MANAGEMENT OF HAEMOPHILIC ARTHROPATHIES.

Makris PE, Gigis P, Nastis K, Purnaras I, Grammatikos P

Haemostasis and Thrombosis Unit AHEPA University Hospital, Thessaloniki Greece.

Haemophilic arthropathy is a serious complication of haemophilic syndromes, since the progressive destruction of articular surfaces result in the eventual deformity and crippling of joints. Furthermore, chronic haemarthrosis is an additional factor of the impairment of the joints. The management of chronic haemarthrosis is not only difficult and costly, but it is also very discouraging for the patient, since it demands long term replacement therapy. The cause of these haemorrhagic episodes is synovitis. In order to improve the clinical manifestations of the arthropathy of our patients and to prevent or correct an eventual crippling we have applied different methods of management. Materiel and methods: Our material constitute of 6 patients. 5 of them were schoolboys and one of them was a male 45 years old. All of them suffered from severe haemophilia A (levels of VIII less than 1%), and chronic haemarthrosis of knee joints.(Two of them had both their knees affected, and the one schoolboy had severe crippling and walked with his both knees in permanent flexion). To four out of five schoolboys we performed synoviorthesis with the colloid isotope Ytrium 90. To the boy with the most dramatic problems we applied arthroscopic synovectomy. The man was managed with total replacement of the knee joint. Results: The four pupils have been followed- up for 16 months after the intra articular infusion of the isotope. Three of them had had complete remission of the haemarthrosis for 12 months and all of them for a total period of 10 months. They have started to swim, and, as a result, the supportive property of the muscles about the joint has been improved. The boy with the crippling has been followed- up for 6 months. Pain and swelling have subsided and the mobility arch has impressingly ameliorated. Physio- and kinesiotherapy had a positive affect on the supportive property of his muscular system. The man who had undergone total replacement of the knee joint is able to walk normally, and as a result his psychological situation has improved. All the patients had better quality of life, either in normal living or in other activities. The most important thing is that psychological condition in these patients have been much improved. Conclusion: Nowadays, there are many ways to treat haemophilic arthropathy. Our decision concerning the appropriate method of management depends mainly on the age of the patient and on the degree of the joint damage.

Dear sir,

I would like send you this abstract concerning the Pacific Rim Haemophilia Workshop, and I would like really to participate in this workshop.

Sincerely yours

Pantelis E Makris

Professor of Haematology