Prophylaxis and treatment of chronic synovitis in haemophilia patients with inhibitors

Abstract

Prophylaxis is paramount to try to avoid the development of haemophilic synovitis. The best treatment for synovitis in patients with inhibitors is radioactive synoviorthesis (rhenium for ankle and elbows, yttrium for knees). With both methods (prohylaxis and radioactive synoviorthesis), we can delay the development of severe haemophilic arthropathy, that eventually will require major orthopaedic surgery.

Radioisotope synoviorthesis in pediatric and adolescent patients with hemophilia

“…In 19 (70.3%) of the 27 synoviorthesis the response was good (6) or excellent (13) and partial in 29.7% (8). There were no cases of "no response" (Table 5).…”

“…8,9 The selection of the radionuclide and the optimal dose remains controversial. For treatment of recurring hemarthrosis and synovitis secondary to hemophilia beta emitters such as gold ( 198 Au), phosphorus ( 32 P), yttrium ( 90 Y), rhenium ( 186 Re) and erbium ( 169 Er) have been used.…”

Synoviorthesis in haemophilia patients with inhibitors

“…From 1971 several series reported the results of radioactive synoviorthesis (RS) in haemophilia patients similar to those of surgical synovectomy, with approximately 80% success with significant (>50%) bleeding reduction [11][12][13][14][15][16][17], also after a long-term follow-up [13]. Moreover, the rigorous physical therapy and factor infusion regimen, which is crucial to achieve a favourable outcome after a surgical synovectomy, are not needed in this setting.…”

“…The selection of optimal radionuclide and dose is controversial. Gold ( 198 Au), yttrium ( 90 Y), phosphorus ( 32 P), rhenium ( 186 Re) and erbium ( 169 Er) have been utilized to treat haemophilic synovitis [11][12][13][14][15][16][17].…”

Radiosynoviorthesis in children with haemophilia

“…From 1971 several series reported the results of radioactive synoviorthesis (RS) in haemophilia patients similar to those of surgical synovectomy, with approximately 80% success with significant (>50%) bleeding reduction (1,4,6,10,14,16), also after a long-term follow-up (6). Moreover, the rigorous physi-cal therapy and factor infusion regimen, that is crucial to achieve a favourable outcome after a surgical synovectomy, are not needed in this setting.…”