in haemophilic synovitis. Virchows Arch 1984; 404: 75-85.
• 4 Mainardi C. Biochemical mechanisms of articular destruction. Rheum Dis Clinics of N America 1987; 13 (02) 215-33.
• 5 Roosendaal G, Vianen ME, Wenting MJG, van Rinsum AC, van den Berg HM, Lafeber FPJG, Bijlsma JWJ. Iron deposits and catabolic properties of synovial tissue from patients with haemophilia. J Bone Joint Surg (Br) 1998; 80 B 540-5.
• 6 Arnold WD, Hilgartner MW. Hemophilic arthropathy current concepts of pathogenesis and management. J Bone Joint Surg 1977; 59 A 287-305.
• 7 Pettersson H, Ahlberg A, Nilsson IM. A radiologic classification of hemophilic arthropathy. Clin Orthop 1980; 149: 153-9.
• 8 Nilsson IM, Berntorp E, Lofqvist T, Pettersson H. Twenty-five years experience of prophylactic treatment in severe hemophilia A and B. J Intern Med 1992; 232: 25-32.
• 9 Manco-Johnson MJ, Nuss R, Geraghty S, Funk S, Kilcoyne R. Results of secondary prophylaxis in children with severe hemophilia. Am J Hemat 1994; 47: 113-7.
• 10 Shupak R, Teitel J, Garvey MB, Freedman J. Intraarticular methylprednisolone therapy in hemophilic arthropathy. Am J Hemtol 1988; 27 (01) 26-9.
• 11 Fernandez-Palazzi F, Caviglia HA, Salazar JR, Lopez J, Aoun R. Intraarticular dexamethasone in advanced chronic synovitis in hemophilia. Clin Orthop Rel Res 1997; 343: 25-9.
• 12 Heisel MA, Clohisy DR, Christie BA, Osip JM, Johnson VA, Page MJ, Key NS, Moertel CL. Intra-articular steroid and joint immobilization for chronic synovitis in patients with bleeding disorders. Hemaware 1999; CR-7: 6.
• 13 Gamba G, Grignani G, Ascari E. Synoviorthesis versus synovectomy in the treatment of recurrent haemophilic haemarthrosis: long-term evaluation. Thromb Haemost 1981; 45 (02) 127-9.
• 14 Molho P, Verrier P, Stieltjes N, Schacher JM, Ounnoughene N, Vassileiff D, Menkes CJ, Sultan Y. A retrospective study on chemical and radioactive synovectomy in severe haemophilia patients with recurrent haemarthrosis. Haemophilia 1999; 05: 115-23.
• 15 Caviglia H, Galatro G, Duhalde C, Perez-Bianco R. Haemophilic synovitis: is rifampicin an alternative?. Haemophilia 1998; 04: 514-7.
• 16 Wiedel JD. Arthroscopic synovectomy in hemophilic arthropathy of the knee. Scand J Haematol 1984; 33 (Suppl. 40) 263-70.
• 17 Rodriguez-Merchan EC, Galindo E, Ladreda JMM, Pardo JA. Surgical synovectomy in haemophilic arthropathy of the knee. Int Orthop 1994; 18: 38-41.
• 18 Greene WB. Synovectomy of the ankle for hemophilic arthropathy. J Bone Joint Surg 1994; 76 A (06) 812-9.
• 19 Eickhoff JJ, Koch W, Raderschadt G, Brackmann HH. Arthroscopy for chronic hemophilic synovitis of the knee. Clin Orthop Rel Res 1997; 343: 58-62.
• 20 Ragni MV, Crossett LS, Herndon JH. Postoperative infection following orthopaedic surgery in human immunodeficiency virus-infected hemophiliacs with CD4 counts < or = 200/mm3. J Arthoplasty 1995; 10 (06) 716-21.
• 21 Makin M, Robin GC. Chronic synovial effusions treated with intra-articular radioactive gold. JAMA 1964; 188 (08) 725-8.
• 22 Oka M, Rekonen A, Ruotsi A, Seppala O. Intra-articular injection of Y-90 resin colloid in the treatment of rheumatoid knee joint effusions. Acta Rheum Scand 1971; 17: 148-60.
• 23 Oka M, Hypen M. Radiation synovectomy: results in rheumatoid knee effusions treated with radioactive yttrium. Scand J Rheumatol 1974; 03: 33-8.
