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Freudenberg LS, Baraliakos X, Kampen WU, Vereb M, Fischer M, Toenshoff G, Boddenberg-Pätzold B, Czech N, Klett R. [Pain reduction by radiosynoviorthesis in rheumatism-induced synovitis of the elbow : Results of a retrospective multicenter data analysis]. Z Rheumatol 2023; 82:892-897. [PMID: 35066630 DOI: 10.1007/s00393-022-01158-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Radiosynoviorthesis (RSO) is a nuclear medical local treatment modality for inflammatory joint diseases. It is indicated in patients with rheumatoid arthritis (RA) in joints with persistent synovitis despite adequate pharmacotherapy. Arthritis of the elbow joint occurs in up to 2/3 of patients with RA. Intra-articular radiotherapy using the beta emitter [186Re] rhenium sulfide leads to sclerosis of the inflamed synovial membrane with subsequent pain alleviation. The clinical efficacy in cubital arthritis, however, has so far only been described in small monocentric studies. OBJECTIVE The degree of pain alleviation by RSO was analyzed in patients with rheumatoid cubital arthritis, treated in several nuclear medical practices specialized in RSO. MATERIAL AND METHODS The subjective pain intensity before and after RSO was documented in a total of 107 patients with rheumatic cubital arthritis using a 10-step numeric rating scale (NRS). A difference of ≥ -2 is rated as a significant improvement. Follow-up examinations were done after a mean interval of 14 months after RSO (at least 3 months, maximum 50 months). RESULTS The mean NRS value was 7.3 ± 2.1 before RSO and 2.8 ± 2.2 after RSO. A significant pain alleviation was seen in 78.5% of all patients treated. The subgroup analysis also showed a significant improvement in the pain symptoms in all groups depending on the time interval between the RSO and the control examination. A significant pain progression was not observed. The degree of pain relief was independent of the time of follow-up. CONCLUSION Using RSO for local treatment of rheumatoid cubital arthritis leads to a significant and long-lasting pain relief in more than ¾ of the treated patients.
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Affiliation(s)
- Lutz S Freudenberg
- ZRN Rheinland und ZRN MVZ GmbH, Überseite 88, 41352, Korschenbroich, Deutschland.
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428.
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | - Willm Uwe Kampen
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Nuklearmedizin Spitalerhof, Radiologische Allianz, Spitalerstr. 8, 20095, Hamburg, Deutschland
| | - Marika Vereb
- Praxis für Radiologie, Nuklearmedizin und Strahlentherapie, Fr.-Ebert-Str. 50, 34117, Kassel, Deutschland
| | - Manfred Fischer
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Praxis für Radiologie, Nuklearmedizin und Strahlentherapie, Fr.-Ebert-Str. 50, 34117, Kassel, Deutschland
| | - Gregor Toenshoff
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Radiologie und Nuklearmedizin, Röntgenpraxis Georgstraße, Georgstr. 16, 30159, Hannover, Deutschland
| | - Barbara Boddenberg-Pätzold
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Praxis Nuramed Köln-West, Max-Planck-Str. 27A, 50858, Köln, Deutschland
| | - Norbert Czech
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Zentrum für Nuklearmedizin und PET/CT Bremen im St. Joseph Stift, Schwachhauser Heerstr. 54, 28209, Bremen, Deutschland
| | - Rigobert Klett
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- ÜBAG für Nuklearmedizin, Hanau-Frankfurt-Offenbach-Gießen, Paul-Zipp-Str. 171-173, 35398, Gießen, Deutschland
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Role of radiosynovectomy in the treatment of rheumatoid arthritis and hemophilic arthropathies. Biomed Imaging Interv J 2007; 3:e45. [PMID: 21614297 PMCID: PMC3097689 DOI: 10.2349/biij.3.4.e45] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2007] [Revised: 06/14/2007] [Accepted: 06/18/2007] [Indexed: 12/19/2022] Open
Abstract
Radiosynovectomy is a novel method of treatment for several acute and chronic inflammatory joint disorders. A small amount of a beta-emitting radionuclide is injected into the affected joint delivering a radiation dose of 70 to 100 Gy to the synovia. The proliferative tissue is destroyed, secretion of fluid and accumulation of inflammation causing cellular compounds stops and the joint surfaces become fibrosed, providing long term symptom relief. The radionuclides are injected in colloidal form so that they remain in the synovium and are not transported by lymphatic vessels causing radiation exposure to other organs. Complete reduction of knee joint swelling has been seen in above 40% and pain relief in 88% of patients. Wrist, elbow, shoulder, ankle and hip joints showed significant improvement in 50-60% and restoration of normal function and long term pain relief has been achieved in about 70% of small finger joints. In hemophilic arthropathies complete cessation of bleeding in about 60% and improved mobility in 75% of patients has been reported.
