Radiosynoviorthesis and Its Effectiveness: Brazilian Experience in 1136 Joints of 572 Patients With Hemophilic Arthropathy

INTRODUCTION: Synovium plays a central role in the development of haemophilic arthropathy (HA). Minimally invasive treatments for haemophilic synovitis are better options than surgery and radiosynoviorthesis (RSO) is considered the treatment of choice. OBJECTIVE: To evaluate the main factors that influenced the results of RSO in HA. METHODS: In this cohort of patients with HA, we retrospectively analysed the effects of RSO 6 months after the procedure in 1136 joints of 572 patients with HA. The variables evaluated were age, diagnosis of bleeding disorder, inhibitor, prophylaxis, joint, pre-RSO synovial volume, type and dose of radiopharmaceutical (RP), Pettersson and MRI scores, number of hemarthroses and pain. RESULTS: The median age of patients was 15 years (range: 2-61 years), and 48.9% of joints belonged to children under 14 years of age. The majority (69.3%) of joints presented changes above 5 points in the Pettersson score for haemophilic arthropathy. The variables that reached statistical significance were the type of joint, RP and the diagnosis of haemophilia. The median (Interquartile Range) number of hemarthroses at 6 months pre-RSO was 10 (4-18), decreasing to 1 (0-3) 6 months post-RSO. A combined improvement in hemarthrosis and pain was observed in 91.6% of treated joints. RP Yttrium-90 Citrate was the most effective when compared to Yttrium-90 Hydroxyapatite and Samarium-153 Hydroxyapatite; elbows and ankles joint showed superior outcomes compared to knees joints. CONCLUSION: This study confirms the results of previous publications, which demonstrated the efficacy of RSO in reducing the number of hemarthroses related to haemophilic synovitis.