Yttrium synovectomy in haemophilic arthropathy.
Between 1987 and 1991 we performed Yttrium-90 (Y-90) silicate radionuclide synovectomies on 40 joints of 20 haemophiliac patients with haemophilic arthropathy. All were male, their mean age was 31 yr and 15 of the 20 (75%) were HIV antibody positive. The number of joint bleeds and amount of factor (VIII and IX) replacement given in the 6 months pre- and 6 and 12 months post-radionuclide synovectomy was compared. Y-90 silicate synovectomy was shown significantly to reduce both the number of joint bleeds (P < 0.001) and factor usage (P < 0.001) in the 6 months after the procedure, a result maintained up to 12 months. Depot methyl prednisolone was co-administered with Y-90 but thought unlikely to contribute to joint response beyond 6 months. The reduction of joint bleeds and factor usage was even more dramatic in the 6- to 12-month period post-synovectomy although this was not reflected by the P value (P < 0.001). The reduction of joint bleeds and factor consumption post-synovectomy was most obvious in elbow joints, although the other joints as a group showed a significant reduction. Patients who were HIV antibody positive showed considerable improvement up to 12 months post-treatment, both in reduction of joint bleeds and as a consequence factor consumption. This improvement was seen to a lesser extent in the smaller HIV-negative group.
Dawson
T M
TM
Department of Rheumatology, Alfred Hospital, Prahran, Melbourne, Australia.
Ryan
P F
PF
Street
A M
AM
Robertson
P L
PL
Kalff
V
V
Kelly
M J
MJ
Cicuttini
F M
FM
D000293:Adolescent; D000328:Adult; D005164:Factor IX / Q000627:therapeutic use; D005169:Factor VIII / Q000627:therapeutic use; D006679:HIV Seropositivity / Q000150:complications; D006395:Hemarthrosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000532:radiotherapy*; D006467:Hemophilia A / Q000150:complications* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013583:Synovial Membrane / Q000528:radiation effects*; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
D015021:Yttrium Radioisotopes; D005169:Factor VIII; D005164:Factor IX