Efficacy of radiation synovectomy (radiosynovectomy or radiosynoviorthesis) with yttrium-90 in exudative inflammation of synovial membrane of knee joints in patients with rheumatic diseases – preliminary report

Abstract

ObjectivesHypertrophic and exudative synovitis of the knee is one of the earliest symptoms in rheumatic diseases. In the case of pharmacotherapy failure, other methods which directly remove the inflamed synovial membrane are used – synovectomies. Radiosynovectomy (RSV) is the radiopharmaceutical application of colloidal solution to joint cavities. In this study, the authors assessed the efficacy of knee radiosynovectomy with yttrium-90 (Y-90) in several groups of patients divided into certain rheumatic diseases.Material and methodsThe study group consisted of 70 patients aged from 29 to 65 years with hypertrophic and exudative synovitis of the knee in rheumatic diseases such as rheumatoid arthritis, osteoarthrosis and spondyloarthropathies. Radiopharmaceutical colloid of Y-90, with a radiation dose of 185-222 MBq in a volume of 2-3 ml, was administered to joint. Then the knee joint was immobilized for 72 h. During visits V1, V2, V3 and V4, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured and ultrasound of the knee was performed. Disease activity was evaluated by the WOMAC scale, HAQ and 100-mm visual analog scale (VAS).ResultsThe most significant difference of synovial hypertrophy, before and after the procedure, was obtained in patients with rheumatoid arthritis. Variability of effusion before and after the procedure in all groups was comparable and statistically significant. The greatest improvement in variability of inflammatory parameters, before and 4 weeks after radiosynovectomy, was observed in patients with rheumatoid arthritis.ConclusionsIn the therapeutic algorithm radiosynovectomy should be located between conservative treatment and operative procedures. Radiosynovectomy does not require hospitalization or prolonged rehabilitation. Radiosynoviorthesis affects the patient's general condition, which is associated with eliminating pain and restoring joint function.

The use of radiosynovectomy in patients with juvenile idiopathic arthritis. Assessment of treatment efficacy and safety

“…Presentation of the inflammation in scales allowed for the gradation of symptoms; a statistically significant reduction in clinical symptoms of knee joint inflammation in the 6 th week after the RS was observed, assessed via the Colorado scale (score reduction from 10.9 ±2.7 to 4.66 ±3.18), reduction of the pain VAS from 50 to 10, the illness VAS assessed by the patient/parent from 69.9 ±13.3 to 32.4 ±16.7 and illness VAS assessed by the physician from 68.8 ±12.4 to 36.9 ±16. In Zalewska's study [15], in a group of patients with RA, significant pain reduction was achieved as an early (4 weeks) benefit of RS -this is confirmed in all of the parameters assessed in the pain category of the WOMAC index. Matryba's study [16] showed pain and oedema reduction in patients with RA assessed in the average period of 56 days from knee joint RS in 68.7% of the patients.…”

“…Compared to the US prior to the RS (n = 18) and 6 weeks after the RS; joint exudate was still present (but in low intensity), there were no differences in the assessment of synovial thickening/hypertrophy, but there was significant reduction of synovial hyperaemia, which confirmed the influence of RS on inflammatory activity. In Zalewska's [15] study, in the RA and SpA groups, a significant reduction in synovial hypertrophy was noted at one month after the RS procedure in RA patients, a reduction in the thickness of the synovial membrane from 7.6 ±2.57 mm to 4.71 ±1.85 mm was observed, and a statistically significant reduction in the joint exudate observed, from 8.91 ±3.65 mm to 5.53 ±2.95 mm. In another study US was performed on average 56 days after the RS; joint exudate was found in 76.8% and synovial hypertrophy in 87.5% [16].…”

Intraarticular injection of a Tin‐117 m radiosynoviorthesis agent in normal canine elbows causes no adverse effects

“…Radiosynoviorthesis has been used successfully to treat rheumatoid arthritis, psoriatic arthritis, osteoarthritis, and other arthropathies in humans . Yttrium‐90, 186 Re, and 169 Er, the radionuclides most frequently used, have some shortcomings.…”

“…Other radiation doses used for radiosynoviorthesis in humans have varied widely, ranging from 15 MBq of 186 Re for fingers and toes to 925 MBq of 188 Re for knees . Radiosynoviorthesis has been successfully achieved in human knees using 90 Y at radiation doses ranging from 184 MBq to 222 MBq . Erbium‐169, which is frequently used in humans for radiosynoviorthesis of small joints such as interphalangeal joints, has been used at radiation doses ranging from 10 to 40 MBq .…”

“…Radiosynoviorthesis causes apoptosis and ablation of inflamed synovial cells via intra‐articular application of low‐energy ionizing radiation. This therapy has been previously used to treat synovitis prior to the onset of permanent structural damage in an effort to prevent, delay, or limit arthritic changes . Radiosynoviorthesis, primarily incorporating yttrium‐90 ( 90 Y), rhenium‐186 ( 186 Re), and erbium‐169 ( 169 Er), has been used successfully to treat rheumatoid arthritis, psoriatic arthritis, and osteoarthritis in humans .…”