Radiosynoviorthesis of Knees by Means of ¹⁶⁶Ho-Holmium-Boro-Macroaggregates

Abstract

The aim of this study was to evaluate adverse and therapeutic effects of applicated holmium-boro-macroaggregates (HBMAs) in the radiosynoviorthesis (RSO) of knees in patients suffering from chronic synovitis. We started RSO of the knees by means of a new radiopharmaceutical (RF) HBMA in patients with gonarthrosis, rheumatoid arthritis, chronic synovitis, psoriatic arthritis, and gout arthropathy. Seventeen (17) intra-articular injections were performed in 15 patients who were receiving a mean activity of 972 MBq (range, 904-1057) of 166Ho-HBMA. Patient inclusion to the study followed a series of inclusion and exclusion criterions. The patients were hospitalized for 3 days. Side-effects were evaluated during their hospital stay and again after 6-8 weeks. Static scintigraphy of knee joints and measurements of blood radioactivity were performed. Therapeutic effects were evaluated after 6-8 weeks and at 6 months. In 2 hours and 2 days following the application, we proved, by means of knee and inguinal scintigraphy, only insignificant radiopharmaceutical leakage from the joint cavity to the inguinal lymph nodes in 4 patients. In the treated patients, no serious adverse effects occurred. Nine (9) patients were without complaints, 4 patients had slight knee exudation, and 2 patients had great exudation. Therapeutic effects were as follows: 2 patients were without pain, 9 were with lower pain, 3 were with the same pain, and 1 patient was with increased pain. Joint motion was improved in 7 patients, remained the same in 7 patients, and was impaired in 1 patient. Analgesics consumption was lower in 5 patients, the same in 9 patients, and greater in 1 patient. Knee exudation was absent in 2 patients, lower in 4 patients, the same in 6 patients, and greater in 3 patients. In 3 patients it was necessary to do surgical RSO. This RF can extend the range of clinically used radiopharmaceuticals for RSO and to supplement space between 90Y with high energy and 186Re with 169Er with lower beta energy. The energy of 166Ho is suitable for great and medium joints (i.e., knees, hips, shoulders, elbows, wrists, and ankles).

Radiosynovectomy using yttrium-90, phosphorus-32 or rhenium-188 radiocolloids versus corticoid instillation for rheumatoid arthritis of the knee

“…Several candidates have been proposed to replace commercially available radiocolloid formulations of yttrium-90, rhenium-186 and erbium-169. These formulations include phosphorus-32 colloid [9,10], rhenium-186 sulphide [11], samarium-153 conjugated to particulate hydroxyapatite [12,13], dysprosium-165 ferric hydroxide [14,15], holmium-166 boromacroaggregates [16,17], ytterbium-175 and lutetium-177 hydroxyapatite [18,19]. In this study, the therapeutic efficacy of yttrium-90 citrate was compared to that of phosphorus-32 and rhenium-188 colloids.…”

Radiosynoviorthesis (RSO): influencing factors and therapy monitoring

“…Various infl uencing factors on the success of RSO have been studied to defi ne its indications [2][3][4][5][6][7][8][9][10]. These include age, sex, joint size, underlying disease, type of radionuclide, additional injection of glucocorticoid, oligo-articular or polyarticular involvement, disease progression, radiological joint damage (Larsen scale), instability and/or axial deviation, body mass index, and psychological motivation for prosthesis implantation.…”

The various therapeutic applications of the medical isotope holmium-166: a narrative review

“…Six months after treatment, 73% of the patients experienced a lower sense of pain. In addition, 2 patients had no knee exudation anymore and a decrease of knee exudation was seen in 4 patients (Kraft et al 2007).…”