Amir Sabet1,2, Andreas Christian Strauss3, Jan Schmolders3, Rahel Bornemann3, Amin Sabet2, Johannes Oldenburg4, Peter Hans Pennekamp3, Hans Juergen Biersack2, Samer Ezziddin5,6. 1. Department of Nuclear Medicine, University Duisburg-Essen, Essen, Germany. 2. Department of Nuclear Medicine, University Hospital, Bonn, Germany. 3. Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany. 4. Department of Experimental Hematology and Transfusion Medicine, University of Bonn, Bonn, Germany. 5. Department of Nuclear Medicine, University Duisburg-Essen, Essen, Germany. samer.ezziddin@uks.eu. 6. Department of Nuclear Medicine, Saarland University, Kirrberger Str., Geb. 50, D-66424, Homburg, Germany. samer.ezziddin@uks.eu.
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.
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.
Entities:
Keywords:
Blood pool imaging; Bone scintigraphy; Hemophilic arthropathy; Radiosynovectomy; Radiosynoviorthesis
Authors: F Peyvandi; R Klamroth; M Carcao; A B Federici; G DI Minno; V Jiménez-Yuste; E C Rodriguez Merchán Journal: Haemophilia Date: 2012-05 Impact factor: 4.287
Authors: James V Luck; Mauricio Silva; E Carlos Rodriguez-Merchan; Navid Ghalambor; Christopher A Zahiri; Richard S Finn Journal: J Am Acad Orthop Surg Date: 2004 Jul-Aug Impact factor: 3.020
Authors: F M van der Zant; R O Boer; J D Moolenburgh; Z N Jahangier; J W J Bijlsma; J W G Jacobs Journal: Clin Exp Rheumatol Date: 2009 Jan-Feb Impact factor: 4.473
Authors: W U Kampen; B Boddenberg-Pätzold; M Fischer; M Gabriel; R Klett; M Konijnenberg; E Kresnik; H Lellouche; F Paycha; L Terslev; C Turkmen; F van der Zant; L Antunovic; E Panagiotidis; G Gnanasegaran; T Kuwert; T Van den Wyngaert Journal: Eur J Nucl Med Mol Imaging Date: 2021-10-20 Impact factor: 9.236