Is radiosynovectomy (RS) effective for joints damaged by haemophilia with articular degeneration in simple radiography (ADSR)?

Abstract

Radiosynovectomy (RS) is known to be effective in the treatment of chronic haemophiliac synovitis. Its effectiveness may, however, be different when the joint treated shows articular degeneration in simple radiography (ADSR). The purpose of this study was to investigate the effectiveness or otherwise of RS in the presence of ADSR. To this end, the objective improvement in five joint parameters (haemarthrosis, joint pain, range of motion, muscle strength and synovial size) has been analysed with respect to the pre-existence or otherwise of ADSR in the articulation treated. An observational retrospective cohort study was conducted. Between January 1993 and December 2006, RS was performed on 78 people with haemophilia. Their average age was 18 (range 7-51). RS procedures were performed on 104 different joints; some joints required more than one injection (a maximum of 3 were given, with a 6-month interval between them), which we refer to respectively as RS-1, RS-2, RS-3, resulting in a total of 156 procedures. The isotopes used were (90)Y on 107 occasions and (186)Re in 49 injections. RS treatment reduced the frequency of haemarthroses, reduced joint pain and reduced synovial size, and resulted in improved muscle strength and range of motion both in joints with ADSR (N=86) and in those without ADSR (N=18). However, no articulation without ADSR required RS-3. The five parameters studied improved to an equal degree in joints with ADSR and without ADSR. No joint without ADSR required RS-3; this was the only difference our study found between joints without ADSR and those with ADSR at the time of the RS.