Feasibility and Toxicity of Intra-Articular 188Re-tin Colloid Injection in Patients with Rheumatoid Arthritis with Three-Phase Positive Bone Scan and Refractory Knee Pain, a pilot study

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that causes chronic synovial inflammation and leads to articular cartilage destruction. In later stages, RA usually causes loss of joint mobility and overt disability [1]. In recent decades, interest in using reactor-produced β particle-emitting radionuclides for developing therapeutic radiopharmaceuticals has grown [2]. Selecting a suitable radionuclide for a specific therapeutic application is related to many factors, such as the half-life of the radiopharmaceutical, nature of particulate emission and energy, and concomitant γ-ray emission characteristics [3]. Several short-lived reactors that produce radionuclides have been introduced, such as 90 Y, 188 Re, 186 Re, 153 Sm, 166 Ho and 105 Rh, and 155 Lu which is used for radionuclide therapies and seems to have more favorable features, especially considering the half-life, in comparison with 89 Sr or 32 P [4].188 Rhenium tin-colloid ( 188 Re-tin) has been used for synovectomy in patients with chronic inflammatory knee joint pain refractory to conventional treatments and has achieved proper results [5]. The on-demand availability of 188 Re from the 188 W/ 188 Re generator is an important feature and facilitates in-hospital radiopharmaceutical production. Rhenium-188 and technetium-99 have similar chemical properties and are presented as a "theragnostic pair". Using and imaging 188 Re-tin agents for therapy is the same as imaging agents prepared with 99m Tc, which is the most commonly used diagnostic radionuclide due to its favorable characteristics [6]. The properties of 188 Re enable the treatment of knee joint disease through its maximum tissue penetration of approximately 11 mm and its mean range of 3.8 mm [7]. In the current study, the toxicity and feasibility of 188 Re-tin colloid injection in the knees of patients with RA and refractory knee pain were analyzed. Materials and Methods___________________This clinical trial study was conducted from 2017 to 2019 at Ghaem Hospital, affiliated with Mashhad Original ArticleOpen AccessRheumatoid arthritis (RA) is a chronic inflammatory joint disease that causes chronic synovial inflammation. Reactor-produced β−particle emitting radionuclides is a new therapeutic strategy in the management of RA. This study was conducted in 2019 and analyzed the toxicity and feasibility of 188 Re-tin colloid injection, Three-Phase Positive Bone Scan, and Refractory Knee Pain. Ten patients with RA were administered radiosynovectomy with 188 Re-tin colloid. The main complications after the intervention were assessed and compared with patients' pre-intervention condition. Patients showed alleviation of pain, tenderness, and morning stiffness after the administration of radiosynovectomy. Only one RA patient received a corticosteroid injection; the other 6 patients did not need a corticosteroid injection after radiosynovectomy. Intra-articular 188 Re-tin colloid injection seems to be an effective treatment modality for refractory knee joint pain in rheumatoid arthritis p...