title: Radiosynoviorthesis in hemophilic arthropathy: pathologic blood pool imaging on pre-therapeutic bone scintigraphy is not a predictor of treatment success.
abstract: OBJECTIVE
  Increased articular99mTc MDP uptake on blood pool imaging (BPI) of patients with rheumatologic conditions is indicative of active inflammatory changes, and has been suggested as a strong predictor of response to radiosynoviorthesis (RSO). In this study, we aimed to assess the value of pretreatment BPI positivity (i.e. scintigraphic-apparent hyperemia) for successful RSO in hemophilic arthropathy.
  
  
  METHODS
  Thirty-four male patients with painful hemophilic arthropathy underwent RSO after failure of conservative treatment. Treated joints comprised the knee in eight, elbow in five, and ankle in 21 patients. Pretreatment triple-phase bone scintigraphy showed hyperemic joints (pathologic BPI) in 17 patients, whereas 17 patients had no increased tracer uptake on BPI. Response to RSO was evaluated 6 months post-treatment by measuring changes in intensity of arthralgia according to the visual analog scale (VAS), bleeding frequency, and range of motion. The association between hyperemia (pathologic BPI) and treatment outcome was examined using nonparametric tests for independent samples.
  
  
  RESULTS
  Clinically evident pain relief occurred in 26 patients (76.5 %), and the mean VAS decreased from 7.7 ± 1.1 to 4.6 ± 2.7 (p < 0.001). Joint bleeding frequency (hemarthrosis) decreased from 4.5 ± 0.6 to 2.1 ± 0.4 during the first 6 months after RSO (p < 0.001). For both parameters (pain relief and bleeding frequency), patients experienced a similar benefit from RSO regardless of pretreatment BPI: arthralgia (p = 0.312) and frequency of hemarthrosis (p = 0.396). No significant improvement was observed for range of motion, but it was significantly more restricted in hyperemic joints both before (p = 0.036) and after treatment (p = 0.022).
  
  
  CONCLUSIONS
  Hemophilic arthropathy can be effectively treated with RSO regardless of pre-therapeutic BPI. Patients in whom articular hyperemia is not detectable by scintigraphy may have similar (outstanding) outcomes, and thus should not be excluded from treatment.
authors: Department of Nuclear Medicine, University Duisburg-Essen, Essen, Germany.|Department of Nuclear Medicine, University Hospital, Bonn, Germany.
authors: Amir
authors: A
authors: Sabet
authors: Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
authors: Andreas Christian
authors: AC
authors: Strauss
authors: Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
authors: Jan
authors: J
authors: Schmolders
authors: Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
authors: Rahel
authors: R
authors: Bornemann
authors: Department of Nuclear Medicine, University Hospital, Bonn, Germany.
authors: Amin
authors: A
authors: Sabet
authors: Department of Experimental Hematology and Transfusion Medicine, University of Bonn, Bonn, Germany.
authors: Johannes
authors: J
authors: Oldenburg
authors: Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
authors: Peter Hans
authors: PH
authors: Pennekamp
authors: Department of Nuclear Medicine, University Hospital, Bonn, Germany.
authors: Hans Juergen
authors: HJ
authors: Biersack
authors: Department of Nuclear Medicine, University Duisburg-Essen, Essen, Germany. samer.ezziddin@uks.eu.|Department of Nuclear Medicine, Saarland University, Kirrberger Str., Geb. 50, D-66424, Homburg, Germany. samer.ezziddin@uks.eu.
authors: Samer
authors: S
authors: Ezziddin
mesh_terms: D000328:Adult; D006467:Hemophilia A / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D007719:Knee Joint / Q000000981:diagnostic imaging; D008297:Male; D011237:Predictive Value of Tests; D011868:Radioisotopes; D011875:Radionuclide Angiography; D013669:Technetium Tc 99m Medronate; D016896:Treatment Outcome
chemical_list: D011868:Radioisotopes; D013669:Technetium Tc 99m Medronate
keywords: Blood pool imaging; Bone scintigraphy; Hemophilic arthropathy; Radiosynovectomy; Radiosynoviorthesis