³²P colloid radiosynovectomy in treatment of chronic haemophilic synovitis: Iran experience

Abstract

Summary. Repeated intra‐articular bleeding with subsequent development of chronic synovitis and cartilage changes, leading to haemophilic arthropathy, is one the most debilitating problems in haemophilic patients. Radiosynovectomy is a familiar therapeutic choice in management of chronic synovitis in haemophilia. We report the treatments results of synoviorthesis with 32 P chromic phosphate with emphasis on clinical aspects. Between 2002 and 2006 we performed 66 procedures in 53 patients. Seven patients were excluded. The remaining 46 patients were followed for an average of 31 months. The mean age of patients at the time of injection was 15.9 years (range: 6–28). There were three repeat injections. According to Fernandez‐pallazi and Cavilgia clinical classification ( Table 1 ) [ 23 ], nine joints were Stage II and 46 were Stage III. In latest follow‐up, 77% of patients reported at least a 50% decrease in bleeding frequency after treatment ( P < 0.0001). The need for antihaemophilic factor consumption dropped by about 74% postradiosynovectomy ( P < 0.0001). In most of the injected joints, the range of motion remained stable or improved. A trend was found for the number of haemarthrosis to increase after a period of considerable improvement. Synoviorthesis using 32 P effectively reduces the intra‐articular bleeding rate and factor concentrate use. Durability of the response seems to be unpredictable, perhaps attributable to the late intervention. An early radiosynovectomy might be more helpful in terms of stability of response to treatment. Classification of haemophilic arthropathy according to clinical severity developed by Fernandez‐pallazi and Cavilgia. Stage Definition I Transitory synovitis With no postbleeding sequelae II Permanent synovitis With persistent thickening of the synovial membrane and diminution of range of motion III Chronic arthropathy As for Grade 2 plus muscular atrophy and axial deformity of the limb IV Ankylosis Fibrous or osseous ankylosis