Synoviorthesis in haemophilia patients with inhibitors

Abstract

Recurrent bleeding into joints represents the clinical hallmark of haemophilia and, if not adequately treated, it may cause chronic synovitis and degenerative arthropathy. In haemophilia patients with inhibitors, a more severe degree of synovitis is often observed owing to the fact that treatment is more problematic in this setting. 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 in inhibitor patients 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.

Radioactive synovectomy with Yttrium90citrate in haemophilic synovitis: Brazilian experience

“…Good outcomes were found in inhibitors patients, similar to that reported by other authors [34–36]. Although the incidence of haemarthroses in patients with and without inhibitors is usually similar [35,36], the burden of orthopaedic problems is known to be more severe in the individuals with inhibitors [36]. We found a higher number of haemarthroses pre‐RS in the non‐inhibitor group (mean 21.39) than in the inhibitors (mean 16.2), independent of age or radiological status.…”

The EANM guideline for radiosynoviorthesis

“…It can also be used when moderate hemarthropathy exists and surgical interventions are not yet required. RSO is an option when inhibitors against factor VIII/IX are present [77,78] or when synovitis persists over 6 months despite intensified factor therapy [58,78]. Before the onset of hemarthropathy, RSO should be used as a first-line treatment in chronic synovitis [58,[78][79][80].…”

“…RSO is an option when inhibitors against factor VIII/IX are present [77,78] or when synovitis persists over 6 months despite intensified factor therapy [58,78]. Before the onset of hemarthropathy, RSO should be used as a first-line treatment in chronic synovitis [58,[78][79][80]. Finally, if the synovitis persists or relapses after the first RSO, it is proposed that the procedure can be repeated up to three times.…”

“…Finally, if the synovitis persists or relapses after the first RSO, it is proposed that the procedure can be repeated up to three times. If synovitis persists after the third RSO, it should be treated surgically [ 58 , 78 , 81 ].…”

Clinical and Radiological Evaluation After Chemical Synovectomy With Rifampicin in Hemophilic Arthropathy: Korean Experience With a 2-Week Interval Protocol

“…In general, medical synovectomy is considered first. The term synoviorthesis (medical synovectomy) is commonly used to describe the intra-articular injection of a substance producing fibrosis of the synovium and subsynovial plexus [ 13 , 14 ]. There are two basic types of medical synovectomy: chemical or radiological.…”