Efficacy of radiosynoviorthesis on clinical outcomes in persons with haemophilia. A systematic review and meta-analysis.

PURPOSE: This systematic-review and meta-analysis investigated the effectiveness of radiosynoviorthesis (RSO) on clinical outcomes in male persons with haemophilia (PwH) and evaluated the quality of existing evidence.

METHODS

Literature searches in PubMed and Web of Science identified 31 studies, with 17 included in the meta-analysis. Random-effects models were computed to analyse RSO-related changes in bleeding frequency, pain, synovial hypertrophy, and orthopaedic joint score. Due to insufficient data, Range of Motion (RoM) changes could not be meta-analytically calculated. Mean differences (MD) for bleeding frequency and standardized mean differences (SMD) for the remaining outcomes were computed.

RESULTS

Results showed significant reductions in bleeding frequency at six months (MD = -5.93 [95 %-CI: -7.80, -4.06], p < 0.001, k = 10) and twelve months (MD = -7.83 [95 %-CI: -12.11, -3.55], p < 0.001, k = 6). Six months post treatment, pain (SMD = -1.31 [95 %-CI: -2.25, -0.38], p = 0.006, k = 5), synovial hypertrophy (SMD = -0.50 [95 %-CI: -0.65, -0.36], p < 0.001, k = 4), and orthopaedic joint score (SMD = -0.61 [95 %-CI: -0.92, -0.30], p < 0.001, k = 4) showed moderate to large improvements. Average RoM changes were minimal (2.6 % improvement). The overall complication rate was 12 per 1000 treated joints.

CONCLUSION

Despite promising results, the overall quality of evidence was moderate to low due to high methodological heterogeneity and lack of control groups. These findings suggest RSO is a safe and effective treatment for key clinical outcomes in PwH, but further well-designed controlled trials are needed to confirm these results.