Efficacy and Safety of Radiation Synovectomy With Yttrium-90: A Retrospective Long-Term Analysis of 164 Applications in 82 Patients

Abstract

SUMMARYIn this long term retrospective study of radiation synovectomy with Yttrium-90 (Y90), we evaluated the results of 164 applications in 82 patients with RA, OA with synovitis, ankylosing spondylitis and psoriatic arthritis. Radiation synovectomy with Y90 has an overall success rate of approximately 50% and is therefore an effective alternative to surgical synovectomy in chronic synovitis which fails to respond to conservative treatment. Elbow and knee responded significantly better than shoulder and ankle joints. Patients with radiological stages from 0 to 2 showed a significantly better success rate than those with stage 3 changes. In responders, repeat therapy for recurrence of symptoms or treatment of a symptomatic corresponding symmetrical joint is advisable. Repeat therapy in a previous non-responder is associated with an unacceptably high failure rate. Therefore, when a joint fails to respond after 6 months, arthroscopy should be performed to evaluate further treatment procedures. A successful result was found in only 11 of 25 joints treated with arthroscopic synovectomy followed by radiation synovectomy within 2 weeks, indicating no benefit of this combination.

Radiosynoviorthesis with rhenium-186 in rheumatoid arthritis: a prospective study of three treatment regimens

“…In marked synovitis, i. e. synovial swelling above the effective range of Re-186, we [8] recommend surgery because lower layers of the synovium are not reached by radiosynoviorthesis and the destructive process will continue. In patients who do not respond to radiosynoviorthesis, we do not recommend that therapy be repeated because of the unacceptably high failure rate [28]. In the case of additional tenosynovitis or bursitis, we favour surgical treatment by teno-and articulosynovectomy to prevent further damage to tendons and soft tissues [29].…”

Radionuclide Therapy of Inflammatory Joint Diseases (Radiation Synovectomy, Radiosynoviorthesis)

“…Right After RSO of talonavicular, cuneonavicular, and tarsometatarsal joints. Corresponding to follow-up scintigram and self-assessment of the patient nearly perfect improvement may indicate that architectural and mechanical factors, rather than inflammation, were responsible for failed RSO and therefore surgery should be considered (Stucki et al 1993). Close cooperation with orthopedists and rheumatologists is necessary to consider RSO in each patient to ensure optimal medical care.…”

Efficacy of radiosynovectomy of the knee in rheumatoid arthritis: Evaluation with magnetic resonance imaging

“…Local therapies include surgical synovectomy and intraarticular injection of substances to control the inflammatory process in the SM (corticosteroids, osmic acid and radiopharmaceuticals) [14]. The efficacy of a therapy is usually measured with parameters that reflect, in an indirect way, the degree of inflammation in the SM (pain, effusion, range of joint mobility, cell counts in SF and scintigraphy) [15][16][17][18]. Arthroscopy [19] does not seem to be a useful method for the routine evaluation of the efficacy of a therapy, because it is an aggressive procedure.…”