Radiosynoviorthese

Korrektur von Fingerdeformitäten

Deformitäten der Langfinger sind neben „Rheumaknoten“ die auffälligsten Veränderungen einer bestehenden Rheumatoiden Arthritis. Die Therapie beinhaltet neben der medikamentösen Einstellung der Patienten konservative Maßnahmen, in deren Mittelpunkt die Ergotherapie steht. Neben konservativen und interventionellen Versorgungen sollte die Synovialektomie zu einem frühen Zeitpunkt erwogen werden, um die Gelenke langfristig zu schützen. Bei fortgeschrittenen Deformitäten müssen periartikuläre Strukturen in der Operation adressiert werden, um Funktionsdefizite so gering wie möglich zu halten. Gleichzeitig ist auf Grund der Dynamik der Grunderkrankung immer mit einer Progredienz und erneuten Operationen zu rechnen. Eine einzelne für ein Gelenk spezifische operative Maßnahme existiert nicht, vielmehr gilt es die verschiedenen Möglichkeiten und erforderliche Alternativen in der Planung zu berücksichtigen, um diese in der Operation entsprechend dem Ziel durchführen zu können.

[Joint DGN, OGNMB and SGNM S1 guideline for radiosynoviorthesis]

This recommendation is intended to provide a guideline for radiosynoviorthesis (RSO) in the effective local treatment of chronic inflammatory (non-infectious) joint diseases. It was developed in an interdisciplinary manner and describes the general objectives, definitions, clinical background information, indication and contraindications of this radionuclide therapy. The requirements to be met by a treatment center, the results of pretherapeutic examinations as well as recommendations on how the treatment should be carried out. Here, organizational and technical issues have been considered. Furthermore, information on the surveillance and follow-up of the treated patients can be found. In general, treatment and follow-up should be done in in close cooperation of the participating disciplines.

[Indications and contraindications for radiosynoviorthesis]

BACKGROUND

Radiosynoviorthesis (RSO) provides a simple method for the treatment of patients with chronic synovitis and has only few side effects.

OBJECTIVES

Evidence-based indications and contraindications for performing RSO based on the current literature are presented.

MATERIAL AND METHODS

Published information on the indications and contraindications for performing RSO in chronic synovitis were analyzed and summarized.

RESULTS

According to the guideline recommendations of the German Society of Rheumatology indications for RSO are given in patients with rheumatoid arthritis, seronegative spondyloarthropathy, crystal arthropathy, villonodular synovitis and hemophilia with recurrent joint bleeding. Osteoarthritis with documented reactive synovitis is also regarded as an indication in the guidelines of the nuclear medicine societies. The European League Against Rheumatism (EULAR) and the German Society of Rheumatology (DGRh) have given no recommendations for using RSO in osteoarthritis. Given the correct indications RSO shows high success rates.

CONCLUSION

The effects of RSO with the named secondary side effects last on average for 5 years. Crucial for the success of RSO are the correct indications, the correct timing and combination with other therapeutic procedures, such as surgical synovectomy.