The impact of platelet-rich plasma on chronic synovitis in hemophilia.

Untreated chronic haemophiliac synovitis leads to the development of haemophilic arthropathy (HA) by affecting the metabolism of chondrocytes. Symptoms are progressive and often surgical intervention is required to prevent total loss of joint function. The focus of our study was to influence the chronic haemophiliac synovitis by means of autologous platelet-rich plasma (PRP) injection. Six patients with hemophilia (PWH), aged between 9 and 45 and manifesting chronic synovitis of the ankle joint on one or on both sides (8 joints in total) were included into the PRP-study. The patients were classified depending on their joint status using the Hemophilia Joint Health Score (HJHS) prior to and again two months after treatment. Three to five ml of PRP was injected into the joint cavity within 30 seconds. In all of the tested PWH pain relief has been reported subjectively by means of the HJHS and VAS scoring systems, comparing the pain intensity before PRP injection and two months after. The difference of pain perception has been found statistically significant for the VAS-scores. Considering the objective synovitis signs shown on MRI before and after PRP injection we recorded a decrease in the volume of free synovial fluid after PRP. All of the tested patients reported benefit of the PRP therapy.

Radiosynoviorthesis in hemophilic joints with yttrium-90 citrate and rhenium-186 sulfide and long term results.

Repeated bleeding in the joint cavities is the most annoying symptom and often has disabling effects in patients with hemophilia (PWH). Our aim was to study the effect of radiosynovectomy (RSO) with beta particle-emitting radiocolloids in the treatment of hemorhagic arthropathy. We have treated 22 joints from 18 patients with hemophilia A, from April 2008 to February 2012, 5 knees, 11 elbows and 6 ankles. Joints were divided into two Groups, those treated with yttrium-90-citrate ((90)Y-C) (5 knees, 2 of them twice)-Group I and those with rhenium-186-sulfide ((186)Re-S) (11 elbows, 1 of them treated twice and 6 ankles)-Group II. A total of 25 treatments. Follow-up period was 3 months, 1 year and 3 years. Results showed a favourable subjective and a better objective result in all 5 joints of Group I and in 15/17 joints of Group II, respectively. Follow-up after 3 months showed significant improvement in Hemophilia Join Health Score (HJHS) after 20 treatments and steady score after 5 treatments. After 1 year, 19 treated joints had improved for the first time, 3 remained steady and 3 were not examined. After 3 years, 9 treated joints were HJHS steady, while 16 were not examined. One year after treatment, 13/14 joints of patients, aged 6-23 years showed better HJHS score, while 9/11 joints of patients aged 26-51 years, showed better HJHS. Synovial membrane thickness as measured by MRI in 8 joints, before and 3 months after treatment was not related to prognosis. In conclusion, in a small group of hemophilic patients with hemorrhagic arthropathy treated with (90)Y-C and with (186)Re-S, our study showed good results irrespective of age in 22/25 treatments after 3 months or 1 year. The thickness of synovial membrane in the 8 joints studied was not related to prognosis.

Radionuclide synovectomy in haemophilic joints.

Chronic synovitis often occurs in people with haemophilia. Untreated chronic haemophilic synovitis affects the metabolism of chondrocytes, thus leading to haemophilic arthropathy. A recently introduced therapeutic protocol includes radiation synovectomy (RS), a safe and cost-effective therapeutic method, which has given satisfactory results in 75% of haemophiliacs with chronic hypertrophic synovitis. Because of its efficacy, we will discuss additional recommendations on the use of RS as a method of choice. The focus of this review is haemophilic arthropathy treatment, including its aetiopathogenesis, reasons for RS indication and its mechanism of action, and use of radioisotopes and other agents for treatment.

Streptokinase increases the sensitivity of colon cancer cells to chemotherapy by gemcitabine and cis-platine in vitro.

The aim was to determine the effect of fybrinolytic therapy by streptokinase on chemotherapy and radiation response in human colon cancer cells. The cells were treated with different concentrations of gemcitabine, cis-platine and streptokinase, at a single use or in combinations. Radiation was tested at a dose 0.5, 5 and 15 Gy in three different schedules. The chemotherapy showed higher cytotoxic effect in combination with streptokinase. On the other hand, the combination of chemotherapy with streptokinase and radiotherapy provide no improvement in sensitivity of cancer cells to treatment. The data suggest that fybrinolytic therapy could influence the effect of chemotherapy.