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Caballero Motta LR, Anzola Alfaro AM, Janta I, Molina Collada J, Henao YK, Pérez Pascual R, Álvaro-Gracia JM, Nieto-González JC. Radiosynovectomy in routine care: an old tool with modern applications. Ther Adv Musculoskelet Dis 2021; 13:1759720X211055309. [PMID: 34868355 PMCID: PMC8641112 DOI: 10.1177/1759720x211055309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: Radiosynovectomy can be an effective treatment for difficult-to-treat monoarthritis resistant to systemic and local standard therapy. The objective of our study was to determine predictors of good response to radiosynovectomy in routine care and give an overview of this underused technique. Methods: Retrospective observational study of all the patients who underwent radiosynovectomy during a 6-year inclusion period. All the procedures were ultrasound guided and the radiopharmaceutical used was chosen according to joint size. The patient was considered to have an effective response to radiosynovectomy if the attending physician reported a positive outcome and there was no need to increase local and or systemic treatment due to arthritis in the affected joint during the next 12 months following the procedure. Results: We included 67 patients who underwent radiosynovectomy in the knee (73.1%), wrist (16.4%), and elbow (10.5%). Overall, 44 (65.7%) procedures were considered effective. In the multivariate analysis, infiltration of wrists (odds ratio = 0.192; confidence interval = 0.046–0.79) and pigmented villonodular synovitis (odds ratio = 0.13; confidence interval = 0.021–0.82) were independently associated with a noneffective response. No patients experienced complications associated with radiosynovectomy during follow-up. Conclusion: Infiltrations of wrists with joint damage seem less likely to have a response to radiosynovectomy. In pigmented villonodular synovitis, radiosynovectomy as an adjuvant therapy for relapse might not be effective when performed more than 6 months after surgery. Overall, radiosynovectomy is an effective and safe treatment for persistent monoarthritis.
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Affiliation(s)
- Liz R Caballero Motta
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo 46, 28007 Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana M Anzola Alfaro
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Iustina Janta
- Servicio de Reumatología, Hospital Clínico de Valladolid, Valladolid, Spain
| | - Juan Molina Collada
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Yulieth Katherine Henao
- Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rebeca Pérez Pascual
- Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José María Álvaro-Gracia
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Juan Carlos Nieto-González
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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Abstract
Purpose Radiosynoviorthesis (RSO) using the intraarticular application of beta-particle emitting radiocolloids has for decades been used for the local treatment of inflammatory joint diseases. The injected radiopharmaceuticals are phagocytized by the superficial macrophages of the synovial membrane, resulting in sclerosis and fibrosis of the formerly inflamed tissue, finally leading to reduced joint effusion and alleviation of joint pain. Methods The European Association of Nuclear Medicine (EANM) has written and approved these guidelines in tight collaboration with an international team of clinical experts, including rheumatologists. Besides clinical and procedural aspects, different national legislative issues, dosimetric considerations, possible complications, and side effects are addressed. Conclusion These guidelines will assist nuclear medicine physicians in performing radiosynoviorthesis. Since there are differences regarding the radiopharmaceuticals approved for RSO and the official indications between several European countries, this guideline can only give a framework that must be adopted individually.
