RADIATION SYNOVECTOMY: TREATMENT OPTION FOR HAEMOPHILIA PATIENTS WITH CHRONIC HAEMARTHROSIS: A REVIEW

Abstract

Background: Ablation of the synovium with radiopharmaceuticals, referred to asradiation synovectomy, (RS), has emerged as a simple affordable and safe procedure thatis highly effective in preventing chronic disabling end stage arthritis in haemophiliapatients.

Objective: To provide a review of the principles and role of radiation synovectomy, (RS),in the management of haemophiliac patients with chronic haemarthrosis, and to considerthe possibility of this treatment option in Kenyan patients with haemophilia.

Data sources: A literature search through the internet using Boolean commands,PubMed interface to MEDLINE, Evidence, the Cochrane library. Papers from reputablehaematology and radiation medicine journals, as well as conference presentations ofthe World Federation of Hemophilia were also included.

Data selection: The searches for papers, abstracts and reviews were limited to Englishlanguage, haemophilia, haemarthrosis, synovectomy, RS, radiopharmaceuticals forRS and safety of RS.

Data extraction: All abstracts, and most of the papers were reviewed. Only thoseabstracts, papers and conference materials from reputable sources were used for thispaper.

Data synthesis: All available papers and abstracts were reviewed for the most up todate information. The indications, requirements, procedure and safety aspects of RSwere examined. The merits of alternative forms of synovectomy were considered. Inthe light of this information, the feasibility of RS as a treatment option for haemophiliapatients in Kenya was considered.

Conclusion: Radiation synovectomy has been carried out on thousands of haemophiliapatients with chronic haemathrosis over the last 20 years. Experience accumulated innumerous centres in America, Europe, Asia, North and South Africa indicates thatmajority of haemophilia patients undergoing RS are spared life long crippling arthritisand deformity. The principle safety concern of the potential for late radiation- relatedmalignancy has been mitigated by appropriate choice of radiopharmaceuticals, andcarefully executed procedure. The effectiveness, simplicity and affordability of RSmake it particularly suitable for treatment of haemophilia patients in developingcountries like Kenya.