Radiosynoviorthesis in Hemophilic Arthropathy: Pathologic Blood Pool Imaging on Pre-therapeutic Bone Scintigraphy is Not a Predictor of Treatment Success

Overview

Journal Eur J Nucl Med Mol Imaging

Specialties Biophysics
Nuclear Medicine
Radiology

Date 2016 Nov 1

PMID 27796541

Citations 4

Authors

Amir Sabet

Andreas Christian Strauss

Jan Schmolders

Rahel Bornemann

Amin Sabet

Johannes Oldenburg

Peter Hans Pennekamp

Hans Juergen Biersack

Samer Ezziddin

Affiliations

Soon will be listed here.

Abstract

Purpose: Increased articular Tc MDP uptake on blood pool imaging (BPI) of patients with rheumatologic conditions is indicative of active inflammatory changes, and has been suggested as a strong predictor of response to radiosynoviorthesis (RSO). In this study, we aimed to assess the value of pretreatment BPI positivity (i.e. scintigraphic-apparent hyperemia) for successful RSO in hemophilic arthropathy.

Methods: Thirty-four male patients with painful hemophilic arthropathy underwent RSO after failure of conservative treatment. Treated joints comprised the knee in eight, elbow in five, and ankle in 21 patients. Pretreatment triple-phase bone scintigraphy showed hyperemic joints (pathologic BPI) in 17 patients, whereas 17 patients had no increased tracer uptake on BPI. Response to RSO was evaluated 6 months post-treatment by measuring changes in intensity of arthralgia according to the visual analog scale (VAS), bleeding frequency, and range of motion. The association between hyperemia (pathologic BPI) and treatment outcome was examined using nonparametric tests for independent samples.

Results: Clinically evident pain relief occurred in 26 patients (76.5 %), and the mean VAS decreased from 7.7 ± 1.1 to 4.6 ± 2.7 (p < 0.001). Joint bleeding frequency (hemarthrosis) decreased from 4.5 ± 0.6 to 2.1 ± 0.4 during the first 6 months after RSO (p < 0.001). For both parameters (pain relief and bleeding frequency), patients experienced a similar benefit from RSO regardless of pretreatment BPI: arthralgia (p = 0.312) and frequency of hemarthrosis (p = 0.396). No significant improvement was observed for range of motion, but it was significantly more restricted in hyperemic joints both before (p = 0.036) and after treatment (p = 0.022).

Conclusions: Hemophilic arthropathy can be effectively treated with RSO regardless of pre-therapeutic BPI. Patients in whom articular hyperemia is not detectable by scintigraphy may have similar (outstanding) outcomes, and thus should not be excluded from treatment.

Citing Articles

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The EANM guideline for radiosynoviorthesis.

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Radiosynovectomy is a safe and an efficient alternative in the treatment of chronic, recurrent knee hemarthrosis.

Iakovou I, Kotrotsios D, Michailos K, Sachpekidis C World J Nucl Med. 2020; 19(2):165-167.

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"la synoviorthèse" can more than synovitis!.

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