Radioisotope synovectomy with rhenium¹⁸⁶in haemophilic synovitis for elbows, ankles and shoulders

Abstract

We have performed 221 radioisotope synovectomy (RS) in more than 150 children and young adults with haemophilia, age ranging 3-30 years (mean 15) in Ege Hemophilia Center, Izmir, Turkey for last 7 years. We always preferred to use Yttrium 90 (Y(90)) for knees; however, since 2005, we started using rhenium 186 (Re(186)) for medium-sized joints with respect to safety. In this article, we have evaluated long-term experience ranging from 6 months to 3 years (mean 18 months) with Re(186) for elbows (n = 35), ankles (n = 26) and shoulders (n = 2) in total of 63 RS procedures for 49 patients. Their age range was 3-30 years and mean age was 15.5. Two mCi of Re(186) intra-articularly injected for treating target joints and chronical synovitis. After RS, joint bleedings were decreased for all patients. The best results were obtained for all joints in patients with grade-II synovitis as like earlier experience with Y(90). Excellent rates (no bleeding) were observed in grade-II synovitis in 81% and 46% for elbows vs. 86% and 57% for ankles after 6 months and after 1 year follow-up of patients, respectively. In grade-III synovitis, excellent rates were 53% and 25% for elbows and 44% and 29% for ankles, respectively. In five joints for five patients, repeated injections were needed for better outcome. No adverse events such as radioisotope leakage, local inflamatory reactions or malignancy development were observed during and after RS. For medium-sized joints, RS with Re(186) seems to be either effective or safe treatment method. Our results confirm those previously published by others on the value of Re(186) synoviorthesis in medium-sized joints in haemophilia patients. After this experience, we changed our protocol and we use Re(186) for all medium-sized joints for treating chronical synovitis.

The Efficacy of Magnetic Resonance Imaging and X-Ray in the Evaluation of Response to Radiosynovectomy in Patients with Hemophilic Arthropathy

“…This success rate is not as high as the previous studies which reported improvement from 75% to 90% after radiosynovectomy(2,3,4,5,6,7,8,9,10,11,33,34). This relatively low success rate might be explained with the high ratio of advanced disease in our patient group, as 10 out of 11 joints showed cartilage loss on pre-procedure MRI.…”

“…To achieve this goal, this hypervascular and hypertrophic synovium should be destroyed by either operative synovectomy or radiosynovectomy (RS). RS has been used effectively for this purpose since 1952 and satisfactory results were obtained (1,2,3,4,5,6,7,8,9,10,11,33,34,35). The assessment of the therapy response of RS in patients with hemophilic arthropathy has been done by measuring the changes in mean number of hemorrhages, pain in the joints, range of motion (ROM) or by imaging studies like blood-pool imaging, plain X-ray and MRI.…”

Comprehensive Care and Delivery of Care in Hemophilia: The Developing World

“…This may be combined with intensive physiotherapy or synoviorthesis [22,23]. The advantage of this approach is that safe factor concentrates can be immediately made available to people with hemophilia.…”

Micronucleus evaluation for determining the chromosomal breakages after radionuclide synovectomy in patients with hemophilia

“…Radioisotope synovectomy decision was taken after the evaluation in Hemophilia Council of Ege University Hospital. Radioisotope synovectomy was performed as an outpatient procedure using routine protocol described and published earlier [5,6]. Two different colloidal radioisotopic agents ( 90 Y and 186 Re) were selected for application.…”

“…Yttrium-90 ( 90 Y) and rhenium-186 ( 186 Re) are the approved radionuclide agents in Europe. Radioisotopic materials have been successfully used for more than 10 years in target joints for hemophilic children [5,6].…”