title: Radiosynoviorthesis in hemophilic joints with yttrium-90 citrate and rhenium-186 sulfide and long term results.
abstract: Repeated bleeding in the joint cavities is the most annoying symptom and often has disabling effects in patients with hemophilia (PWH). Our aim was to study the effect of radiosynovectomy (RSO) with beta particle-emitting radiocolloids in the treatment of hemorhagic arthropathy. We have treated 22 joints from 18 patients with hemophilia A, from April 2008 to February 2012, 5 knees, 11 elbows and 6 ankles. Joints were divided into two Groups, those treated with yttrium-90-citrate ((90)Y-C) (5 knees, 2 of them twice)-Group I and those with rhenium-186-sulfide ((186)Re-S) (11 elbows, 1 of them treated twice and 6 ankles)-Group II. A total of 25 treatments. Follow-up period was 3 months, 1 year and 3 years. Results showed a favourable subjective and a better objective result in all 5 joints of Group I and in 15/17 joints of Group II, respectively. Follow-up after 3 months showed significant improvement in Hemophilia Join Health Score (HJHS) after 20 treatments and steady score after 5 treatments. After 1 year, 19 treated joints had improved for the first time, 3 remained steady and 3 were not examined. After 3 years, 9 treated joints were HJHS steady, while 16 were not examined. One year after treatment, 13/14 joints of patients, aged 6-23 years showed better HJHS score, while 9/11 joints of patients aged 26-51 years, showed better HJHS. Synovial membrane thickness as measured by MRI in 8 joints, before and 3 months after treatment was not related to prognosis. In conclusion, in a small group of hemophilic patients with hemorrhagic arthropathy treated with (90)Y-C and with (186)Re-S, our study showed good results irrespective of age in 22/25 treatments after 3 months or 1 year. The thickness of synovial membrane in the 8 joints studied was not related to prognosis.
authors.affiliation: Department of Tumor Biology, 3rd Faculty of Medicine Charles University Prague, Ruska 87, 100 97 Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Teyssler
authors.forename: Katerina
authors.initials: K
authors.lastname: Taborska
authors.forename: Katarina
authors.initials: K
authors.lastname: Kolostova
authors.forename: Vladimir
authors.initials: V
authors.lastname: Bobek
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002951:Citrates / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use*; D012211:Rhenium / Q000627:therapeutic use*; D013440:Sulfides; D013583:Synovial Membrane / Q000528:radiation effects*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002951:Citrates; D009942:Organometallic Compounds; D013440:Sulfides; C400124:rhenium sulfide; D012211:Rhenium; C045937:yttrium citrate