MRI findings in haemophilic joints treated with radiosynoviorthesis with development of an MRI scale of joint damage

Abstract

We hypothesized that magnetic resonance imaging (MRI) scans taken prior to radiosynoviorthesis may be predictive of response to the procedure in persons with haemophilia. Specifically, response would be inversely related to the severity of synovial hyperplasia. Radiosynoviorthesis was administered to 21 joints with recurrent haemorrhage (target joints). A detailed self-report of haemorrhage history, joint evaluation with scoring according to the World Federation of Haemophilia orthopaedic joint and pain scales, plain radiographs, and MRI studies of the joints were performed pre- and post-radiosynoviorthesis. To augment comparison of the MRI findings to those assessed using the Arnold-Hilgartner and Pettersson scales, a provisional MRI scale for evaluation of haemophilic arthropathy was designed. We found the MRI findings prior to the procedure were not predictive of clinical response; independent of the severity of synovial hyperplasia, most joints bled less and showed improvement by the WFH orthopaedic score. There was generally no change in the severity of synovial hyperplasia after the procedure. We conclude that MRI evaluation is not routinely indicated prior to radiosynoviorthesis.

Neoangiogenesis contributes to the development of hemophilic synovitis

“…[2][3][4] Previous work has suggested the role of iron and cytokines in the pathogenesis of HJD. [7][8][9] Observing that the hemophilic synovium is not only hyperproliferative but also highly vascular, 2,3 we embarked on a study to examine human blood and synovium from subjects with HJD, hypothesizing that angiogenic mediators may play a role in the pathogenesis of HJD.…”

“…6,7 Alternatively, the selective implementation of these strategies would require a more sensitive tool for detecting synovitis than is currently possible with clinical surveillance or plain radiographs. Magnetic resonance imaging (MRI) can detect both synovial and cartilage changes resulting from recurrent hemarthroses, 8 unlike plain radiographs, which detect only advanced bony changes associated with joint arthropathy. 2 However, MRI is expensive and requires sedation in younger children, limiting its utility for routine monitoring of synovitis.…”

State‐of‐the‐art imaging techniques for the evaluation of haemophilic arthropathy: present and future

“…In 2005, the International Prophylaxis Study Group (IPSG) presented a preliminary comprehensive scoring scheme [22,26,27] that combined the pioneer Denver [20] and European MRI scores [21]. The use of such scales should result in a more consistent assessment of haemophilic joints and should facilitate the development of more targeted treatment to prevent or delay further destructive osteoarticular changes.…”

Effects of the factor V G1691A mutation and the factor II G20210A variant on the clinical expression of severe hemophilia A in children results of a multicenter study

“…The MRI classification was made according to Nuss (MRI-score). 10 The maximum ABF of each participating child, based on reviews of patient infusion logs and family reports, was recorded at comprehensive clinical visits. Traumatic or spontaneous joint hemorrhage was defined a priori as an acutely painful swollen joint requiring factor replacement therapy.…”