Editorial comment

Synoviorthesis has been around for more than a quarter of a century. Initially small joints, of persons with chronic inflammatory diseases, were treated with this modality in the hope that the radioactive material could control the synovial reaction and lead to a preservation of congruity in the articular cartilage. Ahlberg [1] reported the use of intra-articular radioactive gold in the haemophilic population in 1971, and some centres in the world followed programmes of intra-articular synovial control using Gold-198 [2]. Radioactive gold, a γ-emitter of radiation was questioned because of the uncontrollable distribution of the radiation effect, and in 1984 Fernandez-Palazzi et al. reported the use of the colloidal Yttrium-90 (90Y) which is a β-emitter and hence far safer [3]. Many centres in the world have initiated programmes of intra-articular synovial control using 90Y [4,5]. The use of radioactive Phosphorus-32 (32P) was reported by Rivard et al. [6] in Canada and more recently by Silva et al. [7] in the United States. The use of 32P has been approved by the Federal Drug Agency (FDA) in America while the use of the other aforementioned radioisotopes to date has no FDA approval. Synovitis in persons with haemophilia develop as a result of haemarthroses which are common in the young person with severe haemophilia. Hypertrophic synovial tissue causes joint destruction and hence the eradication of the hypertrophic synovium is mandatory in the child (Fig. 1) [8]. If the synovium is not eradicated in childhood by the time the patient reaches adulthood the joint will be completely destroyed (Figs 2 and 3). Over the last 20 years despite the drug companies recommendation not to use these materials in children many centres throughout the world have used synoviorthesis to control the intra-articular synovium. Histological examination of the synovium from a person with haemophilia. Note the characteristic picture of hypertrophic synovitis. Clinical views of a haemophilic boy who developed recurrent haemarthroses and synovitis on his right elbow: (a) at 13 years of age; (b) at 37 years of age there is a severe degree of joint deformity. (a) Right elbow of a 5-year-old boy after suffering recurrent haemarthroses since the age of 4 years; (b) at 28 years of age, a severe degree of haemophilic arthropathy can be seen. A decision was taken at the World Federation of Haemophilia congress in Montreal in July 2000, to publish the combined data in order to demonstrate that the injection of radioactive materials into the joints of children is beneficial and safe and that the empirical assumption made by the manufacturers and their recommendation not to use the material in children is both erroneous and detrimental. This volume provides an in-depth analysis of the clinical and technical issues involved in the management of chronic haemophilic synovitis and recurrent haemarthroses by means of synoviorthesis. We owe a debt of gratitude to all the contributors for their enormous effort to write very instructive manuscripts, and especially to Dr Javier Castillo, whose assistance led to the prompt publication of this issue.

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