title: Radiosynovectomy: review of the literature and report from two haemophilia treatment centers.
abstract: Haemophilic arthropathy occurs due to recurrent bleeding into joints leading to swelling, inflammation, destruction of cartilage and bone, and development of arthritis. Although prophylactic replacement therapy assists in preventing arthropathy, it is not always adequate or affordable. Radiosynovectomy is a minimally invasive intervention for treatment of synovitis in haemophilic joints. The procedure utilises locally injected radioisotopes (Y, P, Rh) to ablate abnormal synovium with the goal of decreasing bleeding, slowing progression of cartilage and bone damage and preventing arthropathy. The objective of this review is to summarize the radiosynovectomy literature and to present patient outcomes associated with radiosynovectomy over the past 17 years from two haemophilia treatment centers (HTCs), one in the United States and one in Spain. Articles from these two centers support the current literature. A retrospective medical records review was performed by the two reporting HTCs on patients who underwent radiosynovectomy prior to 2009. Data review included: site of procedure, isotope utilized, bleeding frequency, and procedure complications. Radiosynovectomy is a cost-effective, minimally invasive, well tolerated procedure. As the paradigm for care in haemophilia shifts towards prevention of joint disease, the number of target joints with synovitis will likely decrease, except in patients who develop inhibitors. We propose early consideration of radiosynovectomy for patients with haemophilic synovitis prior to appearance of articular cartilage damage.
authors.affiliation: Indiana Hemophilia and Thrombosis Center, Indianapolis, IN 46260, USA. arampersad@IHTC.org
authors.forename: Angeli G
authors.initials: AG
authors.lastname: Rampersad
authors.forename: Amy D
authors.initials: AD
authors.lastname: Shapiro
authors.forename: E Carlos
authors.initials: EC
authors.lastname: Rodriguez-Merchan
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Maahs
authors.forename: Stacie
authors.initials: S
authors.lastname: Akins
authors.forename: Victor
authors.initials: V
authors.lastname: Jimenez-Yuste
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D000075202:Contraindications; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D007196:Indiana; D007592:Joint Diseases / Q000191:economics / Q000209:etiology; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced; D010761:Phosphorus Radioisotopes / Q000627:therapeutic use; D011868:Radioisotopes; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012211:Rhenium / Q000627:therapeutic use; D013030:Spain; D013585:Synovitis / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use
chemical_list: D010761:Phosphorus Radioisotopes; D011868:Radioisotopes; D015021:Yttrium Radioisotopes; D012211:Rhenium