Treatment with radiosynoviorthesis in hemophilic patients with and without inhibitor

Abstract

Background: Spontaneous bleedings occurring into joints (hemarthrosis) are the most common manifestations of hemophilia and causes severe joint damage ultimately resulting in joint disfunction known as hemophilic arthropathy. Among available therapeutic options for reducing recurrent hemarthrosis-associated damage, radiosynoviorthesis (RS) has proven effective in improving joint function. Aim: To assess the impact of RS with Yttrium(90) citrate (C-Y(90)) on frequency of hemarthroses and joint function in a group of pediatric patients. Methods: Between November 1998 and February 2017, we evaluated 27 pediatric patients with mild, moderate or severe hemophilia with haemophilic arthropathy. Overall, RS was applied in 60 joints. Some patients received more than one single intra-articular injection with C-Y(90). Results: During the follow-up, one patient showed joint bleeding 15 months after RS, one patient after 12 months and one patient after 45 days. The episodes of hemarthrosis were reduced and joint function significantly improved in all patients. Conclusion: RS with C-Y(90) is a simple and safe treatment for reducing the frequency of hemarthroses in patients with hemophilia. It decreases the use of factor VIII / IX and improves joint function.

Therapy Response of the Yttrium-90 (Y-90) Colloid and Rhenium-186 (Re-186) Sulphur Colloid Radiosynovectomy in Hemophilic Arthropathy

“…The result was underlined by the data from Peter et al 2005 10 and Tena et al who reported good to excellent results for radiosynovectomy in 60-80% of patient with hemarthrosis. 11 Similar result was found in the study by Martinez, who reported a significant decreased in bleeding frequency in 70-80% of patient. 12 Rate of bleeding frequency was the only variable used to determine treatment failure, hence the need of further radiosynovectomy.…”

Radiosynovectomy in haemophilic synovitis and arthropathy of the knee: A scoping review

“…Forty‐three studies had sample sizes > 20 knees 5–47 . Sixty‐eight studies were defined as small and were not discussed further.…”

“…15,29,34 A greater magnitude of improvement was seen in the short term in a paediatric cohort from Mexico, though the degree of underlying arthropathy was unknown. 45 Muscle strength is infrequently reported as a functional outcome, however a 10% improvement has been reported with Y-90 using the Medical Research Council scale of muscle power. Improvement in ROM and muscle strength both occurred regardless of whether radiographic arthropathy was present or not.…”

“…The risk of complications of knee RSV is low many cohorts reporting no complication with Y-90 or P32. 11,18,24,29,30,43,45 Local complications consist of bleeding and infection as well as radiation induced acute synovitis, skin burns and tract necrosis.…”

The EANM guideline for radiosynoviorthesis

“…The success of the procedure varies depending on the joint and the severity of the hemarthropathy. Two recent studies show that the dosage of coagulation factors needed decreases after RSO [ 75 , 76 ]. In the study by Kachooei et al, [ 188 Re]rhenium colloid was used, but similar results can be expected with the approved [ 186 Re]rhenium colloid.…”