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Gabriel M, Pöppel TD, Freudenberg LS, Farahati J, Krause T, Buchmann I, Panholzer PJ, Mödder G, Becherer A, Kampen WU, Kurth J, Krause BJ, Wissmeyer M, Kresnik E. [Joint DGN, OGNMB and SGNM S1 guideline for radiosynoviorthesis]. Nuklearmedizin 2021; 60:78-89. [PMID: 33836541 DOI: 10.1055/a-1324-4745] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Michael Gabriel
- Johannes-Kepler-Universitätsklinik Linz, Institut für Nuklearmedizin und Endokrinologie, Österreich.,Medizinische Universität Innsbruck, Universitätsklinik für Nuklearmedizin, Österreich
| | - Thorsten D Pöppel
- MVZ CDT Strahleninstitut GmbH, Centrum für Diagnostik und Therapie, Köln, Deutschland
| | - Lutz S Freudenberg
- Zentrum für Radiologie und Nuklearmedizin (ZRN), Grevenbroich, Deutschland
| | - Jamshid Farahati
- Ev. Bethesda-Krankenhaus Duisburg, Klinik für Nuklearmedizin, Deutschland
| | - Thomas Krause
- Inselspital Bern, Universitätsklinik für Nuklearmedizin, Schweiz
| | - Inga Buchmann
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Sektion für Nuklearmedizin, Deutschland
| | - Peter J Panholzer
- Salzkammergut-Klinikum Vöcklabruck, Institut für Nuklearmedizin, Österreich
| | - Gynter Mödder
- NURAMED in Köln-Marsdorf, Gemeinschaftspraxis für Radiologie & Nuklearmedizin, Deutsches Zentrum für Radiosynoviorthese, Köln, Deutschland
| | | | | | - Jens Kurth
- Universitätsmedizin Rostock, Klinik und Poliklinik für Nuklearmedizin, Deutschland
| | - Bernd J Krause
- Universitätsmedizin Rostock, Klinik und Poliklinik für Nuklearmedizin, Deutschland
| | - Michael Wissmeyer
- Hôpitaux Universitaires de Genève, Service de Médecine Nucléaire, Schweiz
| | - Ewald Kresnik
- Privatklinik Villach GmbH & Co KG, Institut für Nuklearmedizin, Österreich
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Vadi SK, Chouhan DK, Gorla AKR, Shukla J, Sood A, Mittal BR. Potential Adjunctive Role of Radiosynovectomy in Primary Synovial Osteochondromatosis of the Knee: A Case Report. Nucl Med Mol Imaging 2017; 51:252-255. [PMID: 28878852 DOI: 10.1007/s13139-016-0466-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/01/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022] Open
Abstract
Primary synovial osteochondromatosis (PSOC) is a rare but clinically significant cause of morbidity especially in the male population. Surgery is the primary treatment of choice, but the recurrence rate is reported to be high. Moreover, the presence of widespread loose bodies makes it a cumbersome procedure. The complete removal of the disease is tough at times and results in early recurrence. Radiosynovectomy is an established technique for treating various joint arthropathies. The role of radiosynovectomy in case of PSOC has not yet been explored. This case report described the case of a young male with PSOC of the knee joint who was treated with radiosynovectomy for pain relief. The patient reported complete relief from the pain along with significant improvement in joint mobility. The post-therapy three-phase bone scan also validated the reduction in joint inflammation. The patient was taken for surgical removal of the redundant loose bodies after a significant improvement in the pain and reduction in inflammation. Post-therapy radiation fibrosis of the synovium also helped in the en bloc removal of the disease. The role of radiosynovectomy in PSOC needs to be further explored concerning its potential role as an adjuvant to surgical procedures.
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Affiliation(s)
- Shelvin Kumar Vadi
- Departments of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Devendra Kumar Chouhan
- Departments of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Arun Kumar Reddy Gorla
- Departments of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Jaya Shukla
- Departments of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Ashwani Sood
- Departments of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Bhagwant Rai Mittal
- Departments of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
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Abstract
Osteoarthritis is the most frequent joint disorder and substantially affects patient quality of life. As an age-related disease it leads to an increasing financial burden for the healthcare system due to the current demographic changes. Osteoarthritis affects every single tissue in the joint. The identification of the source of disease symptoms is the key to a successful management. Therapeutic approaches include non-pharmacological and pharmacological treatment. Surgery is the therapeutic end stage (e.g. total joint replacement, high tibial osteotomy and arthrodesis). This overview focuses on the pharmacological treatment whereas the clinical manifestations and non-pharmacological approaches are only briefly dealt with.
