Rhenium188- radiosynovectomy for chronic hemophilic synovitis: evaluation of its efficacy in hemophilic patients and establishment of radiosynovectomy at Joint Care Clinic

BackhroundsRadiosynovectomy (RSO) is widely used in management of chronic synovitis in haemophilia.Commercially available radiopharmaceuticals are costly, and therefore new agents may beof interest. Radiocolloids labelled with less costly and more accessible radionuclides likerhenium188- are of interest to developing countries. The aim of this study was to evaluatethe efficacy of radiosynovectomy by rhenium188- in patients with chronic synovitis due tohemophilia.MethodsAll patients were enrolled after taking the history and recording the number of intraarticularbleedings, the required amount of factor, and other information of the disease. Thequestionnaires and checklists related to the patients› function and the amount of pain werecompleted. After the above, the rhenium188- was injected into the joint and its distributionanalyzed by using a gamma monitor. Six months after the injection synovial thickness wasmeasured by MRI. Also, at a time interval of 6 and 12 months after the injection, simpleradiography was repeated. Patients› performance and pain questionnaires (FISH, VAS),the range of motion, number of bleeding episodes and required amount of factor wererecorded at intervals of 6 ,3 ,1 and 12 months after injection.Results In this clinical trial, 20 patients with hemophilia were studied during a one-year period. Allof them were male and the mean age was 13.88 ± 22.99 years. The Trend of changes in themean number of patients› bleeding episodes per month (P = 0.015), the amount of factorrequirement (P <0.001), the mean score of VAS at resting (P = 0.014) and activity time (P<0.001), FISH score (P <0.001), Gilbert score (P <0.001) and synovial thickness (P <0.001)were significant. The trend of changes in the average score of Peterson (P = 0.623) andDenver (P = 0.331) among the patients were also evaluated using repeated measurementanalysis, which was not significant.ConclusionsThe results of this study indicate a high clinical impact, safety and low invasion of rhenium188 in radiosynovectomy of hemophilic patients. Considering the availability and relativelylow cost of rhenium 188 in our country, this can be a good treatment option for hemophilicpatients.