Effects of intraarticular 32P colloid in the treatment of hemophilic synovitis of the knee

Abstract

Background:Chronic synovitis is a consequence of recurrent intraarticular hemorrhage in patients with hemophilia. Eventually, synovitis leads to degeneration of the articular cartilage, with serious consequences that impact the quality-of-life in hemophiliacs. The aim of our study was to investigate the short term clinical effects of intraarticular injection of the radionuclide preparation32P colloid (32P-labelled colloidal chromic phosphate suspension) on recurrent intraarticular hemorrhages in patients with hemophilic synovitis of the knee.Materials and Methods:Patients who met the inclusion criteria (n = 22) were enrolled in an open-label study between October 2011 and September 2012.32P colloid was injected into the knee joint and patients were followed up over 6 months after treatment. Hemorrhage frequency, visual analog scale pain score, hospital for special surgery knee score, knee circumference, upper knee circumference, knee diameter, and knee range of motion (ROM) were compared before and after treatment with intraarticular32P colloid injection.Results:In 24 knees evaluated in 22 participating patients, there was a significant reduction in the number of hemorrhages after32P colloid treatment, along with significant pain relief. However, there were no statistically significant changes in the degree of joint swelling, degree of muscle atrophy and knee ROM between the pre and post treatment evaluations.Conclusion:The frequency of joint hemorrhage in patients with hemophilic knee synovitis can be significantly reduced and local symptoms can be improved in the short term by intraarticular injection of32P colloid.

Pathogenesis and treatment options for hemophilic synovitis

“…In 2004 Dunn et al reported a 14-year-old boy that had RS to the left elbow and right ankle. Ten months later the patient was diagnosed with ALL but again a causal link was not confirmed [24] Whilst Y90 or Rh186 are generally used in Europe, the radionuclide used in the USA and other countries is P32 which also achieves satisfactory results [41,42].…”

Radiosynovectomy in haemophilic synovitis and arthropathy of the knee: A scoping review

“…With P-32, reductions of more than 75% in bleeding frequency are reported in the short term. 5,12,13,18,20,36 Complete resolution is also observed in a quarter of cases within the 6 months following treatment though there is a trend towards losing this status over time and at 15 years there is no significant difference in haemarthrosis frequency observed. 5,12,13 Limited data is available for rhenium isotopes on bleeding, with reduction in the average number of bleeds and complete bleeding resolution in the short term in most patients reported.…”

“…There are limited studies comparing pre-and post-treatment function with P-32 though no significant change in ROM or WFH joint functional exam have been identified in small studies. 5,18 Long-term follow up of patients receiving P-32 suggests that there is a significant functional deterioration in RSV patients after 15 years likely due to the natural history of the underlying arthropathy. 13 Following Y-90 RSV, most patients maintained or improved knee flexion (88%) and extension (84%).…”

Haemophilia care in China: Achievements in the past decade

“…Radiosynovectomy is a good option for those who have synovitis with repeated bleeding. Surgeons in China have performed radiosynovectomy with p‐32 colloid in patients with haemophilic synovitis and significantly reduced the frequency of bleeding in these patients 28,29 . Surgical synovectomy and arthroplasty were also performed in patients with haemophilia who had progressed to joint deformity and significantly improved their joint function 30,31 …”