Die Radiosynoviorthese (RSO) ist fester Bestandteil der Therapie bei Patienten mit Hämophilie mit rezidivierenden Gelenkeinblutungen. 70–90 % der Patienten erleben eine verminderte Blutungsfrequenz, nachlassende Schmerzen und verbesserte Beweglichkeit. Der Artikel beschreibt die Pathomechanismen der Erkrankung und die Besonderheiten bei der RSO der zumeist noch jungen Patienten, die prätherapeutische Diagnostik, die Durchführung der RSO und die Nachsorge.
Abstract
Background: Radiosynoviorthesis (RSO) is an important treatment modality in patients with reccurrent joint bleedings from haemophilia and is anchored in both national and international guidelines. The indication for RSO is a chronic synovitis of at least 3–6 months despite intensified clotting factor substitution or in case of 3 or more joint bleedings in 6 months. The aim of RSO is – similar to the treatment of synovitis in other inflammtory joint diseases – a fibrosis and sclerosis of the inflamed synovial membran. Thus, the vicious circle of „bleeding – synovitis – neoangiogenesis – increased bleeding frequency” is effectively interrupted. This pathomechanism will otherwise lead to an irreversible joint damage, called haemophylic arthropathy with a serious reduction of the quality of life.
Objectives: This paper describes and discusses the role of radiosynoviorthesis as an important part of the treatment plan for patients suffering from hemophiliac joint disease.
Materials and methods: Both the basic pathomechanisms of hemophiliac arthropathy and the distinctive features of RSO in those patients, often at younger ages, are described, in particular the issues of pretherapeutic diagnostic imaging, the choice of the appropriate radiocolloids and their activities, specific procedural aspects of RSO and the follow-up, respectively.
Results: A total of 70–90 % of patients with hemophilia benefit from RSO with a significantly reduced frequency of joint bleedings, with alleviation of pain and with an increase in joint mobility. However, the best clinical results are achieved in earlier stages of the disease with less pronounced joint deterioration.
Conclusion: Radiosynoviorthesis is an integrated part of the treatment schedule in patients with hemophiliac joint disease suffering from chronic synovitis.
Schlüsselwörter
Hämophilie - Synovitis - Radiosynoviorthese - RSO
Keywords
haemophilia - synovitis - RSO - radiosynoviorthesis
