Radiosynoviorthesis in children with haemophilia

Summary

Recurrent bleeding into joints represents the clinical hallmark of haemophilia and, if not adequately treated, it may cause chronic synovitis and degenerative arthropathy. The first treatment option of recurrent haemarthroses and/or chronic synovitis is represented by synoviorthesis, both chemical and radioisotopic, with a success rate of approximately 80% for both. However, radioisotopic synoviorthesis should be preferred because it makes it possible to obtain complete synovial fibrosis usually in one session, without the need for repeated injections, thus reducing the risk of bleeding complications and concentrate consumption. For all these reasons this procedure should be implemented and supported, particularly in developing countries.

Keywords

Synoviorthesis - haemophilia

• References

• 1 Ahlberg A. Radioactive gold in the treatment of chronic synovial effusion in haemophilia. Proceedings of the VII Congress World Federation of Hemophilia. International Congress Series 252. Amsterdam: Excerpta Medica 1971: 212-215.
• 2 Aronstam A, Rainsford SG, Painter MJ. Patterns of bleeding in adolescents with severe haemophilia A. BMJ 1979; 1: 469-470.
• 3 Buzzard BM. Physiotherapy for prevention and treatment of chronic hemophilic synovitis. Clin Orthop 1997; 343: 42-46.
• 4 Dunn AL, Busch MT, Wyly JB, Abshire TC. Radio-nuclide synovectomy for hemophilic arthropathy: a comprehensive review of safety and efficacy and recommendation for a standardized treatment protocol. Thromb Haemost 2002; 87: 383-393.
• 5 Dunn AL, Manco-Johnson M, Busch MT, Balark KL, Abshire TC. Leukemia and P32 radionuclide synovectomy for hemophilic arthropathy. J Thromb Haemost 2005; 3: 1541-1542.
• 6 Fernandez-Palazzi F, Rivas S, Cibeira JL. et al. Radioactive synoviorthesis in hemophilic hemarthrosis. Clin Orthop 1996; 328: 14-18.
• 7 Fernandez-Palazzi F. Treatment of acute and chronic synovitis by non-surgical means. Haemophilia 1998; 4: 518-523.
• 8 Hakobyan N, Kazarian T, Jabbar KJ, Valentino LA. Pathobiology of hemophilic synovitis. I. Over-expression of mdm2 oncogene. Blood 2004; 104: 2060-2064.
• 9 Leissinger CA. Inhibitor development in patients with hemophilia: an overview. Semin Hematol 2006; 43: 1-2.
• 10 Löfqvist T, Petersson C, Nilsson IM. Radioactive synoviorthesis in patients with hemophilia with factor inhibitor. Clin Orthop 1997; 343: 37-41.
• 11 Manco-Johnson MJ, Abshire TC, Shapiro AD. et al. Prophylaxis versus episodic treatment to prevent joint disease in boys with severe hemophilia. N Engl J Med 2007; 357: 535-544.
• 12 Mannucci PM, Tuddenham EGD. The hemophilias – from royal gene to gene therapy. N Engl J Med 2001; 344: 1773-1779.
• 13 Ribbans WJ, Phillips MA. Haemophilic ankle arthropathy. Clin Orthop 1996; 328: 39-45.
• 14 Rivard GE, Girard M, Belanger R. et al. Synoviorthesis with colloidal 32P chromic phosphate for the treatment of hemophilic arthropathy. J Bone Joint Surg Am 1994; 76: 482-488.
• 15 Rodriguez-Merchan EC, Rocino A. Literature review of surgery management in inhibitor patients. Haemophilia 2004; 10: 22-29.
• 16 Rodriguez-Merchan EC, Valentino L, Quintana M. Prophylaxis and treatment of chronic synovitis in haemophilia patients with inhibitors. Haemophilia 2007; 13: 45-48.
• 17 Scharrer I, Bray GL, Neutzling O. Incidence of inhibitors in haemophilia A patients – a review of recent studies of recombinant and plasma-derived factor VIII concentrates. Haemophilia 1999; 71: 71-76.
• 18 Thomas S, Assi P, Gabriel M. et al. Synoviorthesis with Yttrium 90 in the hemophilic synovitis: 24 months of follow-up in 53 joints and 177 patients submitted?. Haemophilia 2008; 14 (02) 77.
• 19 Valentino LA, Hakobyan N, Kazarian T. et al. Experimental haemophilic synovitis: rationale and development of a murine model of human factor VIII deficiency. Haemophilia 2004; 10: 280-287.