rifampin and Hemophilia-A

The indication for a synoviorthesis (medical synovectomy) is chronic haemophilic synovitis causing recurrent haemarthroses, unresponsive to haematological treatment. Synoviorthesis is the intra-articular injection of a certain material to diminish the degree of synovial hypertrophy, decreasing the number and frequency of haemarthroses. There are two basic types of synoviorthesis: chemical synoviorthesis and radiation synoviorthesis. On average, the efficacy of the procedure ranges from 76 to 80%, and can be performed at any age. The procedure slows the cartilaginous damage which intra-articular blood tends to produce in the long term. Synoviorthesis can be repeated up to three times with 3-month intervals if radioactive materials are used (Yttrium-90 and Phosphorus-32), or weekly up to 10-15 times if rifampicin (chemical synovectomy) is used. After 30 years of using radiation synovectomy worldwide, no damage has been reported in relation to the radioactive materials. Radiation synovectomy is currently the preferred procedure when radioactive materials are available, however, rifampicin is an effective alternative method if radioactive materials are not available. Several joints can be injected in a single session, although no more than two joints at the same time is probably the best protocol to follow.

Topics: Hemarthrosis; Hemophilia A; Humans; Injections, Intra-Articular; Radioisotopes; Radiopharmaceuticals; Rifampin; Synovitis

Rifampicin is an antibiotic that has been currently used for the treatment of noninfectious articular lesions with satisfactory results. The first experience was performed with patients who presented rheumatoid arthritis, and later with haemophilic patients. The clinical experience of three haemophilia centres which used rifampicin for the treatment of chronic haemophilic synovitis is presented here. The protocols were different. It was observed that rifampicin is more effective when it is used in small joints (elbows and ankles), than when used in bigger ones (knees), and that a high number of injections predicts failure. Mention is also made of experimental studies in animals where it was shown that the healing pattern of rifampicin is similar to that of NSAIDs.

Topics: Animals; Clinical Trials as Topic; Hemarthrosis; Hemophilia A; Humans; Rifampin; Synovitis

Rifampicin synoviorthesis has been empirically used for the treatment of haemophilic synovitis for some time. This paper reports on the experience of three Latin American centers with this treatment and compares it with radioactive synoviorthesis results. Chemical synoviorthesis with rifampicin is best indicated in younger patients (< 15 years) and small joint (ankles and elbows).

Topics: Hemophilia A; Humans; Nucleic Acid Synthesis Inhibitors; Rifampin; Synovitis

This paper reviews personal experience in the treatment of recurrent haemarthrosis and chronic synovitis by non-surgical means. Experience with synoviorthesis with rifampicine and radioactive colloids is analyzed, and a multiple chromosomal study to demonstrate safety of radioactive injections is described. The results obtained are so very satisfactory as to recommend non-aggressive synoviorthesis as the treatment of choice to prevent recurrence of bleeding. Long experience in the treatment of chronic arthropathy with intrarticular corticosteroids and hyaluronic acid has shown very promising results.

Topics: Colloids; Hemophilia A; Humans; Osmium Tetroxide; Rifampin; Synovitis

Recurrent bleeding into joints represents the clinical hallmark of haemophilia and, if not adequately treated, it may cause chronic synovitis and degenerative arthropathy. In haemophilia patients with inhibitors, a more severe degree of synovitis is often observed owing to the fact that treatment is more problematic in this setting. The first treatment option of recurrent haemarthroses and/or chronic synovitis is represented by synoviorthesis, both chemical and radioisotopic, with a success rate of approximately 80% for both. However, radioisotopic synoviorthesis should be preferred in inhibitor patients because it makes it possible to obtain complete synovial fibrosis usually in one session, without the need for repeated injections, thus reducing the risk of bleeding complications and concentrate consumption. For all these reasons this procedure should be implemented and supported, particularly in developing countries.

Topics: Adolescent; Adult; Antibiotics, Antitubercular; Blood Coagulation Factor Inhibitors; Child; Child, Preschool; Hemarthrosis; Hemophilia A; Humans; Injections, Intra-Articular; Radioisotopes; Radiopharmaceuticals; Rifampin; Synovitis; Treatment Outcome; Young Adult

The article presents ultrasonic characterization of hemophilic synovitis in 73 hemophilia patients. The technology of performing rifampicin synoviortesis under ultrasonic control has been developed, ensuring the exact fulfilling intraarticular punctures taking into account the alterations in the intraarticular structures and optimization of filling the articular cavity with sclerosant. The effectiveness of the developed method was 93.7% in the 3 years of follow-up observations.

