Effects of radiosynoviorthesis on pain in patients with haemophilia

Introduction: Haemarthroses lead to synovitis that subsequently induces structural joint alterations and pain in patients with haemophilia (PwH) [1]. To counteract this vicious cycle, radiosynoviorthesis (RSO) as a minimally invasive procedure is increasingly administered. This study investigated the efficacy of RSO on pain-related parameters in PwH over a one-year course.

Method: In total, 84 adult PwH with moderate or severe haemophilia A or B were initially included. Complete data were available for 56 PwH, with 30 PwH receiving RSO at the ankle, knee, or elbow joint and 26 PwH served as the control group. Three patients received two RSOs at different joints. Anthropometric and disease-related (e.g., type, treatment) information and clinical data on pain and the orthopaedic joint condition (Haemophilia Joint Health Score; HJHS) were obtained prior to RSO treatment (Pre) and 3 months (Post3), 6 months (Post6), and 12 months (Post12) afterwards. Pain-related parameters comprised the assessment of pressure pain thresholds (PPT) and the average pain intensity on a numerical rating scale (NRS) over the past two weeks. To statistically examine the efficacy of RSO on PPT and NRS, two-way mixed method ANOVA models were computed. Main effects ‘time’ (Pre, Post3, Post6, Post12) and ‘joint’ (joints with RSO treatment [J-RSO, n=33], joints contralateral [J-CL, n=33], joints of control group [J-Con, n=156]) as well as the interaction effect ‘time’ x ‘joint’ were calculated.

Results: RSO was indicated for 9 elbow, 6 knee, and 18 ankle joints. In terms of NRS, a significant interaction effect and significant main effects for the factors ’time’ and ‘joint’ were observed (all p<0.001). For J-RSO, NRS was significantly reduced at Post3 (p<0.001), Post6 (p=0.004), and Post12 (p=0.002) compared to Pre. For J-CL, a significant reduction in NRS was found at Post6 (p=0.019). No significant changes in NRS were observed for J-Con. Regarding PPT, no significant interaction effect (p=0.550) and no significant main effect for ‘joint’ (p=0.736), however, a significant main effect for ‘time’ (p<0.001) were observed. For J-RSO, PPT were significantly increased at Post6 (p=0.011) and Post12 (p=0.010), however, not at Post3 (p=0.064) compared to Pre. For J-CL and J-Con, a significant increase in PPT was found at Post6 (p=0.018) and Post12 (p<0.001), respectively.

Conclusion: RSO treatment represents an effective method to improve subjectively perceived pain 3 months post treatment, with the effect lasting for at least 12 months. Pain sensitivity also decreased 6 months after the RSO treatment, but was not significantly different compared to the control group. Interestingly, RSO does not exclusively alleviate pain at the joint indicated treatment, but might also affect pain perception at the contralateral side.

Publikationsverlauf

Artikel online veröffentlicht:
13. Februar 2025

• References

• 1 Gualtierotti R, Solimeno LP, Peyvandi R. 2021; Hemophilic arthropathy: Current knowledge and future perspectives. J Thromb Haemost 19 (09) 2112-2121