Introduction of a guideline for the treatment of synovitis in patients with hemophilia

B. Habermann1, A. Seuser2, T. Hilberg3 (1Mainz, Germany, 2Bonn, Germany, 3Wuppertal, Germany)

Bleeding disorders, coagulation and fibrinolytic factors
Date: 17.02.2017,
Time: 17:15 - 18:15

Objective: Treatment of patients with hemophilia (PwH) has changed through the last decades. Especially the implementation of a prophylactic treatment with factor concentrates in young patients has reduced the incidence of severe bleedings. Nevertheless, many patients suffer from synovitis due to previous bleedings and there it still a lack of knowledge of how and when to treat a synovitis in those patients. Since a synovitis after a bleeding event is the start point of joint degeneration, it is crucially important to start an adequate treatment at the right moment. The aim of our work was, to develop a guideline based on the evidence in literature to support physicians, medical staff and patients in the treatment of synovitis in PwH.

Methods: All member societies of the AWMF were invited to take part in the work of our guideline group. The group consisted of experts in the fields of hemophilia and hematology, nuclear medicine, pediatrics, physiotherapy, orthopedics, radiology, and sports medicine. Based on the regulations of the AWMF, the present and past literature on synovitis and hemophilia was acquired, systematically reviewed and thereafter assessed by the Oxford rating system. All papers and abstracts were scanned and finally reviewed in detail by the working group. The content was evaluated and summarized to a comprehensive paper.

Results: We developed the underlying work for a guideline that may help physicians, medical staff and patients to treat a synovitis according to the available evidence in literature. The result is subdivided in diagnostics, treatment and secondary prophylaxis of synovitis. Besides a comprehensive paper we plan to develop short versions for physicians and patients that offer a quick guide in the daily routine work.

Conclusion: The guideline may be a valuable tool for physicians, medical staff and patients for the treatment of early and late onset synovitis. With it, treatment of the PwH will be based on what has been published in literature in the near future. However, the review of the literature has shown that many established treatment options can’t be substantiated with sufficient evidence in literature and are only recommended by experts’ opinion. Nevertheless, the content of our guideline can be also a central basis for necessary further research.