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Affiliation(s)
- L Wildi
- Rheumaklinik, UniversitätsSpital Zürich, Gloriastr. 25, 8091, Zürich, Schweiz,
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6
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Abstract
The pharmacological management of osteoarthritis includes pure analgesia, anti-inflammatory drugs and substances supporting tissue maintenance in osteoarthritic joints. The decision for the treatment modality is made depending on the affected joint, the stage of the disease, the extent and frequency of inflammatory flares and the patient risk profile. This article gives an overview of the current treatment modalities including the advantages and disadvantages.
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Radiosynoviorthesis for Treating Recurrent Joint Effusions After Endoprosthetic Knee Replacement. Clin Nucl Med 2012; 37:727-31. [DOI: 10.1097/rlu.0b013e31825ae488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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¹⁵³Sm-HM for arthritic knee pain. Estimated dosimetry. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2012; 35:63-9. [PMID: 22238018 DOI: 10.1007/s13246-011-0122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 12/17/2011] [Indexed: 10/14/2022]
Abstract
Osteoarthritis is the most common type of arthropathy and after cardiovascular diseases is the most disabling disease in developing countries. The dosimetry for the clinical application of 153-samarium-hydroxymacroaggregates (¹⁵³Sm-HM) for radiation synovectomy (RSV) and palliative treatment for arthritic pain, as far as we know, has not been reported. The aim of this research was to estimate the radiation dose necessary for synovial ablation and pain palliation with minimum risk to the patient. ¹⁵³Sm-HM (370 MBq) was administered intra-articularly in a patient with severe knee pain and hindered motility. Regions of interest drawn on sequential, conjugated, anterior and posterior scintigraphy images were used to obtain the respective activity. The data was entered into a knee joint histological-geometric model designed with micrometric dimensions to represent the synovial cell layers. The Monte Carlo code was used to calculate the absorbed dose in each of the 12 model-cells representing the distance from the synovial liquid to the cartilage or bone. The absorbed dose in the synovial cavity was 114 Gy which is sufficient energy for RSV. The treated patient referred little pain and higher motility with no adverse reactions. ¹⁵³Sm-HM is a potentially valid radiopharmaceutical for RSV, which effectively palliates knee pain.
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Kisielinski K, Bremer D, Knutsen A, Röttger P, Fitzek JG. Complications following radiosynoviorthesis in osteoarthritis and arthroplasty: osteonecrosis and intra-articular infection. Joint Bone Spine 2010; 77:252-7. [PMID: 20381398 DOI: 10.1016/j.jbspin.2010.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 02/03/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES In the literature, radiosynoviorthesis (RSO) has been associated only with a small number of complications. There is a trend towards increasing the use of RSO in diverse indications. After repeatedly observing several complications following RSO, a retrospective evaluation was undertaken to estimate the safety of this method. METHODS Between 1995-2007, we evaluated the outcome of RSO in 93 patients (143 knees, seven hips, seven shoulders, three elbows, one ankle) who presented to our orthopaedic department after joint treatment with yttrium-90((90)Y) or Rhenium-186((186)Re) colloid in an external nuclear medicine institution. RESULTS Seventy-nine of the 93 RSO treated patients had advanced primary or secondary osteoarthritis (OA), 12 had an arthroplasty. In seven cases, rheumatoid arthritis (RA) was responsible for secondary OA. The benefit in pain relief, as self-reported by the patients was low. Twenty-two of the 93 patients showed complications following RSO. We observed osteonecrosis (ON) in 19 and infection in five patients, including two with both complications. These findings were proven clinically, radiologically, intraoperatively, microbiologically and histologically. Statistical analysis revealed a strong correlation of arthroplasty to infection (rho=0.798, alpha=0.01), and a strong correlation of chronic obstructive pulmonary disease (COPD) and RA to ON following RSO (rho=0.674, alpha=0.01). Diabetes mellitus (DM) was also significantly correlated to ON after RSO treatment (rho=0.488,alpha=0.05). CONCLUSIONS Our data suggest that RSO may not be as safe as it has previously been reported, especially in advanced OA and arthroplasty.
