Objective
To assess the clinical outcome of chemical synovectomy with rifampicin in hemophilic arthropathy by using the World Federation of Hemophilia (WFH) scoring system and plain radiograph.
Methods
We performed rifampicin synovectomy (RS) on 30 joints of 28 hemophilic patients diagnosed as hemophilic arthropathy stage I–III (based on Fernandez-Palazzi clinical classification). Clinical status (bleeding frequency, pain, joint physical status) and radiological staging were evaluated as parts of the WFH scoring system before and 1 year after RS. The patients were divided into two groups by the Arnold-Hilgartner scale of the initial X-ray as stage 3 or less for the low-stage group (n=17) and over 3 for the high-stage group (n=13).
Results
Total WFH joint physical scores were reduced after injection, and the number of bleeding episodes and pain showed especially significant improvement. For other subscores of the WFH joint physical score, only swelling, range of motion, and crepitus showed statistically significant improvement. According to the severity of the radiologic finding, the WFH joint physical score of both the low-stage and high-stage groups showed significant improvement. In the radiological aspect, the low-stage group, without joint space narrowing at the initial plain radiograph, showed no further aggravation after injection. However, in the high-stage group, radiology found aggravation regardless of the procedure.
Conclusion
It is suggested that chemical synovectomy with rifampicin may prevent hemarthrosis and improve clinical symptoms. Especially in the early stage of arthropathy without joint-space narrowing, it seems to have an additional benefit that delays radiological aggravation and preserves joint status.

Citations

• Global trends in hemophilic arthropathy research: a bibliometric and visualization analysis
  Zhihao Wei, Lijun Ou, Sheng Chai, Dongdong Zhang, Gangjian Tang
  Frontiers in Medicine.2025;[Epub]     CrossRef
• Rifampicin-Induced Toxic Hepatitis in a Patient with Hemophilia After Chemical Synovectomy
  Mehmet Can Uğur, Semih Aydoğdu, Elçil Kaya Biçer, Can Balkan, Kaan Kavaklı
  Turkish Journal of Hematology.2024; : 64.     CrossRef
• Ultrasound-guided joint procedures in hemophilia: technique, indications and tips
  Hortensia De la Corte-Rodriguez, E. Carlos Rodriguez-Merchan, M. Teresa Alvarez-Roman, Primitivo Gomez-Cardero, Victor Jimenez-Yuste
  Expert Review of Hematology.2024; 17(8): 419.     CrossRef
• Synovitis in hemophilia: preventing, detecting, and treating joint bleeds
  E. Carlos Rodriguez-Merchan
  Expert Review of Hematology.2023; 16(7): 525.     CrossRef
• Hemophilic arthropathy: how to diagnose subclinical bleeding early and how to orthopedically treat a damaged joint
  E. Carlos Rodriguez-Merchan
  Expert Review of Hematology.2023; 16(9): 651.     CrossRef
• The role of intraarticular injections of hyaluronic acid in joint pain relief in hemophilic arthropathy
  E. Carlos Rodriguez-Merchan
  Expert Review of Hematology.2023; 16(11): 811.     CrossRef
• Successful Chemical Synovectomy in a Patient with Acquired von Willebrand Syndrome with Chronic Synovitis Due to Recurrent Knee Hemarthrosis: A Case Report
  Roberta Gualtierotti, Claudio De Magistris, Eugenia Biguzzi, Jacopo Acquati Lozej, Alessandra Iurlo, Luigi Piero Solimeno, Flora Peyvandi
  Rheumatology and Therapy.2022; 9(5): 1465.     CrossRef
• Radiosynovectomy for the Treatment of Chronic Hemophilic Synovitis: An Old Technique, but Still Very Effective
  Emerito Carlos Rodriguez-Merchan, Hortensia De la Corte-Rodriguez, Maria Teresa Alvarez-Roman, Primitivo Gomez-Cardero, Victor Jimenez-Yuste
  Journal of Clinical Medicine.2022; 11(24): 7475.     CrossRef
• Synovitis and synovectomy in haemophilia
  Lize F. D. van Vulpen, Sylvia Thomas, Swapnil A. Keny, Shubhranshu S. Mohanty
  Haemophilia.2021; 27(S3): 96.     CrossRef
• Low‐dose surgical prophylaxis: Optimization of use of World Federation of Hemophilia Humanitarian Aid donated clotting factor concentrates to developing countries
  Magdy El Ekiaby, Assad Haffar
  Haemophilia.2020; 26(S3): 11.     CrossRef

