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

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  Frontiers in Medicine.2025;[Epub]     CrossRef
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• Hemophilic arthropathy: how to diagnose subclinical bleeding early and how to orthopedically treat a damaged joint
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  Expert Review of Hematology.2023; 16(9): 651.     CrossRef
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  E. Carlos Rodriguez-Merchan
  Expert Review of Hematology.2023; 16(11): 811.     CrossRef
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  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
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Pseudoaneurysm arises from disruption in arterial wall continuity resulting from inflammation, trauma or iatrogenic cause. Stroke patient with pseudoaneurysm during rehabilitation has not been reported yet. A 62-year-old man who participated in comprehensive rehabilitation program after stroke presented with right thigh swelling and pain. On physical examination, non-pulsatile tender and broad mass was palpated in the lateral region of right lower thigh. A 2.7 cm-sized pseudoaneurysm in right vastus muscle was identified by a duplex ultrasonography and enhanced CT- angiogram. The patient was successfully treated with ultrasonography-guided thrombin injection and embolization. At this time, laboratory test revealed prolongation of aPTT, undetectable factor VIII levels and the presence of the factor VIII antibody, which made the diagnosis of acquired hemophilia A. The patient was discharged 7 weeks later. We report a case of pseudoaneurysm during rehabilitation program in hemiplegic patient with acquired hemophilia A. (J Korean Acad Rehab Med 2010; 34: 242-246)