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Affiliation(s)
- Kai Kisielinski
- Orthopaedic Surgery Department at the Kliniken Oberallgäu gGmbH, Trettachstr, 16, 87561 Oberstdorf, Germany.
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Yttrium-90 radiation synovectomy in knee osteoarthritis: a prospective assessment at 6 and 12 months. Nucl Med Commun 2009; 30:472-9. [PMID: 19357547 DOI: 10.1097/mnm.0b013e32832b52b9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the outcome of yttrium-90 radiation synovectomy at 6 and 12 months in patients with knee osteoarthritis unresponsive to systematic or local medical treatment. METHODS Consecutive patients with osteoarthritic knee pain resistant to conventional therapy and submitted to intraarticular yttrium-90 treatment because of synovial inflammation, as demonstrated by early-phase bone scintigraphy, were prospectively evaluated at 6 and/or 12 months. The assessment of the outcome of treatment was based on self-reporting of relief of knee pain limiting daily activities, measured as percentage reduction of the pretherapeutic joint discomfort with a Visual Analogue Scale. Resting and nocturnal pain also were considered, together with knee flexibility and ultrasonographic changes. RESULTS Among a total of 97 patients, a > or =50% Visual Analogue Scale pain palliation was experienced by 64 of 90 (71.1%) patients at 6 months and 50 of 69 (72.5%) at 12 months (P = 0.992). Moreover, nocturnal and resting pain alleviation, gain in knee flexibility and regression of large joint effusions and Baker's cysts were observed in considerable proportions. In the evaluation of the outcome of treatment in 62 patients with serial assessments using a composite criterion, 42 (67.7%) versus 40 (64.5%) had a satisfactory response at 6 and 12 months, respectively (P = 0.850). The probability of a favourable therapeutic result was inversely related to the severity of radiographic joint changes. CONCLUSION Yttrium-90 synovectomy exerts a beneficial therapeutic effect in a substantial proportion of patients with osteoarthritic knee pain and synovial inflammation, inadequately controlled by pharmacotherapy. Clinical improvement is inversely related to radiographic knee damage.
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11
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Calegaro JU, Machado J, DE Paula JC, DE Almeida JSC, Casulari LA. Clinical evaluation after 1 year of 153-samarium hydroxyapatite synovectomy in patients with haemophilic arthropathy. Haemophilia 2009; 15:240-6. [PMID: 18976248 DOI: 10.1111/j.1365-2516.2008.01908.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J U Calegaro
- Nuclear Medicine Service of the Hospital de Base do Distrito Federal (HBDF), Brasília, DF.
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12
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Rehart S, Arnold I, Fürst M. [Conservative local therapy of inflammation of joints: local invasive forms of therapy]. Z Rheumatol 2008; 66:382-7. [PMID: 17721706 DOI: 10.1007/s00393-007-0195-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Local invasive procedures represent possibilities for the treatment of arthritic swollen joints without surgical interventions, when general measures alone are not successful and intra-articular injections are of utmost importance in this context. The differences between degenerative and rheumatologic diseases must be considered as well as possible specific adverse reactions, side effects and contraindications. The technical intervention is performed according to the guidelines of scientific societies such as the Scientific Medical Profession Society (AWMF). Cortisone and radiosynoviorthesis/chemosynoviorthesis are suitable for activated rheumatic and degenerative joints, low-grade radiation therapy or infiltration of hyaluronic acid is recommended for relief in cases of arthritic inflammation. The combination of arthroscopic synovectomy and subsequent radiosynoviorthesis in the early stages of rheumatically swollen joints show the best results with respect to regression prophylaxis and slowing the process of rapidly progressing destruction of chondral surfaces and distension of the capsules and ligaments.
