ABSTRACT
Recurrent bleeding into joints represents the clinical hallmark of haemophilia and, if not adequately treated, it may cause chronic synovitis and degenerative arthropathy. The first treatment option of recurrent haemarthroses and/or chronic synovitis is represented by synoviorthesis, both chemical and radioisotopic, with a success rate of approximately 80% for both. However, radioisotopic synoviorthesis should be preferred because it makes it possible to obtain complete synovial fibrosis usually in one session, without the need for repeated injections, thus reducing the risk of bleeding complications and concentrate consumption. For all these reasons this procedure should be implemented and supported, particularly in developing countries.
Subject(s)
Hemarthrosis/etiology , Hemarthrosis/radiotherapy , Hemophilia A/complications , Radioisotopes/administration & dosage , Synovitis/etiology , Synovitis/radiotherapy , Blood Coagulation Factor Inhibitors/blood , Child , Coagulants/administration & dosage , Factor IX/administration & dosage , Factor VIII/administration & dosage , Hemarthrosis/drug therapy , Humans , Synovitis/drug therapyABSTRACT
Recurrent bleeding into joints represents the clinical hallmark of haemophilia and, if not adequately treated, it may cause chronic synovitis and degenerative arthropathy. In haemophilia patients with inhibitors, a more severe degree of synovitis is often observed owing to the fact that treatment is more problematic in this setting. The first treatment option of recurrent haemarthroses and/or chronic synovitis is represented by synoviorthesis, both chemical and radioisotopic, with a success rate of approximately 80% for both. However, radioisotopic synoviorthesis should be preferred in inhibitor patients because it makes it possible to obtain complete synovial fibrosis usually in one session, without the need for repeated injections, thus reducing the risk of bleeding complications and concentrate consumption. For all these reasons this procedure should be implemented and supported, particularly in developing countries.
Subject(s)
Antibiotics, Antitubercular/therapeutic use , Hemophilia A/drug therapy , Radiopharmaceuticals/therapeutic use , Rifampin/therapeutic use , Synovitis/drug therapy , Adolescent , Adult , Blood Coagulation Factor Inhibitors/blood , Child , Child, Preschool , Hemarthrosis/complications , Hemarthrosis/drug therapy , Hemophilia A/physiopathology , Humans , Injections, Intra-Articular/methods , Radioisotopes , Synovitis/etiology , Synovitis/pathology , Treatment Outcome , Young AdultABSTRACT
Today, total joint replacement is the treatment of choice for chronic haemophilic arthropathy of the knee and hip in developed and developing countries. After the last World Haemophilia Congress and Musculoskeletal Congress, we cannot say the same for haemophilic patients with inhibitors because elective surgery today is still limited to few centres and extremely few patients. This is because until the first half of the 1990s, performing surgery in haemophilic patients with inhibitors was associated with a high risk of bleeding. With the availability of activated recombinant factor VII, the first surgical procedures were performed, but they still remain limited because of the elevated costs of replacement therapy. Our goal for the future must be to ensure the same possibility of surgical intervention in haemophilic patients both with and without inhibitors. This will be possible, thanks to the experience of some centres with an increased number of patients, where today this kind of surgery is routinely performed.