Objective
To investigate the etiologic diseases of inflammatory back pain (IBP) and to propose a diagnostic algorithm for approaching the patients with IBP. Method: One-hundred-and-forty patients with IBP visiting the clinic for spinal disorders were involved. Clinical features of spondyloarthropathy (SpA) through medical records, presence of intervertebral disc disease, sacroiliitis and degenerative spondylosis through plain radiography and magnetic resonance image (MRI) of spine and pelvis, HLA B27 positivity, and quantitative laboratory results of acute phase reactant were retrospectively reviewed. Results: Diverse spinal disorders were indentified as etiologic diseases for IBP that were SpA (44 patients), diffuse idiopathic skeletal hyperostosis (DISH) (15 patients), degenerative spondylosis (15 patients), HLA B27 associated IBP (14 patients), lumbosacral radiculopathy (4 patients), and others (48 patients). When onset age was less than 45 years, the most frequent cause was SpA. When onset age was more than 45 years, DISH and degenerative spondylosis were the most frequent causes. Onset age (p=0.002), age at presenting to clinic (p=0.001), number of items satisfying IBP criteria (p=0.001), HLA B27 positivity (p=0.000), and elevated acute phase reactant (p=0.002) were statistically associated with SpA. Conclusion: The relative frequency among various etiologic disease of IPB is different depending on the onset age of IPB. Onset age of IBP, numbers of items satisfying IBP criteria, and laboratory test for HLA B27 and acute phase reactant can be useful factors for determining the causes of IBP, especially for diagnosing SpA. Diagnostic algorithm for approaching the patients with IBP is proposed according to the sensitivity and specificity of the factors which have statistically meaningful relationship with diagnosis of SpA. (J Korean Acad Rehab Med 2009; 33: 377-385)

Objective
To investigate the relationship between spondyloarthropathy and peripheral neuropathy in spinal pain patient undergoing hemodialysis due to chronic renal failure. Method: Subjects were 60 patients complaining posterior neck or back pain, undergoing regular hemodialysis for chronic renal failure. They were divided into two groups according to the radiologic findings: spondyloarthropathy group (SAG, n=28) and no-spondyloarthropathy group (NSAG, n=32). Nerve conduction studies of extremities, simple spinal radiologic examination and bone mineral density at the lumbar spine were taken. Results: Electrodiagnostic study revealed 26 patients (43%) had carpal tunnel syndrome, 32 (53%) had ulnar neuropathy, and 32 (53%) had peripheral polyneuropathy. Carpal tunnel syndrome was more frequent in SAG, but other neuropathic fingings, bone mineral density and duration of hemodialysis were not different between two groups. Conclusion: Nerve conduction study could be useful to screen the peripheral neuropathy in patients undergoing hemodialysis due to chronic renal failure. If they complained spinal pain, and diagnosed as spondyloarthropathy by radiologic examination, we might need to do electrodiagnostic study for early detection and treatment of carpal tunnel syndrome. (J Korean Acad Rehab Med 2009; 33: 72-76)

Atlantoaxial subluxation in undifferentiated spondyloarthropathy is extremely rare and has not been reported. We describe a case of 27-year-old man who was diagnosed as undifferentiated spondyloarthropathy with atlantoaxial subluxation with an initial complaint of painful swelling of right 1st metatarsophalangeal joint and posterior neck pain. Roentgenograms showed sclerotic change and increased hazziness in right 1st metatarsophalangeal joint. Magnetic resonance images and roentgenograms of the cervical spine showed inflammation of odontoid process and atlantoaxial subluxation. Bone scan showed hot uptakes in left sacroiliac joint, right 1st & 4th metacarpophalangeal joints and 1st metatarsophalangeal joint. HLA-B27 gene was positive. Spontaneous atlantoaxial subluxation and undifferentiated spondyloarthropathy was diagnosed and conservatively treated with oral medication. Currently, there is no definite neurological sign. Early recognition and awareness of potential clinical complications is important in preventing compressive damage on central nervous system. (J Korean Acad Rehab Med 2008; 32: 361-365)

Objective
To investigate the diagnostic value of magnetic resonance imaging (MRI) in early detection of sacroiliitis, to identify risk factors of early sacroiliitis, and to propose a diagnostic algorithm for early ankylosing spondylitis (AS). Method: Twenty-nine consecutive patients with inflammatory back pain (IBP) and unclear sacroiliitis (unilateral grade 2≥sacroiliitis in plain radiography (PR) based on modified New York criteria) were studied. Clinical features of spondyloarthropathy, HLA B27 positivity, and MR image set of the sacroiliac (SI) joints were obtained. Two radiologists interpreted MR images independently to diagnose definite sacroiliitis. An association between sacroiliitis in MRI and each clinical and laboratory feature was assessed with linear logistic regression analysis. Post-test probability was determined with sensitivity/specificity of clinical and laboratory features. Results: MRI showed definite sacroiliitis in sixteen patients. The most frequently noted finding was erosion and high signal intensity lesion within the joint cavity in gadolinium enhanced T1-weighted images. Unilateral grade 2≥sacroiliitis in PR was the only significant risk factor of definite sacroiliitis in MRI. When unclear sacroiliitis in PR, more than one clinical feature of spondyloarthropathy, and HLA B27 were found, probability of AS was 83% in a proposed diagnostic algorithm. Conclusion: MRI of the SI joints can detect sacroiliitis in more than half of patients with IBP and unclear sacroiliitis in PR. Unilateral grade 2≥sacroiliitis in PR was a risk factor of definite sacroiliitis in MRI. A diagnostic algorithm for early detection of AS is proposed. (J Korean Acad Rehab Med 2007; 31: 440-446)

