Wolfgang Miesbach: Synovitis and Haemophilia in Focus at GTH2026
Wolfgang Miesbach, Professor of Medicine at Frankfurt University Hospital, shared a post on LinkedIn:
”Joint Health in Focus: Synovitis and Haemophilia — Excellent presentation by Thomas Hilberg at GTH2026.
Synovitis remains poorly defined — especially the transition to ‘chronic’ — yet early and consistent treatment is essential to protect joint health.
Diagnosis: clinical exam plus imaging.
Ultrasound – practical for monitoring synovial hypertrophy.
MRI – superior for detecting post‑gadolinium enhancement, haemosiderin, and osteochondral damage, and shows where ultrasound reaches its limits.
Haemophilia treatment:
FVIII trough levels of ~8–12% are more effective than 3–5%, and in selected cases ≥30% for several months may be needed — yet many patients still show persistent hypertrophic synovium.
Treatment algorithms:
- Acute synovitis (<3 months): factor replacement/non‑factor therapy, arthrocentesis when indicated, short‑term anti‑inflammatory therapy, pain control, and stepwise physiotherapy with re‑evaluation after 4–6 weeks.
- Chronic synovitis (>3 months): re‑assess haemophilia treatment and diagnostics (incl. MRI), optimise anti‑inflammatory and pain control, intensify physiotherapy, and — if inadequate response — consider radiosynoviorthesis (RSO) and, ultimately, surgery.”
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