Yttrium Synovectomy in Haemophilic Arthropathy

Abstract

Between 1987 and 1991 we performed Yttrium-90 (Y-90) silicate radionuclide synovectomies on 40 joints of 20 haemophiliac patients with haemophilic arthropathy. All were male, their mean age was 31 yr and 15 of the 20 (75%) were HIV antibody positive. The number of joint bleeds and amount of factor (VIII and IX) replacement given in the 6 months pre- and 6 and 12 months post-radionuclide synovectomy was compared. Y-90 silicate synovectomy was shown significantly to reduce both the number of joint bleeds (P < 0.001) and factor usage (P < 0.001) in the 6 months after the procedure, a result maintained up to 12 months. Depot methyl prednisolone was co-administered with Y-90 but thought unlikely to contribute to joint response beyond 6 months. The reduction of joint bleeds and factor usage was even more dramatic in the 6- to 12-month period post-synovectomy although this was not reflected by the P value (P < 0.001). The reduction of joint bleeds and factor consumption post-synovectomy was most obvious in elbow joints, although the other joints as a group showed a significant reduction. Patients who were HIV antibody positive showed considerable improvement up to 12 months post-treatment, both in reduction of joint bleeds and as a consequence factor consumption. This improvement was seen to a lesser extent in the smaller HIV-negative group.

The Efficacy of Magnetic Resonance Imaging and X-Ray in the Evaluation of Response to Radiosynovectomy in Patients with Hemophilic Arthropathy

“…This relatively low success rate might be explained with the high ratio of advanced disease in our patient group, as 10 out of 11 joints showed cartilage loss on pre-procedure MRI. There are reports indicating that the likelihood of a favourable response was higher in joints with no or little radiological damage, similar to the findings in patients with rheumatoid arthritis (10,11,12). It has been proposed that initial findings on MRI, in particular, measures of the severity of synovial hyperplasia, may be inversely related to clinical response to radiosynoviorthesis (13).…”

“…This success rate is not as high as the previous studies which reported improvement from 75% to 90% after radiosynovectomy(2,3,4,5,6,7,8,9,10,11,33,34). This relatively low success rate might be explained with the high ratio of advanced disease in our patient group, as 10 out of 11 joints showed cartilage loss on pre-procedure MRI.…”

“…To achieve this goal, this hypervascular and hypertrophic synovium should be destroyed by either operative synovectomy or radiosynovectomy (RS). RS has been used effectively for this purpose since 1952 and satisfactory results were obtained (1,2,3,4,5,6,7,8,9,10,11,33,34,35). The assessment of the therapy response of RS in patients with hemophilic arthropathy has been done by measuring the changes in mean number of hemorrhages, pain in the joints, range of motion (ROM) or by imaging studies like blood-pool imaging, plain X-ray and MRI.…”

Radiosynovectomy in Hemophilic Synovitis: Correlation of Therapeutic Response and Blood-Pool Changes

“…This outcome is comparable to the previous reports which had a success rate ranged from 75% to 90% after radiosynovectomy with Y-90, Re-186, and other radionuclides in patients with hemophilia. [4][5][6][7][8][9][10][11][12]20 In this study, radiosynovectomy fails to control hemarthrosis in 13% of the joints (joints had less than 30% reduction in bleeding episodes or no chance). On the other hand, 3% of treated joints had moderate improvement, and 9% of treated joints had mild improvement.…”

Is Corticosteroid Coinjection Necessary for Radiosynoviorthesis of Patients with Hemophilia?

“…10 In the hope of reducing complications, hospitalization, and cost, nonsurgical synovectomy using radionuclides in patients with hemophilia was first reported by Ahlberg et al 11 After that, there have been several studies concerning the usefulness and clinical success of this procedure. [12][13][14][15][16] It is generally accepted that radioactive synovectomy is safe, easily performed, requires low antihemophilic factor coverage, and can be carried out on an ambulatory basis. It is also reported that radiosynovectomy can be effective in reducing hemarthrosis frequency up to approximately 75% on average.…”