• 24 Gumpel JM. The role of radiocolloids in the treatment of arthritis. Rheumatol Rehabil 1974; 13: 1-9.
• 25 Jalava S. Irradiation synovectomy. In experimental arthritis and human rheumatoid arthritis. Scand J Rheumatol 1974; (Suppl. 04) 1-32.
• 26 Oka M. Radiation synovectomy of the rheumatoid knee with yttrium-90. Ann Clin Res 1975; 07: 205-10.
• 27 Muller W, Pavelka K, Fridrich R. Treatment of chronic articular effusions with 90-yttrium. Scand J Rheumatol 1975; 04: 216-20.
• 28 Doyle DV, Glass JS, Gow PJ, Daker M, Grahme R. A clinical and prospective chromosomal study of yttrium-90 synovectomy. Rheumatol Rehabil 1977; 16: 217-22.
• 29 Menkes CJ. Is there a place for chemical and radiation synovectomy in rheumatic diseases?. Rheumatol Rehabil 1979; 18 (02) 65-77.
• 30 Sheppeard H, Aldin A, Ward DJ. Osmic acid versus Yttrium-90 in rheumatoid synovitis of the knee. Scand J Rheumatol 1981; 10: 234-6.
• 31 Onetti CM, Gutierrez E, Hliba E, Aguirre CR. Synoviorthesis with 32P-colloidal chromic phosphate in rheumatoid arthritis – clinical, histophathologic and arthrographic changes. J Rheumatol 1982; 09: 229-38.
• 32 Spooren PFMJ, Rasker JJ, Arens RPJH. Synovectomy of the knee with 90Y. Eur J Nucl Med 1985; 10: 441-5.
• 33 Van Soesbergen RM, Hoefnagel CA, Marcuse HR, Dijkstra PF, Bernelot HJMoens. Radiosynoviorthesis of the knee: a doubleblind trial of 1 versus 5 mCi Gold-198. Clin Rheumatol 1988; 07 (02) 224-30.
• 34 Taylor WJ, Corkill MM, Rajapaske CAN. A retrospective review of yttrium-90 synovectomy in the treatment of knee arthritis. Br J Rheumatol 1997; 36: 1100-5.
• 35 Jahangier ZN, Jacobs JWG, Van Isselt JW, Bijlsma JWJ. Persistent synovitis treated with radiation synovectomy using yttrium-90: a retrospective evaluation of 83 procedures for 45 patients. Br J Rheumatol 1997; 36: 861-9.
• 36 Asavatanabodee P, Sholter D, Davis P. Yttrium-90 radiochemical synovectomy in chronic knee synovitis: a one year retrospective review of 133 treatment interventions. J Rheumatol 1997; 24: 639-42.
• 37 Isomaki AM, Oka M, Pitkanen R, Rantala I. Response of synovial immunocytes to intra-articular agents in experimental arthritis. Scand J Rheumatol 1975; 04: 129-33.
• 38 Kershbaumer F, Bauer N, Altmann H. Effects and side effects of radiosynovectomy with yttrium 90 on rheumatic joint cartilage. Arch Orthop Traumat Surg 1979; 93: 95-102.
• 39 Guaydier-Souquieres C, Beguin J, Ollivier D, Loyau G. Knee arthroscopy after yttrium or osmic acid injection. Arthroscopy 1989; 05 (01) 70-5.
• 40 Combe B, Krause E, Sany J. Treatment of chronic knee synovitis with arthroscopic synovectomy after failure of intraarticular injection of radionuclide. Arthritis Rheum 1989; 32 (01) 10-14.
• 41 Winston MA. Radioisotope therapy in bone and joint disease. Sem Nucl Med 1979; 09 (02) 114-20.
• 42 Johnson LS, Yanch JC. Absorbed dose profiles for radionuclides of frequent use in radiation synovectomy. Arthritis Rheum 1991; 34 (12) 1521-30.
• 43 Luck JV, Siegel M, Rivard GE, Fernandez-Palazzi F, Wiedel J, Manco-Johnson M, Lee K, Harbert J. Radionuclide synovectomy. The Hemophilia Bulletin 1993; Oct. 1-6.