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Schomäcker K, Dietlein M, Mödder G, Boddenberg-Pätzold B, Zimmermanns B, Fischer T, Schicha H. Stability of radioactive colloids for radiation synovectomy: influence of X-ray contrast agents, anaesthetics and glucocorticoids in vitro. Nucl Med Commun 2005; 26:1027-35. [PMID: 16208182 DOI: 10.1097/01.mnm.0000183801.20018.f8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This in-vitro study investigated the influence of the contrast agents iothalamate (Conray) and special preparations of iotrolan (Isovist) and iopromide (Ultravist) without ethylenediaminetetraacetic acid (EDTA), the anaesthetic Scandicain and the glucocorticoid triamcinolone on the stability of 90Y-, 169Er- and 186Re-radiocolloids used for radiation synovectomy. METHODS Vials of 1 ml of synovial fluid and 0.02 ml of radiocolloid suspension (0.56-3.6 MBq) were mixed with 0.06, 0.6 and 1.0 ml of each contrast agent. In an additional series, 0.1 ml of Scandicain and 0.1 ml of triamcinolone were tested. Thin layer chromatography and ultrafiltration/centrifugation were performed between 1 h and 15 days after incubation with negative and positive controls. RESULTS Within 24 h, 0.6 and 1.0 ml of Conray had mobilized 5-20% of the 90Y and 169Er out of the colloids. No interference between 186Re-colloids and Conray was visible before the ninth day after incubation. Iotrolan and iopromide without EDTA had no effect on the stability at shorter incubation periods of up to 6 days. The addition of Scandicain did not produce low-molecular 90Y or 169Er in the presence of synovial fluid. The fraction of low-molecular 186Re reached 4% after 24 h. Triamcinolone did not have any effect on stability in the presence of synovial fluid. CONCLUSION The disintegration of the radioactive colloids can be attributed to either the formation of EDTA complexes or radiolytic effects. The volume of the injected contrast agent should be as small as possible to confirm correct intra-articular distribution.
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Affiliation(s)
- Klaus Schomäcker
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany.
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Jablonka K, Freyschmidt J, Uhlenbruck C. Ungewöhnliche Fingergelenkdestruktionen nach Radiosynoviorthese (RSO) und Cortisoninjektionstherapie bei Bouchard-Arthrose. Z Rheumatol 2005; 64:576-80. [PMID: 16328763 DOI: 10.1007/s00393-005-0690-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Accepted: 11/17/2004] [Indexed: 11/30/2022]
Abstract
UNLABELLED Starting in 1998, a female patient suffering from activated Bouchard arthrosis was treated with intra-articular steroid injections into digits of both hands. In September 2001, an additional therapy with erbium-169 injections into the same joints was begun. The injections were continued until March 2003. No benefit was observed. Instead, severe destruction of the involved joints with articular necroses and marked periarticular calcifications had occurred. The course of events are documented by plain film examinations. CONCLUSIONS The indication for alternating steroid injections and radio-synovectomies in patients with activated Bouchard arthrosis has to be reconsidered. In vivo and in vitro experiments are necessary to evaluate the potential harms of this combination of therapies. A close clinical and radiological control of treatment outcome with reevaluation of the indication is necessary.
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Affiliation(s)
- K Jablonka
- Klinik für radiologische Diagnostik und Nuklearmedizin, Klinikum Bremen Mitte, St. Jürgen-Strasse, 28205 Bremen, Germany
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