Characteristics of radio-isotopes for intra-articular therapy.

Ingrand, Jacques

doi:10.1136/ard.32.suppl.3

Cited by 62 publications

(26 citation statements)

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“…Radioactive agents used most frequently worldwide include yttrium-90 ( 90 Y), gold ( 198 Au), rhenium ( 186 Re) and phosphorous-32 ( 32 P). These agents vary with regard to size, half-life and emission properties-see Table I (Ingrand, 1973;Winston et al, 1973). The ideal agent should emit b-rays (which have a relatively shallow depth of penetration) and have a short halflife (Erken, 1991).…”

Section: Radionucleotide Synovectomymentioning

confidence: 99%

Modern management of haemophilic arthropathy

2007

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SummaryCurrently available factor concentrates for treatment of patients with haemophilia are virally inactivated or are made by recombinant technology and their broad use in developed nations has resulted in the dramatic elimination of the treatment‐related viral illnesses that decimated the haemophilia community in the late 20th century. The major morbidity experienced by patients with haemophilia today is joint disease, a result of repeated bleeding episodes into joint spaces. Although administration of factor concentrates to prevent bleeding has been demonstrated to prevent haemophilic joint disease when applied assiduously, repeated bleeding episodes induce synovitis that is irreversible and may progress despite subsequent prophylaxis. Surgical and nuclear medicine interventions are available to reduce the pain of haemophilic arthropathy and to reduce further bleeding episodes. Patients with high titre inhibitors are at great risk for the development of joint disease and present the greatest therapeutic challenges when joint surgery is needed.

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Section: Radionucleotide Synovectomymentioning

confidence: 99%

Modern management of haemophilic arthropathy

2007

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“…This results in fibrosis and finally sclerosis of the synovial membrane. 2 Treatment with 90 Y is often directly followed by treatment with glucocorticoid, using the same needle. The purpose is to prevent leakage with skin-and-needle tract burn after injection of 90 Y and to bridge the lag phase before the onset of the clinical effect of RSO.…”

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confidence: 99%

Pretreatment macrophage infiltration of the synovium predicts the clinical effect of both radiation synovectomy and intra-articular glucocorticoids

Jahangier

2006

Annals of the Rheumatic Diseases

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Objective: To explore whether pretreatment features of synovial tissue in patients with gonarthritis could predict the clinical effect of radiation synovectomy with yttrium-90 ( 90 Y) and glucocorticoids or with intraarticular glucocorticoids alone. Methods: A synovial biopsy was carried out blindly 2 weeks before treatment in 66 patients with persistent gonarthritis, who were randomised to treatment either with 90 Y and triamcinolone or with placebo and triamcinolone. Immunohistochemistry was used to detect T cells, macrophages, B cells, plasma cells, fibroblast-like synoviocytes, adhesion molecules and pro-inflammatory cytokines. Stained sections were evaluated by digital image analysis. Individual patient improvement was expressed using a composite change index (CCI; range 0-12). Successful treatment was defined as CCI >6 after 6 months. Results: Patients with rheumatoid arthritis, psoriatic arthritis, undifferentiated arthritis and other causes of gonarthritis were included. The overall response rate was 47%. Clinical efficacy in both therapeutic groups was similar and not dependent on diagnosis. No significant differences were noted between baseline microscopic features of synovial tissue inflammation in patients with rheumatoid arthritis and in those with non-rheumatoid arthritis (ie, all diagnoses other than rheumatoid arthritis). The number of macrophages in the synovial sublining was significantly higher in responders than in non-responders (p = 0.002), independent of treatment group and diagnosis. The clinical effect was positively correlated with pretreatment total macrophage numbers (r = 0.28; p = 0.03), sublining macrophage numbers (r = 0.34; p = 0.005) and vascular cell adhesion molecule 1 expression (r = 0.25; p = 0.04). Conclusion:The observations support the view that intra-articular treatment either with 90 Y and glucocorticoids or with glucocorticoids alone is especially successful in patients with marked synovial inflammation.

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“…radiation the smallest effective dose should be 90Y should be reserved for cases of chronic arthritis used, if necessary with repeated application (Jalava, unresponsive to other treatment and should be 1974). restricted in young patients because of the long life (4) In view of the appearance of the known secondary expectancy (de la Chapelle and others, 1972;Dolphin, effects of therapy with 90Y on the joint cartilage and 1973; Stevenson and others, 1973;Ingrand, 1973; on the fibrocartilage of the cruciate ligaments, the Jalava and Salonius, 1974).…”

Section: Discussionmentioning

confidence: 99%

Effect of yttrium 90 on experimental allergic arthritis in rabbits.

Meier-Ruge¹,

Müller²,

Pavelka³

1976

Annals of the Rheumatic Diseases

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-66. Effect of yttrium 90 on experimental allergic arthritis in rabbits. Seventeen rabbits were immunized with complete Freund's adjuvant and bovine serum albumin by the method of Dumonde and Glynn (1962), as modified by Cooke and Jasin (1972). Fifteen weeks after allergic arthritis developed in the knee joint, 8 animals were given an injection of 200 ,uCi yttrium 90 (90Y) into the left joint cavity; 7 were injected with 400 ,uCi. The animals were sacrificed at 2, 4, 8, 12, and 16 weeks, and at 6 and 12 months after the injection. The right knee joint served as control for assessment of untreated allergic arthritis. Morphological control of the severity of the arthritis was provided by sacrificing 2 uninjected animals 13 weeks after immunization.After 13 weeks the allergic arthritis progressed to severe inflammation of the knee joint marked by massive round-cell infiltration, oedema, and proliferation of synovial mesothelium in the synovial villi and joint capsule.Treatment with 90Y was effective 2 weeks after injection with the disappearance of inflammatory oedema and marked regression, of round-cell infiltration. This was accompanied by degeneration of the synovial mesothelium and fibrosis of the subsynovial tissue and synovial vessels as a secondary effect of the radiation.In the animals with severe allergic arthritis, the healing effects of 90Y were more marked than the secondary effects of the radiation. The secondary effects were dosedependent and consisted of patchy necrosis of the chondrocytes in the fibrocartilage, in the meniscus, in the cruciate ligaments, and in the tangential cartilage of the joint. There was also localized bone-marrow necrosis in the tibia adjacent to the joint.Treatment with 90Y of arthritic knee joints with the lowest effective dose of the isotope-if necessary with repeated application-seemsjustified. A single large dose does not have a greater therapeutic effect and causes more radiation damage to the joint.In view of the possible secondary effects in the joint, the indication for 90Y therapy should be restricted, particularly in young patients, to cases of chronic relapsing arthritis unresponsive to other treatment.

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Characteristics of radio-isotopes for intra-articular therapy.

Abstract: 0 i. concentrated in the synovium (S) and sparing the cartilage (C).

Cited by 62 publications

References 0 publications

Modern management of haemophilic arthropathy

Modern management of haemophilic arthropathy

Pretreatment macrophage infiltration of the synovium predicts the clinical effect of both radiation synovectomy and intra-articular glucocorticoids

Effect of yttrium 90 on experimental allergic arthritis in rabbits.

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