RESUMEN
Background: In patients with hemophilia, radionuclide synoviorthesis, or the intra-articular injection of a radionuclide to decrease the synovial hypertrophy tissue, aims to decrease or avoid hemarthrosis. Aim: To evaluate the effectiveness of radionuclide synoviorthesis in hemophilia. Material and Methods: Observational retrospective study of the evolution of 107 male patients aged 3 to 54 years who were subjected to radionuclide synoviorthesis between 2007 and 2015. Results: Of 164 treated joints, in 65% treatment was successful, (defined as zero to two hemarthroses and absence of synovitis during the follow up period), in 17% it was partially successful (defined as two or less hemarthroses, but persistence of the synovitis) and failed in 18% of the procedures. No important complications were recorded. Conclusions: Radionuclide synoviorthesis has an overall 82% success rate, is minimally invasive, can be used at any age and is inexpensive We recommend its implementation in Chilean hemophilia treatment centers.
Asunto(s)
Humanos , Masculino , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Radioisótopos/administración & dosificación , Renio/uso terapéutico , Sinovitis/terapia , Radioisótopos de Itrio/uso terapéutico , Hemartrosis/terapia , Hemofilia A/terapia , Sinovitis/fisiopatología , Sinovitis/diagnóstico por imagen , Factores de Tiempo , Reproducibilidad de los Resultados , Estudios Retrospectivos , Resultado del Tratamiento , Hemartrosis/fisiopatología , Hemartrosis/diagnóstico por imagen , Hemofilia A/fisiopatología , Inyecciones IntraarticularesRESUMEN
Radiosynovectomy is a local form of radiotherapy used as second-line treatment in the management of inflammatory and non-inflammatory arthropathies with unsatisfactory response to local or systemic corticosteroid therapy. Its efficacy is similar to that of surgical synovectomy, with the advantages of being a low-cost and minimally- invasive treatment that requires a shorter recovery time. Its efficacy is greater in the treatment of inflammatory arthritis characterized by synovitis, such as rheumatoid arthritis and juvenile chronic arthritis with mono/oligoarticular involvement, especially in upper extremity joints. A number of isotopes can be used in colloidal suspensions. Rhenium-186-sulphide colloid is currently indicated for the treatment of medium-sized joints. The ultrasound-guided injection is suitable for small joints, such as wrist. For proper and safe use and administration of this technique the collaboration of a trained and experienced radiologist is critical to successful treatment.
La radiosinovectomía es una forma local de radioterapia utilizada como tratamiento de segunda línea en el manejo de artropatías inflamatorias y no inflamatorias con respuesta insatisfactoria a la terapia sistémica o local con corticoesteroides. Tiene una eficacia similar a la sinovectomía quirúrgica, con las ventajas de ser un tratamiento de menor costo, menos cruento y con menor tiempo de convalecencia. Su eficacia es mayor en artropatías inflamatorias caracterizadas por sinovitis, como la artritis reumatoide y artritis crónica juvenil, con compromiso mono u oligoarticular y en articulaciones de extremidades superiores. Existen múltiples isótopos que se pueden utilizar en suspensiones coloidales, siendo el sulfuro coloidal de renio-186 el utilizado para la articulación radiocarpiana. Una técnica de administración adecuada es fundamental para el éxito del tratamiento, siendo la inyección con guía ultrasonográfica adecuada para articulaciones de volumen pequeño, instancia en la que la colaboración del médico radiólogo entrenado es fundamental.