What is the role of radiosynovectomy in the treatment of hemophilia A?

Updated: Jan 14, 2019
  • Author: Douglass A Drelich, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

In patients who develop synovitis from joint bleeds, intra-articular injection of radioisotopes to ablate the synovium (radiosynovectomy) can be used to decrease bleeding, slow progression of cartilage and bone damage, and prevent arthropathy. Yttrium-90 and rhenium-186 have proved equally effective for radiosynovectomy. [63] A review by Rodriguez-Merchan et al concluded that radiosynovectomy is effective, safe, and well tolerated. [63]

The review by Rodriguez-Merchan included 500 synovectomies in 443 joints of 345 patients with chronic hemophilic synovitis. One to three injections were administered, with a 6-month interval between injections. On average, the number of hemarthroses decreased by 64.1%, articular pain decreased by 69.4%, the degree of synovitis decreased by 31.3%, and the World Federation of Haemophilia score improved by 19%. Only four complications (0.9%) occurred. In 28 joints (6.3%), arthroscopic synovectomy or total knee replacement was eventually required. [30]


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