• 44 Johnson LS, Yanch JC, Shortkroff S, Barnes CL, Spitzer AI, Sledge CB. Beta-particle dosimetry in radiation synovectomy. Eur J Nucl Med 1995; 22: 977-88.
• 45 Rosenthall L. Use of radiocolloids for intra-articular therapy for synovitis. In: Therapy in nuclear medicine. Spencer RP. New York: Grune & Stratton; 1978: 147-53.
• 46 Gratz S, Gobel D, Behr TM, Herrmann A, Becker W. Correlation between radiation dose, synovial thickness, and efficacy of radiosynoviorthesis. J Rheumatol 1999; 26 (06) 1242-9.
• 47 Nuss R, Kilcoyne RF, Rivard GE, Murphy J. Late clinical, plain x-rays, and magnetic resonance imaging findings in haemophilic joints treated with radiosynoviorthesis. Haemophilia 2000; 06: 658-63.
• 48 Ahlberg A. Radioactive gold in the treatment of chronic synovial effusion in haemophilia. Proc VII Congress World Fed Haemophilia Excerpta Medica Amsterdam 1971; 212-5.
• 49 Ahlberg A, Pettersson H. Synoviorthesis with radioactive gold in hemophiliacs. Acta Orthop Scand 1979; 50: 513-7.
• 50 Van’t Pad Bosch PJI, van de Putte LBA, Boerbooms AMTh, Geerdink PJ. Radiosynoviorthesis in haemophilic joint disease. Z Rheumatol 1981; 40: 237-9.
• 51 Ortonowski G, Ziemski JM, Kucharski W, Woy-Wojciechowski J. Synoviorthesis with 198 Au colloid in haemophilia patients. A preliminary report. Folia Haematol Int Mag Klin Morphol Blutforsch 1990; 117 (04) 505-10.
• 52 Lofqvist T, Pettersson C. Synoviorthesis in young patients with hemophilia and inhibitory antibodies. Ped Hem Oncol 1992; 09: 167-70.
• 53 Lofqvist T, Pettersson C, Nilsson IM. Radioactive synoviorthesis in patients with hemophilia with factor inhibitor. Clin Orthop Rel Res 1997; 343: 37-41.
• 54 Rodriguez-Merchan EC, Magallon M, Martin-Villar J, Galindo E, Ortega F, Pardo JA. Long term follow up of haemophilic arthropathy treated by Au-198 radiation synovectomy. Int Orthop 1993; 17: 120-4.
• 55 Rodriguez-Merchan E, Magallon M, Galindo E, Lopez-Cabarcos C. Hemophilic synovitis of the knee and the elbow. Clin Orthop Rel Res 1997; 343: 47-53.
• 56 Rivard GE, Girard M, Cliché CL, Guay JP, Belanger R, Besner R. Synoviorthesis in patients with hemophilia and inhibitors. Canadian Med J 1982; 127: 41-2.
• 57 Rivard GE, Girard M, Lamarre C, Jutras M, Danais S, Guay JJP, Belanger RD. Synoviorthesis with colloidal 32P chromic phosphate for hemophilic arthropathy: clinical follow-up. Arch Phy Med Rehabil 1985; 66: 753-6.
• 58 Rivard GE. Synoviorthesis with radioactive colloids in hemophiliacs. In: Recent Advances in Hemophilia Care. Alan R. Liss, Inc; 1990: 215-29.
• 59 Rivard GE, Girard M, Belanger R, Jutras M, Guay JP, Marton D. Synoviorthesis with colloidal 32P chromic phosphate for the treatment of hemophilic arthropathy. J Bone Joint Surg 1994; 76-A (04) 482-8.
• 60 Siegel ME, Siegel HJ, Luck Jr. JV, Quines CP. Clinical utilization of P-32 chromic phosphate radiosynovectomy in hemophilia: outcome results of 125 procedures and relative cost analysis. Radiology 1999; 213 supp 51.
• 61 Siegel HJ, Luck JV, Siegel ME, Quines C, Anderson E. Hemarthrosis and synovitis associated with hemophilia: clinical use of P-32 chromic phosphate synoviorthesis for treatment. Radiology 1994; 190: 257-61.
• 62 Siegel ME, Siegel HJ, Luck JV. Radiosynovectomy’s clinical applications and cost effectiveness: a review. Sem Nucl Med 1997; 27 (04) 364-71.
