THERAPEUTIC OPTIONS IN THE MANAGEMENT OF HEMOPHILIC SYNOVITIS

There is a complex relationship between recurrent bleeding, synovitis, and the development of arthritis in the patient with hemophilia, Ther e are many options available for the treatment of recurrent bleeding a nd hemophilic synovitis, indicating that none works very well, Conserv ative treatment, including replacement of the missing clotting factor for 3 to 6 months, intermittent steroids, immobilization, and physical therapy should be tried before synovectomy is indicated, Synovectomy can be achieved through an open procedure, arthroscopically, or by inj ection of a radioactive material into the joint, Radioactive synovecto my is indicated in patients with inhibitors to the clotting factor, pa tients with advanced human immunodeficiency virus and advanced hepatit is, and in those patients with multiple joint involvement, Arthroscopi c synovectomy is the procedure the authors recommend for the knee and ankle joints, although open synovectomy offers an excellent alternativ e, The greatest risk to these procedures is a decreased range of motio n, and this is most problematic in the young child who cannot cooperat e with a program of physical therapy.