Radioisotope synoviorthesis in pediatric and adolescent patients with hemophilia

Abstract

ObjectiveTo assess the outcome and adverse-effects of the radioisotope synoviorthesis in pediatric and adolescent patients with hemophilia. Material and methodsProspective study of historical cohort was conducted. A total of 20 consecutive hemophiliacs with a mean age of 13.1 years (range 4–17) were included with a mean follow-up of 64.9 months (range 18–109). The diagnosis of synovitis was established on the basis of clinical follow-up including radiological images (radiography and/or MRI). For evaluation, the classification proposed by Fernandez-Palazzi was used. Inclusion criteria: Patients aged less than 18 years old with hemophilia and more than one haemarthrosis in less than 3 months remaining a chronic synovitis despite prophylactic therapy intensification. Exclusion criteria: Any contraindication for radionuclide synoviorthesis. Twenty-seven radioisotope synoviorthesis with 90Y-citrate-colloid and/or 186Re-sulphide-colloid were done. The effectiveness of the procedure was assessed through pre and posttreatment clinical comparison at 6 months after radioisotope synoviorthesis. ResultsNineteen of the 27 synoviorthesis (70.3%) had a good or excellent response and 8 joints (29.7%) had partial response. It was necessary to repeat the procedure in 3 joints in 3 different patients, obtaining in all cases a good or excellent response. We appreciated inflammatory reaction after procedure in 4 cases (14.8%), which improved with analgesics and nonsteroidal anti-inflamatory drugs. None of the patients presented malignant or premalignant lesions during the follow-up. ConclusionThe radionuclide synoviorthesis is a very effective procedure in pediatric and adolescent patients with hemophilia, being a minimally invasive procedure, easy to perform, safe and with minimal side effects.