• 63 Heim M, Horoszowski H, Lieberman L, Varon D, Martinowitz U. Methods and results of radionucleotide synovectomies. In: Musculoskeletal problems in Hemophilia. Gilbert MS, Greene WD. (eds.). National Hemophilia Foundation; New York: 1990: 98-101.
• 64 Erken EHW. Radiocolloids in the management of hemophilic arthropathy in children and adolescents. Clin Orthop Rel Res 1991; 264: 129-35.
• 65 Solimeno P, Lozej E, Gringeri A, Santagostino E, Tradati FC, Simoni L, Torri G. Yttrium 90 synovectomy in the management of chronic synovitis in patients with hemophilia. Proc XXth Int Congress of the WFH, Athens Oct 12-17 1992; Abs #275.
• 66 Van Kasteren MEE, Novakova IRO, Boerbooms AMTh, Lemmens JAM. Long term follow up of radiosynovectomy with yttrium-90 silicate in haemophilic haemarthrosis. Ann Rheum Dis 1993; 52: 548-50.
• 67 Dawson TM, Ryan PFJ, Street AM, Robertson PL, Kalff V, Kelly MJ, Cicuttini FM. Yttrium synovectomy in haemophilic arthropathy. Br J Rheumatol 1994; 33: 351-6.
• 68 Fernandez-Palazzi F, deBosch NB, deVargas AF. Radioactive synovectomy in haemophilic haemarthrosis: follow-up of fifty cases. Scand J Haematol 1984; 33 (Suppl. 40) 291-300.
• 69 Fernandez-Palazzi F, Rivas S, Cibeira JL, Dib O, Viso R. Radioactive synoviorthesis in hemophilic hemarthrosis. Clin Orthop Rel Res 1996; 328: 14-18.
• 70 Fernandez-Palazzi F. Treatment of acute and chronic synovitis by nonsurgical means. Haemophilia 1998; 04: 518-23.
• 71 Salis G, Molho P, Verrier P, Stieltjes N, Vassilieff D, Ounnoughene N, Schacher JM, Perpignano G, Sultan Y, Menkes CJ. Nonsurgical synovectomy in the treatment of arthropathy in von Willebrand’s disease. Rev Rheumatol 1998; 65 (04) 232-7.
• 72 DePalma AF, Cotler JM. Haemophilic arthropathy. Arch Surg 1956; 72: 247-50.
• 73 Lee P. The efficacy and safety of radiosynovectomy. J Rheumatol 1982; 09 (02) 165-8.
• 74 Anonymous Radioactivity and lymphocytic chromosomes. Br Med J 1973; 02 (858) 68-9.
• 75 Lloyd DC, Dolphin GW. Radiation-induced chromosome damage in human lymphocytes. Br J Radiol 1977; 34: 261-73.
• 76 Falcon de Vargas A, Fernandez-Palazzi F. Cytogenetic studies in patients with hemophilic hemarthrosis treated by 198 Au, 186 Re, and 90 Y radioactive synoviorthesis. J Ped Orthop part B 2000; 09: 52-4.
• 77 Stevenson AC. Chromosomal damage in human lymphocytes from radio-isotope therapy. Ann Rheum Dis 1973; (32) 19-28.
• 78 De La Chapelle A, Oka M, Rekonen A, Ruotsi A. Chromosome damage after intra-articular injections of radioactive yttrium. Ann Rheum Dis 1972; 31: 508-12.
• 79 Gumpel JM, Stevenson AC. Chromosomal damage after intra-articular injection of different colloids of yttrium 90. Rheumatol Rehab 1975; 14: 7-12.
• 80 Daker MG. Prospective chromosomal study of 30 patients undergoing 90Y synovectomy. Rheumatol Rehabil 1979; 18 (Suppl. 01) 41-4.
• 81 Cannas M, Beltrami V, Lamberti L, Bigatti P. Cytogenetic study on the circulating lymphocytes of rheumatoid arthritis patients treated with yttrium-90. Med Sci Res 1994; 22: 133-5.
• 82 Dolphin GW. Biological hazards of radiation. Ann Rheum Dis 1973; (32) 23-8.
