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Radiosynoviorthesis in hemophilic arthropathy: pathologic blood pool imaging on pre-therapeutic bone scintigraphy is not a predictor of treatment success

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Increased articular 99mTc 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.

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Author notes

    Authors and Affiliations

    1. Department of Nuclear Medicine, University Duisburg-Essen, Essen, Germany

      Amir Sabet & Samer Ezziddin

    2. Department of Nuclear Medicine, University Hospital, Bonn, Germany

      Amir Sabet, Amin Sabet & Hans Juergen Biersack

    3. Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany

      Andreas Christian Strauss, Jan Schmolders, Rahel Bornemann & Peter Hans Pennekamp

    4. Department of Experimental Hematology and Transfusion Medicine, University of Bonn, Bonn, Germany

      Johannes Oldenburg

    5. Department of Nuclear Medicine, Saarland University, Kirrberger Str., Geb. 50, D-66424, Homburg, Germany

      Samer Ezziddin

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    1. Amir Sabet
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    Correspondence to Samer Ezziddin.

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    No funding was received for this research in the form of specific grants from any funding agency in the public, commercial, or not-for-profit sector.

    Human and animal studies

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors

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    Informed consent was obtained from all individual participants included in the study.

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    Amir Sabet and Andreas Christian Strauss contributed equally to this work.

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    Sabet, A., Strauss, A.C., Schmolders, J. et al. Radiosynoviorthesis in hemophilic arthropathy: pathologic blood pool imaging on pre-therapeutic bone scintigraphy is not a predictor of treatment success. Eur J Nucl Med Mol Imaging 44, 461–467 (2017). https://doi.org/10.1007/s00259-016-3549-4

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