Treatment with radiosynoviorthesis in hemophilic patients with and without inhibitor

Background. Spontaneous bleedings occurring into joints (hemarthrosis) are the most common manifestations of hemophilia and causes severe joint damage ultimately resulting in joint disfunction known as hemophilic arthropathy. Among available therapeutic options for reducing recurrent hemarthrosis-associated damage, radiosynoviorthesis (RS) has proven effective in improving joint function. Aim. To assess the impact of RS with Yttrium 90 (90Y) on frequency of hemarthroses, need for prophylaxis and joint function in a group of pediatric patients, as well as on costs for hospitalization. Methods . Between November 1998 and February 2017, we evaluated 27 pediatric patients with mild, moderate or severe hemophilia with haemophilic arthropathy. Patients suffered between two and five episodes of hemarthrosis per month. Overall, RS was applied in 60 joints. All patients but 3 received one single intra-articular injection with 90Y. Results. During the follow-up, one patient showed a recurrent joint bleeding 15 months after RS wit 90Y, one patient after 12 months and one patient after 45 days. Both costs of hospitalization and need for prophylaxis were reduced. Conclusion. RS with 90Y is a simple and safe treatment for recurrent hemarthrosis in patients with hemophilia. It decreases the use of factor VIII / IX and improves joint function.