Radiosynovectomy in Hemophilic Synovitis

Abstract

Radisosynovectomy (RS) is a local form of radionuclide therapy used in various forms of arthritis characterized by synovitis. In hemophilic arthropathy, RS provides removal of inflamed synovium and prevents further joint damage. This review focuses on the practical aspects of radionuclide synovectomy in hemophilic patients and describes the issues both related to the methodology and post-therapeutic follow-up.Conflict of interest:None declared.

Effect of radiosynoviorthesis on the progression of arthropathy and haemarthrosis reduction in haemophilic patients

“…The current literature shows that radiosynovectomy is a safe and efficient therapy . However, during years, the question of which agent is optimal for radio‐nucleotide synovectomy has been a controversial issue .…”

“…Several radioisotopes can be used for radiosynovectomy and the ideal radioisotope should be a pure beta emitter, with a limited range of penetration through the tissues and a moderate physical half‐life. The most commonly used radioisotopes are Yttrium‐90 citrate colloid ( 90 Y), rhenium‐186 sulphide colloid ( 186 Re) and phosphorus chromic phosphate colloid ( 32 P) …”

“…The therapeutic criteria for synoviorthesis are mainly based on the presence of repetitive haemarthrosis not resolved with factor replacement therapy and/or evidence of synovitis (an alteration of the soft tissues, with changes in echostructure) identified using imaging techniques (ultrasound and/or MRI) . Several studies have demonstrated the effectiveness of synoviorthesis in reducing bleeding frequency, however, its effects on the degenerative joint process are still unspecified.…”

“…The most commonly used radioisotopes are Yttrium-90 citrate colloid ( 90 Y), rhenium-186 sulphide colloid ( 186 Re) and phosphorus chromic phosphate colloid ( 32 P). 11,14,[18][19][20][21][22][23] RS reduces synovial inflammation (at between 2 and 6 months), pain and haemorrhagic frequency, increasing the quality of life of the patient. 9,11,13,14,19,21,22,24 The therapeutic criteria for synoviorthesis are mainly based on the presence of repetitive haemarthrosis not resolved with factor replacement therapy and/or evidence of synovitis (an alteration of the soft tissues, with changes in echostructure) identified using imaging techniques (ultrasound and/or MRI).…”

“…9,11,13,14,19,21,22,24 The therapeutic criteria for synoviorthesis are mainly based on the presence of repetitive haemarthrosis not resolved with factor replacement therapy and/or evidence of synovitis (an alteration of the soft tissues, with changes in echostructure) identified using imaging techniques (ultrasound and/or MRI). 8,18,25 Several studies have demonstrated the effectiveness of synoviorthesis in reducing bleeding frequency, [9][10][11]14,19,24,[26][27][28] however, its effects on the degenerative joint process are still unspecified. Thus, the aim of this study was to evaluate the progression of arthropathy in patients with haemophilia treated with RS in the Haemostasis and Thrombosis Unit (UHT) of the University and Polytechnic Hospital La Fe (Valencia, Spain) as well as to corroborate the effects of this technique with reduction in haemorrhagic episodes in these patients.…”