Topics: Adolescent; Adult; Child; Female; Hemophilia A; Humans; Injections, Intra-Articular; Male; Middle Aged; Nucleic Acid Synthesis Inhibitors; Rifampin; Synovitis; Treatment Outcome; Ultrasonography; Young Adult

Topics: Adolescent; Child; Follow-Up Studies; Hemarthrosis; Hemophilia A; Humans; Hyaluronic Acid; Injections, Intra-Articular; Male; Rifampin; Synovitis

Chemical synovectomy has been used for the last three decades as an alternative for surgical synovectomy in the treatment of chronic haemophilic synovitis. Comparable results have been obtained with the many different radionuclides used: decreased bleeding, decreased pain and stable range of motion, in more than 50% of treated patients. Yttrium 90Y and Phosphorus 32P seem to be the isotopes of choice. Osmic acid and rifampicine have been used in a relatively small number of subjects. Global result of treatment with these two pro-ducts seems to be less favourable than with radionuclides. Late effects of chemical synovectomy are not known.

Topics: Hemarthrosis; Hemophilia A; Humans; Osmium Tetroxide; Practice Guidelines as Topic; Radioisotopes; Radiopharmaceuticals; Rifampin; Synovial Membrane; Synovitis

The purpose of this paper was to assess the effectiveness of intra-articular injected rifampicine in haemophilic patients in order to achieve synovectomy by preventing repeated intra-articular bleeding. We have used this technique in haemophilic patients previously and reported our results on 13 cases [1]. Two hundred and fifty milligrams of rifampicine was injected into the elbow and ankle joints and 500 mg was injected into knee joints with 3-10 mL of lidocaine, depending on the joint size. The injections were repeated once a week for 7 weeks. Patients were only covered with antihaemophilic factor on the day of the injection at 30% above their coagulation level. We evaluated the results using two measures: subjective reports from the patient and objective assessment by the examiner. In the subjective reports the patient graded the results from their own perspective from 1 (poor) to 10 (excellent): 1-3, poor; 4-6, fair; 7-8, good; and 9-10, excellent. In the objective reports the grading was: excellent ('dry joint', full function, no haemarthrosis, no synovitis); good (clinical improvement, synovitis, reduction of haemarthroses, full function); fair synovitis (reduction of haemarthroses, no change in function); poor synovitis (persistent haemarthroses). This paper reports on the results of 38 patients with 39 joints with more that 3 years follow up, mean 1.8 years. There were 22 knees, nine elbows and eight ankles. Subjectively, there were excellent results in 21 joints (11 knees, six elbows and four ankles) good results in 15 joints (eight knees, three elbows and four ankles), fair results in two knees and a poor result in one knee. Objectively, results obtained were excellent in 20 joints (11 knees, six elbows and three ankles); good in 17 (nine knees, three elbows and five ankles); fair in one knee and poor in one knee.

Topics: Adolescent; Adult; Antifibrinolytic Agents; Child; Drug Evaluation; Hemarthrosis; Hemophilia A; Humans; Injections, Intra-Articular; Male; Outcome Assessment, Health Care; Patient Satisfaction; Rifampin; Synovectomy; Synovial Membrane

For many years, Rifampicin has been used empirically for the treatment of hemophilic chronic synovitis with encouraging results. A study was performed in which Rifampicin was shown to reduce the inflammation of joints affected by hemophilic synovitis. A clinical study was performed on 48 hemophilic patients (48 joints). Seventeen elbows, eight knees, and 23 ankles were treated. The mean age of the patients was 6 years (range, 4-23 years) and the mean followup was 29 months (range, 24-53 months). Overall, 40 excellent results and eight good results were obtained. The average number of weekly injections of Rifampicin was 3.06 (range, 1-10 injections). Eight patients experienced pain on the first injection, which subsided gradually with the subsequent procedures. Synoviorthesis with Rifampicin seems to be a good method for the treatment of hemophilic synovitis, especially in small joints (elbows and ankles) and in younger children.

Topics: Adolescent; Adult; Age Factors; Animals; Ankle Joint; Anti-Bacterial Agents; Arthralgia; Child; Child, Preschool; Chronic Disease; Disease Models, Animal; Elbow Joint; Follow-Up Studies; Forecasting; Hemarthrosis; Hemophilia A; Hemophilia B; Humans; Injections, Intra-Articular; Knee Joint; Logistic Models; Male; Rabbits; Rifampin; Synovitis; Treatment Outcome