Outcome of Radioactive Synoviorthesis in Haemophiliac Arthropathy

Purpose of the Study:

Spontaneous intraarticular haemorrhages are the most frequent bleeding episodes encountered in the haemophiliac population, causing pain, joint deformity and arthropathy. Chronic haemophiliac arthropathy is characterised by persistent joint swelling, proliferative synovitis, and damage to or loss of articular cartilage. Elimination of the synovitis is the key to prevention of recurrent intraarticular haemorrhages and joint damage. The purpose of the study was to investigate the indications for, and outcome of, radioactive synoviorthesis for haemophiliac arthropathy.

Methods:

A retrospective study was done to assess the results of 12 intra-articular injections of radioactive Yttrium-90 colloid, performed in 10 patients from November 1993 to December 2006. Patients were referred by the Haematology Unit if they had a target joint, as defined as >2 bleeds into the same joint in the preceding 6 months. Follow up was conducted at 6 monthly intervals, assessing clinical and radiological outcomes.

The radiological involvement of the target joint, the pre- and post-treatment range of movement, presence of synovitis and bleeding events were compared from presentation to that at follow up. Range of movement of each target joint was assessed and compared to that at follow-up.

Results:

The average age at time of injection was 10.6 years (range 6–15). The duration of follow-up was 35 months (range 6 to 60 months).

The involved joints had an average of 2 bleeds each in the 6 months preceding the injection (24 events). Following Yttrium injection only 1 out of 12 joints had a bleed in the subsequent 6 months (1 event).

Synovitis of the target joint resolved in 11 of 12 joints.

Nine target joints (75%) showed a favourable improvement in range of movement. Those with a favourable radiological score had a better clinical outcome, but even those with a poor score showed improvement.

Conclusion:

In this study, intra-articular injection of radioactive Yttrium-90 colloid was shown to:

1. –

   Significantly reduce bleeding events in a Haemophiliac cohort

2. –

   Resolve synovitis in 11 out of 12 joints with haemophiliac arthropathy

3. –

   Improve range of movement in the majority of patients

4. –

   This was best in those with a better radiological appearance at presentation.

5. –

   Those with a poorer radiological grade also showed some improvement suggesting that while results are less certain, patients may still benefit from the intervention.