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32P Radiosynoviorthesis in children with hemophilia
Marilyn J Manco-Johnson1, Rachelle Nuss, James Lear
1Department of Pediatrics, University of Colorado Health Sciences Center, Denver, USA. marilyn.manco-johnson@uchsc.edu
Insights
Radiosynoviorthesis using P-colloid significantly reduced joint bleeding, pain, and improved function in children with hemophilia. This treatment offers a cost-effective alternative for managing hemophilic synovitis.
Area of Science:
- Pediatric Rheumatology
- Hematology
- Nuclear Medicine
Background:
- Children with hemophilia often experience recurrent joint bleeding and synovitis.
- Current treatments for hemophilic synovitis can be invasive or costly.
Purpose of the Study:
- To prospectively evaluate the safety, efficacy, and cost-effectiveness of P-colloid radiosynoviorthesis.
- To reduce the frequency of joint bleeding in pediatric hemophilia patients with synovitis.
Main Methods:
- P-colloid was injected into affected joints of children diagnosed with hemophilia and synovitis.
- Safety was monitored via beta-scanning and physical assessment.
- Efficacy was assessed by changes in bleeding frequency, pain, and physical function pre- and post-injection.
Main Results:
- 100 injections were administered to 91 joints in 59 children.
- All children demonstrated a significant decrease in bleeding rates (P < 0.0001) and pain (P = 0.03), with improved physical function (P = 0.02).
- No immediate adverse events related to the injections were observed, and costs were substantially lower than alternatives.
Conclusions:
- P-colloid radiosynoviorthesis is an effective treatment for reducing joint hemorrhage, pain, and improving function in children with hemophilia.
- Long-term safety data are still warranted to fully establish the benefits of this procedure.
Background:
This study was performed to prospectively evaluate the safety, efficacy, and cost of injecting P-colloid into joints of children with hemophilia and synovitis to decrease the rate of joint bleeding.
Patients And Methods:
Eligibility included a diagnosis of hemophilia, history of more than six hemorrhages into a joint within a 6-month period, and evidence of synovitis by objective imaging. With written, informed consent, 0.25 to 1.0 mCi of P-colloid was injected into the problem joints. Safety was monitored by external beta-scanning and physical assessment. Efficacy was determined by analysis of the change in joint hemorrhage frequency from 6 months before and up to 96 months after the injection using a signed-rank test. Physical assessment and pain assessment were analyzed similarly using values obtained within 1 week before and 6 months after the radiosynoviorthesis. Cost was modeled using charges from the authors' institution in relation to existing alternative therapies.
Results:
One hundred injections were given into 91 joints in 59 children. Seven children had high-titer neutralizing antibodies to factor VIII or IX. Nine children were infected with HIV. Joints injected included 44 ankles, 19 knees, 27 elbows, and 1 shoulder. Nine joints required reinjection. All children showed a significant decrease in bleeding rate (P < 0.0001) and pain (P = 0.03), with improved physical function (P = 0.02). In one child acute lymphocytic leukemia developed, but it was judged unrelated to the two P injections that he had received 3 and 10 months before the leukemia diagnosis. There were no cases of bleeding, infection, or inflammation caused by the injection. Cost was substantially less than medical and surgical alternatives.
Conclusions:
Radiosynoviorthesis is effective in limiting the frequency of joint hemorrhage, decreasing pain and improving function in children with hemophilia. However, long-term safety studies are needed.