Intra‐articular rifamycin in haemophilic arthropathy

Abstract

Synoviorthesis is the intra-articular injection of chemical or radioactive substances able to produce fibrosis of hypertrophied synovium, which has proved effective in the treatment of chronic haemophilic synovitis. Between September 1999 and October 2001 we treated 28 outpatients (25 with haemophilia A, three with haemophilia B). Our treatment was focused on pain and functional limitation of joints. A schedule was adopted to treat each joint using intra-articular rifamycin once a week, repeated five times. Patients were covered with factor replacement on demand. Oral analgesia was offered as required because of acute but transient painful inflammatory reaction. Their median age was 34 years (range 15-60 years). The indication for synoviorthesis was chronic synovitis characterized by recurrent haemarthroses, persistent pain and limited range of motion (ROM). Thirty-five joints were treated with a total of 169 injections, including six joints (20%) in patients with inhibitors. In five patients two joints were treated in the same session. Thirty procedures were completed: 24 (80%) were considered effective (as excellent or good), while six were considered insufficient (20%). Pain was reduced in 96% of cases and in 70% the ROM was improved. In our experience intra-articular infiltration with rifamycin appears to be effective in reducing joint pain and in improving the ROM. The procedure presents a low risk of bleeding, can be used for patients with inhibitors and multiple joints can be treated without any additional cost.

Intra-Articular Oxytetracycline for Synoviorthesis in the Treatment of Advanced Hemophilic Arthropathy

“…In our regional context, the most viable procedure yields on chemical synoviorthesis, with intraarticular administration of antifibrinolytic and fibrosing substances, causing synovial atrophy and bleeding tissue eradication, thus preventing further hemarthrosis [5,6,12]. Historically there have been described some substances for use in chemical synoviorthesis like talc, bleomycin, povidone iodine, sodium hydroxide etc.…”

“…Intraarticular oxytetracycline for synoviortesis, have reported a clinical effectiveness about 80% in avoiding hemarthrosis recurrence when applied together with a physical therapy program [5,12] and, as well as rifampicin, is the most accessible and cheap agent for this purpose [6,12]. Thus, intraarticular oxytetracycline currently represents our best option in management of early arthropathy, to stop repetitive bleeding.…”

“…It can be performed by chemical or mechanical means, achieving synovial fibrosis and decreasing the frequency of hemarthrosis, which prolongs both integrity and function of the joint [2,5,11,12].…”

Orthopedic disorders of the knee in hemophilia: A current concept review

“…Oral D-penicillamine may be especially useful in patients with inhibitors. Another method to perform CS is by means of intra-articular injections of rifampicin [25] or oxytetraycline [26] . Alternative, RS is a favorable alternative to oral D-penicillamine and to rifampicin or oxytetracycline for synovectomy, because its efficacy has been proven over the last 40 years [27] .…”

On the main stages of the history of intra-articular therapy

“…Maggiore interesse, invece, ha suscitato nell'artrite reumatoide, la somministrazione intra-articolare della rifamicina, un antibiotico che però in questo caso avrebbe avuto lo scopo di frenare la proliferazione sinoviale. Questa terapia, proposta nel 1980 da Innocenzo Caruso (42), ebbe inizialmente, malgrado l'improbabile propaganda con cui si cercò di diffonderla ed i contrasti con la reumatologia "ufficiale", una certa eco in Italia (43) ed anche altrove (44), ma poi venne di fatto abbandonata, ove si eccettuino alcuni casi di sinovite associata ad emofilia, sui quali sono state pubblicate pochi anni fa esperienze che hanno dimostrato risultati più che soddisfacenti (45,46). Una tappa fondamentale nella storia delle terapie intra-articolari è stata, invece, quella relativa all'introduzione dell'acido jaluronico, ovvero il principale costituente del liquido sinoviale e responsabile della sua viscosità, identificato nel 1934 da Karl Meyer (Fig.…”