Institute for Experimental Hematology and Transfusional Medicine, Clinical University of Bonn, Bonn, Germany -
Praxis Nuramed Köln-West, Köln, Germany.
Q J Nucl Med Mol Imaging. 2022 Dec;66(4):334-344. doi: 10.23736/S1824-4785.22.03474-4. Epub 2022 Sep 15.
Chronic synovitis is contributing to the development of arthropathy in hemophilia A and B. In most patients with severe and moderate hemophilia, during lifetime, joint damage progresses despite early prophylaxis and intense treatment with coagulation factor concentrates. Recurrent hemorrhages into the joints and subclinical bleeding lead to chronic inflammation of the synovium, neoangiogenesis and remodeling, sustaining a vicious circle of bleeding-remodeling-bleeding and progression of osteochondral damage. Imaging techniques including ultrasound and MRI are able to early visualize synovitis and osteochondral changes. Early detection and sustained therapy of synovitis are important preconditions to prevent further deterioration of joint status. Chronic synovitis requires intensified substitution of coagulation factors and concomitant analgetic, antiphlogistic and physical therapy. The value of early radiosynoviorthesis (RSO) as effective method to control ongoing synovitis is discussed here. RSO is recommended as first choice therapy in case of persistant chronic synovitis, recorded in both national and international guidelines.
慢性滑膜炎是导致 A 型和 B 型血友病性关节病发展的原因。在大多数重度和中度血友病患者中，尽管进行了早期预防和凝血因子浓缩物的强化治疗，但关节损伤仍会在其一生中持续进展。关节内反复出血和亚临床出血导致滑膜炎的慢性炎症、新血管生成和重塑，维持着出血-重塑-出血的恶性循环，从而导致骨软骨损伤的进展。包括超声和 MRI 在内的影像学技术能够早期观察到滑膜炎和骨软骨变化。早期发现和持续治疗滑膜炎是预防关节状况进一步恶化的重要前提。慢性滑膜炎需要强化凝血因子替代治疗，并同时进行镇痛、抗炎和物理治疗。本文讨论了早期放射性滑膜切除术（RSO）作为控制持续性滑膜炎的有效方法的价值。RSO 被推荐作为持续性慢性滑膜炎的首选治疗方法，这在国内外指南中均有记录。
