Radioactive synovectomy with Yttrium⁹⁰citrate in haemophilic synovitis: Brazilian experience

Abstract

Recurrent haemarthroses leading to chronic synovitis and arthropathy remain a major cause of morbidity in patients with haemophilia. Radioactive synovectomy (RS) is considered the first choice of treatment for chronic haemophilic synovitis. The aim of this study was to evaluate the effect of RS with Yttrium(90) citrate (C-Y(90)) in the joints of patients with chronic haemophilic synovitis. From 2003 to 2007, 245 joints (118 knees, 76 elbows, 49 ankles and two shoulders) of 190 patients with haemophilia or von Willebrand disease were submitted to RS with C-Y(90) at Hemocentro de Mato Grosso, Brazil. Forty joints had radiographic Pettersson scores above 8. There were 36 joints of 22 patients with inhibitors to factor VIII. The procedure was safe with low occurrence of adverse events. The main effect was the overall reduction in joint bleeding frequency, from 19.8 to 2.6 per year post-RS. Similar results were obtained in cases with high radiographic scores and in inhibitor patients. Pain reduction was observed in most cases. Average range of motion was maintained or increased 1 year post-RS in most joints. Extension was stable or increased in 88.2% of the knees and 86.5% of the elbows. Ankle plantarflexion was stable or increased in 90.9%, whereas dorsiflexion was maintained or increased in 87.9%. Worsening of the range of motion, when present, ranged from 14 to 17 degrees. We concluded that RS with C-Y(90) represents an important resource for the treatment of chronic haemophilic synovitis, markedly reducing joint bleeding frequency and pain, irrespective of the radiographic stage and inhibitor status.

A new approach for radiosynoviorthesis: A dose-optimized planning method based on Monte Carlo simulation and synovial measurement using 3D slicer and MRI

“…This particular patient was lately referred to knee arthroscopy. Concerning the number of hemarthroses in a 6‐month period, Patients 6 and 7 did not return to the follow‐up questions established by Thomas et al In the same period, there was a surgical procedure to repair the knee of Patient 2 (knee meniscus surgery). Patient 9 was advised to repeat RSO.…”

“…Eight were males, six with severe hemophilia A, one with moderate hemophilia A, one with moderate hemophilia B, and there was a female patient with factor V deficiency. Inclusion criterion for RSO was blood‐induced synovitis according to previously published protocol . Exclusion criteria were ruptured Baker's cyst (patient number 1), severe arthropathy with reduced joint space, synovial cyst, and severe cartilage and bone erosions (patients number 3 and 4).…”

“…Another important aspect is that, differently from rheumatoid arthritis, in hemophilic arthropathy most patients are children and adolescents. To manage these discrepancies, the current protocol adjusts the activity injected in children to 50 or 100% of the activity used in adults, depending on the size of the joint . The adult protocol considers an estimated surface for the knee, ankle, elbow, hip, and shoulder of 200, 44, 60, 110, and 85 cm 2 , respectively .…”

Nacionalna priporočila za obravnavo bolnikov s hemofilijo

“…Zelo učinkovita je radioizotopna sinovektomija z Y-90 (itrijem) ali z Re-186 (renijevim koloidom). Ima malo stranskih učinkov in se lahko izvede ambulantno (154)(155)(156)(157)(158). Pred posegom zadostuje enkratni dvig manjkajočega faktorja na najmanj 30 % in nato rehabilitacija sklepa za vzpostavitev normalnega stanja (1).…”

Comprehensive Care and Delivery of Care in Hemophilia: The Developing World

“…A single dose of clotting factor is often sufficient for a single injection of isotope and regular physiotherapy postinjection is advised to help the patient regain strength, proprioception, and normal functional use of the joint [25,26]. Synovium becomes inflamed and friable after repeated bleeding and it leads to its hypertrophy.…”