• 83 Plon SE, Peterson LE. Childhood cancer, heredity and the environment. In: Principles and Practice of pediatric oncology. Pizzo PA, Poplack DG. (eds) 3rd edition. Philadelphia PA: Lippincott-Raven Publishers; 1997: 26-9.
• 84 Menkes CJ. Radioisotope synoviorthesis in rheumatoid arthritis. Rheumatol Rehabil 1979; 18 (01) 45-6.
• 85 Lipton JH, Messner HA. Chronic myeloid leukemia in a woman with Still’s disease treated with 198 Au synoviorthesis. J Rheumatol 1991; 18 (05) 734-5.
• 86 Goh K, Jacox RF, Anderson FW. Chromosomal abnormalities. Findings in a patient with lymphoma and rheumatoid arthritis treated with intraarticular gold Au 198. Arch Pathol Lab Med 1980; 104: 473-5.
• 87 Stevenson AC. et al. Cytogenetic and scanning study of patients receiving intra-articular injections of gold-198 and yttrium-90. Ann Rheum Dis 1973; 32: 112-3.
• 88 Cibere J, Sibley J, Haga M. Rheumatoid arthritis and the risk of malignancy. Arth Rheum 1997; 40 (09) 1580-6.
• 89 Peters W, Lee P. Radiation necrosis overlying the ankle joint after injection with yttrium-90. Ann Plast Surg 1994; 32: 542-3.
• 90 Wilson APR, Prouse PJ, Gumpel JM. Listeria monocytogenes septic arthritis following intra-articular yttrium-90 therapy. Ann Rheum Dis 1985; 43: 518-9.
• 91 Kendall PH. Untoward effects following local hydrocortisone injection. Ann Phys Med 1958; 04: 170-5.
• 92 Hollander JL. Arthrocentesis and intrasynovial therapy. In: Arthritis and Allied Conditions. McCarty DJ. 9th edition. Lea & Febiger; Philadelphia: 1979: 402-14.
• 93 Davis P, Jayson MIV. Acute knee joint rupture after yttrium 90 injection. Ann Rheum Dis 1975; 334: 62-3.
• 94 Gumpel JM. 90Y colloids in chronic synovitis of the knee: a review 1970 to 1977. Rheumatol Rehabil 1979; 18 (01) 38-40.
• 95 Yates DB, Scott JT, Ramsey N. Double-blind trial of 90-Y for chronic inflammatory synovitis of the knee. Rheumatol Rehabil 1979; 18 (Suppl. 01) 446-7.
• 96 Williams PL, Crawley JCW, Freeman AM, Lloyd DC, Gumpel JM. Feasibility of outpatient management after intra-articular yttrium-90: comparison of two regimens. Br Med J 1981; 282 6257 13-14.
• 97 Jaworski R, McLean R, Choong K, Smart R, Edmonds J. Re-evaluating the need for hospitalization following synovectomy using yttrium-90 silicate. Br J Rheumatol 1993; 32: 1012-7.
• 98 Rekonen A, Kuikka J, Oka M. Retention and extra-articular spread of intra-articularly injected 90Y silicate. Scand J Rheumatol 1976; 05: 47-8.
• 99 Williams ED, Caughey DE, Hurley PJ, John MB. Distribution of yttrium 90 ferric hydroxide colloid and gold 198 colloid after injection into the knee. Ann Rheum Dis 1976; 35: 516-20.
• 100 Goode JD, Howey S. Effect of premedication with intra-articular hydrocortisone on the retention of 198 Au in the knee joint in rheumatoid arthritis. Ann Rheum Dis 1973; 32 supp 43-5.
• 101 Ramsey NW. Retention of 90 Y in patients with rheumatoid arthritis. Ann Rheum Dis 1973; 32 supp 38-40.
• 102 Fearn CBDA. Studies of the spread of radioactive gold colloid. Ann Rheum Dis 1973; 32 supp 34-37.
• 103 Gumpel JM, Farran HEA, Williams ED. Use of yttrium 90 in persistent synovitis of the knee. Ann Rheum Dis 1974; 33: 126-8.
• 104 Gumpel JM, Beer TC, Crawley JCW, Farran HEA. Yttrium 90 in persistent synovitis of the knee – a single centre comparison. The retention and extra-articular spread of four 90 Y radiocolloids. Br J Radiol 1975; 48: 377-81.