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Affiliation(s)
- S Rehart
- Klinik für Orthopädie und Unfallchirurgie,Markus-Krankenhaus, Akademisches Lehrkrankenhaus der Johann-Wolfgang-Goethe-Universität, Wilhelm-Epstein-Strasse 2, 60431, Frankfurt am Main, Germany.
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Abstract
Intraarticular therapy is an established form of therapy in chronic inflammatory joint diseases. Besides the injection of glucocorticoids, radiosynoviorthesis is a frequently used procedure. Intraarticular injected beta-emitting radionuclides are indicated in chronic synovitis with recurrent joint effusions in rheumatoid arthritis, seronegative spondyloarthritis, villonodular synovitis after surgery and for bleeding prophylaxis in haemophilic arthropathy. The value of radiosynoviorthesis in activated osteoarthritis is not yet clarified.
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Affiliation(s)
- W Seidel
- Medizinische Klinik IV, Universitätsklinikum Leipzig, Abt. Rheumatologie.
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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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Rau H, Franke C, Goretzki G, Spitz J. Radiosynoviorthesis in Osteoarthritis and Other Disorders with Concomitant Synovitis in Comparison to Rheumatoid Arthritis. Cancer Biother Radiopharm 2005; 20:349-55. [PMID: 15989483 DOI: 10.1089/cbr.2005.20.349] [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: 11/12/2022] Open
Abstract
AIM The aim of this study was to evaluate the effectiveness of radiosynoviorthesis (RSO) in osteoarthritis and other disorders with concomitant synovitis versus rheumatoid arthritis by means of a standardized questionnaire. METHODS Eight-hundred and three RSO treatments were monitored in 691 patients by seven centers in three countries, using standardized questionnaires. Patients were assigned to three groups according to their age (20-40, 41-60, and 61-80 years). Additionally, the data was analyzed separately for patients with rheumatoid arthritis (group A) and those with osteoarthritis, psoriasis arthritis, pigmental villonodular synovitis, or persistent effusions after joint replacement (group B). RESULTS Quality of life improved in 78% of group A and 59% of group B (p < 0.01). Ameliorations of joint pain, swelling/effusion, or flexibility were found in 80% of group A and 56% of group B (p < 0.01). The response rate was similar for small- and large-sized joints in group A, but was significantly higher for large-sized joints in group B (p < 0.01). The positive effects on joint pain, swelling/effusion, or flexibility lasted longer in group A (p < 0.01). Repeated RSOs were as effective as initial RSOs. The clinical outcome was not influenced by age, gender, or transient immobilization for 48 hours after RSO. CONCLUSION Although slightly more efficient in rheumatoid arthritis, RSO represents an effective treatment option also in osteoarthritis and other disorders with concomitant synovitis.
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Affiliation(s)
- Harald Rau
- Praxis für Nuklearmedizin, Wiesbaden, Germany.
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16
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Abstract
The aim of this study was to compare the treatment results between radiosynoviorthesis and reradiosynoviorthesis of knees. Before the radiosynoviorthesis, an ultrasonography, X-ray, and three-phase bone scintigraphy were done. The treatment effect can be expected if a synovitis is proved by these examinations. To knees, 200 MBq of the yttrium citrate was injected for the first radiosynoviorthesis or for reradiosynoviorthesis. After an application, it is possible to do the scintigraphic examination, when information about a tracer distribution in joints is obtained. The treatment effect was evaluated by the clinical examination, the ultrasonography, and the three-phase bone scintigraphy with some lapse of time. If the effect of the radiosynoviorthesis was not satisfying, it could be repeated no sooner than 6 months later. Among our patients we had a high percentage of the repeated radiosynoviorthesis. The authors applicated the yttrium citrate to 1243 knees. A rate between single radiosynoviorthesis and reradiosynoviorthesis was 11:8. Repeated radiosynoviorthesis were as effective as the initial ones, and their repeated use does not decrease the expected therapeutic effect.
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Affiliation(s)
- Otakar Kraft
- Department of Nuclear Medicine, University Hospital, Ostrava-Poruba, Czech Republic.
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