The co effect of prophylaxis and radiosynovectomy on bleeding episodes in haemophilic synovitis

Abstract

Prophylactic substitution treatment and radiosynoviorthosis have a leading role in preventing irreversible haemophilic arthropathy. The aim of the study was to evaluate the effects of prophylaxis treatment and radiosynovectomy on the length of intervals between subsequent haemorrhages in haemophilic patients. Thirty-three joints were treated with radiosynovectomy in 28 patients with bleeding disorders. (90)Y colloid was used in knees and (186)Re colloid for elbows, shoulders and ankles. Twenty patients were on prophylaxis. Joint X-rays were evaluated on the Pettersson scale between 0 (normal) and 13 (severe joint destruction). During an observation period (range 6-44 months) bleeding episodes were recorded and data statistically analysed. Before radiosynovectomy, increasing intensity of the prophylaxis 10% lengthens intervals between two haemorrhages by 1% (P < 0.05). In patients with a Pettersson score higher than nine, intervals between bleedings are shorter by 73% (P < 0.05), in comparison with patients with lower Pettersson scores of 0-5. After radiosynovectomy, the length of the first non-bleeding interval increased by 120% (to 60 days) in comparison with the intervals before the procedure (P < 0.001). But, in the following year and half, every subsequent non-bleeding interval was 8% shorter (P < 0.1). In that period, prophylaxis shortened the non-bleeding interval by 1.7% (P < 0.05) per 10% increase of its intensity. Radiosynovectomy is more efficient in patients with less affected joints and is less efficient in younger patients. Prophylaxis reduced time between the bleedings episodes after isotope application. Before radiosynovectomy, prophylaxis reduces the number of haemorrhages. Our findings support data previously published by Rodriguez-Merchan et al. [J Thromb Haemost, 5 (2007) P-W-126].

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

“…Regarding the number of bleeding episodes, our results, in line with previous studies have demonstrated the effectiveness of RS in reducing haemorrhagic frequency. The number of haemarthrosis events reduced by 71.13%, from 582 to 168, this being a statistically significant reduction ( P < .001).…”

“…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.…”

The Limitations and Unmet Needs of the Five Cornerstones to Guarantee Lifelong Optimization of Prophylaxis in Hemophilia Patients

“…Joint damage is determined by synovial membrane blood release into the joint, which is responsible for structural joint damage ( Table 2 ). 15 The target joint has been classically defined as one in which at least three or more spontaneous bleeding events have taken place within a 6-month period. 6 Nevertheless, the current improved prophylactic treatments have succeeded in reducing recurrent joint bleeds to such an extent that allowing the occurrence of more than two bleeds with no therapeutic intervention is rather uncommon.…”

Nacionalna priporočila za obravnavo bolnikov s hemofilijo

“…Zelo učinkovita je radioizotopna sinovektomija z Y-90 (itrijem) ali z Re-186 (renijevim koloidom). Ima malo stranskih učinkov in se lahko izvede ambulantno (154)(155)(156)(157)(158). Pred posegom zadostuje enkratni dvig manjkajočega faktorja na najmanj 30 % in nato rehabilitacija sklepa za vzpostavitev normalnega stanja (1).…”