Neuropathic arthropathy is a chronic and progressive disease of bone and joints. One of the most common causes of neuropathic arthropathy is syringomyelia. Syringomyelia associated with Arnold-Chiari I malformation has been well documented in many reports. We report a case of 76 year-old woman presented with the right elbow joint pain and stiffness. Her symptom was caused by neuropathic arthropathy associated with Arnold-Chiari I malformation and syringomyelia. The purpose of this paper is to emphasize that neuropathic arthropathy requires the evaluation of central nervous system to assess for occult causal lesion. (J Korean Acad Rehab Med 2007; 31: 252-256)

Objective
To investigate the differences in clinical and radiologic features between HLA-B27 positive ankylosing spondylitis (AS) and HLA B27 negative AS. Method: Ninety-nine consecutive patients who were suspected as AS in initial diagnostic process were studied. HLA-B27 was examined with microlymphocytotoxicity method in all patients. A radiologist and a physiatrist re- read plain pelvis radiographies of all patients. Difference in onset age and C-reactive protein (CRP) depending on HLA B27 status and an association between HLA B27 status and clinical and radiologic features were tested. Results: Sacroiliitis (≥bilateral grade 2) was identified in 63 of 77 patients with HLA B27 and 7 of 22 patients without HLA B27 through the re-reading process. Ten percent of definite AS was HLA B27 negative AS. Five of 22 patients without HLA B27 were diagnosed as diffuse idiopathic skeletal hyperostosis. There was a significant association between sacroiliitis (≥bilateral grade 2) and HLA B27 (p＜0.05) in re-reading process. No significant difference was found in onset age, and CRP depending on HLA B27 status. No significant association was noted between HLA B27 and gender, clinical and radiologic features. Conclusion: HLA B27 is useful in diagnosing AS in patients with clinical features of AS and sacroiliitis (≥unilateral grade 1). None of clinical and radiologic parameters are associated with HLA B27 status. It does not make difference in onset age of AS. To make a more concrete conclusion, a study of a much larger number of HLA B27 negative AS patients will be necessary. (J Korean Acad Rehab Med 2007; 31: 220-227)

The causes of Charcot joint gradually has grown since Charcot's original description of syphilitic neuropathic joint disease in 1868. Recently, diabetic mellitus is the commonest condition associated with neuropathic bone and joint disease. But trauma can precipitate the development of the typical neuropathic Charcot joint. It has been suggested that the altered mechanics of walking throws an abnormal stress on the sensory deprived joint so that arthropathy develops. This paper is reporting a case of developed idiopathic Charcot-like arthropathy in both knee and elbow joints. Intra-articular steroid injection and repeated trauma caused the patient to develop idiopathic Charcot-like arthropathy. The purpose of this paper is to emphasize that early recognition and conservative treatment may alter the course of certain neuropathic joints. (J Korean Acad Rehab Med 2003; 27: 280-284)

Objective
To investigate the musculoskeletal causes of anterior chest pain and know the prevalencies of the diseases.

Method: During 4-year periods (1997∼2001), 37 patients with anterior chest wall pain was analyzed with regard to the causes of pain and the frequencies of the diseases.

Results: 17 patients (45.9%) had systemic diseases and 20 patients (54.1%) had focal joint problems. Systemic disease included the undifferentiated spondyloarthropathy (18.9%), ankylosing spondylitis (13.5%), psoriatic arthritis (2.7%), SAPHO (Synovitis, Acne, Psoriasis, Hyperostosis, Osteitis) syndrome (8.1%), and rheumatoid arthritis (2.7%). Focal joint diseases included costochondritis (10.8%), sternoclavicular inflammatory arthropahty (5.4%), sternoclavicular hyperostosis (2.7%) and infective arthritis (2.7%). Other focal joint problems were pain in sternoclavicular joint with the tenderness and swelling (2.7%), pain in costochondral joint (13.6%), sternoclavicular joint (5.4%), xyphoid process (2.7%) with only focal tenderness. 3 (8.1%) patients had pain in chest wall which had no focal tenderness and swellings on the joint.

Conclusion: Diverse systemic diseases were identified as causes of the anterior chest wall pain. So physiatrist keep in mind this result and make use of them in diagnostic approaching of the anterior chest pain due to chest wall skeletal involvement. (J Korean Acad Rehab Med 2003; 27: 96-101)