The outcome of chemical synovectomy with Rifampicin in chronic hemophilic synovitis: The Syrian experience

Chronic arthropathy is the most common complication of moderate to severe hemophilia. Chemical synovectomy with Rifampicin offers a cost-effective alternative to radioactive synovectomy, especially in resource-limited settings like Syria. A retrospective study was conducted at the Syrian Hemophilia Society (2020-2024), involving 50 patients (69 target joints) with hemophilic synovitis. Outcomes were assessed using the Hemophilia Joint Health Score visual analogue scale (VAS) for pain, range of motion (ROM), Arnold-Hilgartner classification, and annual bleeding rate,pre- and post-intervention. Participants were predominantly young (mean age 18.99 ± 6.51 years), with hemophilia A (80%). A significant delay was noted between target joint onset and intervention (mean 40.30 months). The knees were most affected (72%), with moderate joint involvement (Arnold-Hilgartner Class II-III). Regional disparities emerged: Damascus patients showed better outcomes (HJHS: 2.33 vs 7.04; VAS: 1.11 vs 3.27, P < .001). Most patients improved significantly (P < .05), except those with mild phenotypes (no HJHS/VAS improvement), ankle involvement (no ROM improvement), and Arnold score 0 (no ROM improvement). Findings underscored inequities in care access across regions. Rifampicin-based chemical synovectomy is a viable, accessible treatment for hemophilic synovitis in low-resource settings. It led to significant improvements in pain, bleeding episodes, joint health, and mobility. However, regional healthcare disparities and delayed interventions remain key challenges affecting outcomes.