Role of radiosynovectomy in the treatment of rheumatoid arthritis and hemophilic arthropathies

Abstract

Radiosynovectomy is a novel method of treatment for several acute and chronic inflammatory joint disorders. A small amount of a beta-emitting radionuclide is injected into the affected joint delivering a radiation dose of 70 to 100 Gy to the synovia. The proliferative tissue is destroyed, secretion of fluid and accumulation of inflammation causing cellular compounds stops and the joint surfaces become fibrosed, providing long term symptom relief. The radionuclides are injected in colloidal form so that they remain in the synovium and are not transported by lymphatic vessels causing radiation exposure to other organs. Complete reduction of knee joint swelling has been seen in above 40% and pain relief in 88% of patients. Wrist, elbow, shoulder, ankle and hip joints showed significant improvement in 50-60% and restoration of normal function and long term pain relief has been achieved in about 70% of small finger joints. In hemophilic arthropathies complete cessation of bleeding in about 60% and improved mobility in 75% of patients has been reported.

Clinical outcome of radiosynovectomy in haemophilia a patients with chronic knee synovitis

“…All showed clinical improvement in both TLS (subjective sore) and MKSS (objective sore) and circumference of knee joint at the suprapatellar region measurements. Among the various studies conducted, the clinical improvement was shown to be in the range between 60% to 80% across various joints in nine studies published between 1982-1991 by Deutsch et al [12] .The follow up time in different studies ranged between one month to five years. The difference in the rates of clinical improvement across studies can be attributed to various factors.…”

Short-term clinico-radiological outcome of chronic knee synovitis among haemophilia A patients post phosphorus-32 radiosynoviorthesis

“…As there are no reported studies from India which looked into P-32 isotope use in radiosynoviorthesis, we compared our study results with those studies done outside India. Among the various studies conducted, the clinical improvement was shown to be in the range between 60% and 80% across various joints in nine studies published between 1982 and 1991 by Das 12 . The follow-up time in different studies ranged between 1 month and 5 years.…”

Hemophilic arthropathy of the elbow: prophylaxis, imaging, and the role of invasive management

“…Rhenium 186 and phosphorus 32 are often chosen for use in the elbow because they wield less energy than yttrium 90, which is often used in the knee. 11 Phosphorus 32 has specifically been noted for its shallow depth of penetration and is thus often selected for a focused administration and avoiding important structures such as the physis. 39 The specific dose will vary on the basis of the agent used and the thickness of the targeted synovium.…”

“…It also stops mononuclear infiltration and causes fibrosis of the hypertrophied, hypervascular synovitic membrane. 11 Various agents are available for the procedure, and specific selections are based on the size of the affected joint and the desired depth of penetration. Rhenium 186 and phosphorus 32 are often chosen for use in the elbow because they wield less energy than yttrium 90, which is often used in the knee.…”