Chemical synoviorthesis with osmic acid in haemophilia

Based on previous experience in inflammatory arthritis, a small number of open studies have evaluated the usefulness of chemical synoviorthesis with osmic acid in haemophilia, with various assessment criteria and a wide range of follow-up periods. Based on these studies, the efficacy of osmic acid seems modest, with 30-44% of good clinical and radiological results, but with fair or poor clinical results in other patients with a possible deleterious effect on cartilage. Osmic acid was found inferior to Yttrium-90 in one retrospective study. Synoviorthesis with osmic acid seems particularly indicated in haemophilic arthritis with no or mild radiological deterioration in children between 8 and 15 years of age. However, prospective randomized studies are clearly required to evaluate the symptomatic and structural effects of chemical and radioactive synoviorthesis in haemophilic arthritis.