Clinical outcome of radiosynoviorthesis: a meta-analysis including 2190 treated joints

Abstract

A variety of indications for radiosynoviorthesis have been reported in literature, but the clinical outcome differs and depends on the primary disease and the pre-existing degenerative changes. This metaanalysis was carried out to establish groups for radiosynoviorthesis based on clinical outcome with respect to primary disease, clinical stage and the pre-existing degenerative changes. The literature search was carried out using the MEDLINE search term 'radionuclide synovectomy'. Based on reports in the literature we determined groups for radiosynoviorthesis for clinical use. Our literature list comprised 2190 joints that were treated with radiosynoviorthesis. The overall response rate for all treated joints was 72.5+/-17%. The mean improvement rate for the treated joints in rheumatoid arthritis was 66.7+/-15.4%. For osteoarthritis the success rate was 56+/-11%, with better results in case of minimal radiological changes. Radiosynoviorthesis in patients with changes according to Steinbrocker I and II was successful in 72.8+/-12.3%, and in 64+/-17.3%, respectively. Steinbrocker III and IV had a mean success rate of 52.4+/-23.6%. In the case of haemophilia and Willebrand's disease a reduction of joint bleedings and factor usages after radiosynoviorthesis was evident in 91+/-4.3%. In patients with pigmented villonodular synovitis radiosynoviorthesis was successful in 77.3+/-25.3%. It is concluded that radiosynoviorthesis provides better results in rheumatoid arthritis than in osteoarthritis. Minimal or moderate changes according to Steinbrocker stages I and II respond better to radionuclide therapy than do stages III and IV. Deformed or unstable joints might fail treatment and therefore surgical interventions should be considered. Close cooperation with orthopaedists and rheumatologists is necessary to consider radiosynoviorthesis in each patient to ensure optimal medical care.

Radiosynoviorthesis of acromioclavicular joint using 169Er-citrate: prospective evaluation of efficacy

“…In patients with rheumatoid arthritis and osteoarthritis, the clinical and scintigraphic outcomes were observed mainly in joints with decreasing blood pool indices and the response to RSO according to BPI was associated with subjective response in 129/157 (82.2 %) in the study of Zuderman et al [13], underlining the BS as a valuable tool for monitoring RSO efficacy [8,13]. In our study the two-phase BS including BPI and bone phase was performed less than 2 months prior and 4-8 months after RSO.…”

“…The absorbed dose of radiation about 100 Gy leads to a synovectomy similar to surgical synovectomy [6]. The leakage rate is low, if the joint is immobilized and if particles with an appropriate size of 5-10 μm are used [5,7,8]. The pain reduction typically occurs up to 4 weeks after RSO.…”

“…However, earlier in the course of the disease the RSO is indicated, the better results can be expected [8].…”

“…The documented efficacy of RSO in significant proportion of patients (average response 73 ± 17%) [8] with persistent chronic arthritis despite previous line(s) of treatment including intraarticular administration of corticosteroids encouraged us to launch this first prospective study of feasibility, efficacy and safety of RSO in arthritis of AC-joint.…”

Evaluation of patients with diffuse pigmented villonodular synovitis of knee with functional scoring systems after surgery and radiosynovectomy

“…Reduction in joint bleeding and factor usage has been shown to be evident in 91% of cases of haemophilia and Willebrand's disease. Treatment failure is especially seen in deformed and unstable joints [17].…”