Radiosynovectomy in the Therapeutic Management of Arthritis

Abstract

Radiosynovectomy is a well-established therapy in arthritis and involves an intra-articular injection of small radioactive particles to treat a synovitis. In Europe, frequent indications are rheumatoid and poly-arthritis. Especially in Germany radiosynovectomy is the second common therapy in Nuclear Medicine with about 40,000–60,000 treated joints per year. In Spain, USA, Turkey, Argentines and Philippines the therapy is more use in hemophilic arthritis with excellent results. Especially in developing countries with low availability of clotting factors, the radiosynovectomy represent a cost effective therapeutic option for repeated bleedings in hemophilic arthropathy. The special focus in these countries is maintaining of mobility and work ability. Often only the knee and medium joints (ankle, elbow and shoulder) are treated using yttrium-90, rhenium-186 or phosphorus-32. However, in rheumatoid arthritis most common affected joints are the fingers. For the treatment in these small joints, erbium-169 is necessary. Unfortunately, erbium-169 is only available in Europe. Further indications for radiosynovectomy are osteoarthritis and the articular effusion after joint replacement. The reported response rates in rheumatoid and poly-arthritis range from 60% to 80% depends from the stage of previous arthrosis. The best effectiveness of therapy was observed in hemophilic arthritis with response rate of 90% and significant reducing of bleeding frequency. The therapy is well-tolerated with low rate of side effects. In respect of the specific uptake of particles in the synovia and short range of beta radiation, the radiation exposure outside the joint is very low. The radiosynovectomy has efforts in comparison to surgical synovectomy: it's a minor intervention with low costs; and simultaneous treatments of multiple joints or treatment in short intervals are possible. The presented paper summarized the published papers and reports our own experiences in >15,000 treated joints.

Rheumatoid Arthritis: A Brief Overview of the Treatment

“…Radiosynovectomy is an alternative to surgical synovectomy; it involves intra-articular injection of small radioactive particles, is cost-effective, and can treat multiple joints simultaneously [43]. Repair of ruptured tendons can also be done through arthroscopy, most commonly in the rotator cuff of the shoulder.…”

All-Trans Retinoic Acid Inhibits Migration and Invasiveness of Rheumatoid Fibroblast-Like Synoviocytes

“…The experience of drugs targeting synoviocytes in RA does not go beyond preclinical studies (Dong-Liang et al, 2016). However, several therapies intended to reduce synovial hyperplasia, including radioactive, surgical, and arthroscopic synovectomy, are still applied with success in refractory patients with RA (Chalmers et al, 2011;Lee et al, 2014;Knut, 2015).…”

Nuklearmedizin in Diagnostik und Therapie rheumatischer Erkrankungen: Skelettszintigrafie, Hybridbildgebung mit SPECT/CT und PET/CT sowie Radiosynoviorthese

“…Die RSO ist demnach die zweihäufigste durchgeführte Prozedur in der Nuklearmedizin (ca. 40.000-60.000 behandelte Gelenke/Jahr) mit niedrigen Raten unerwünschter Ereignisse [85]. Die durchschnittlichen Ansprechraten liegen zwischen 60 und 80 % [85].…”