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

Abstract

Radiation Synovectomy (Radiosynoviorthesis = RSO) is a proven important instrument for local treatment of chronic inflammatory joint diseases in the context of medical and orthopaedic efforts. By local application of radioactive agents an attempt is made to influence the painful destructive synovial process favourably as an alternative to surgical synovectomy. Basically, RSO is indicated for the local treatment of almost all kinds of chronic synovitis. The main indications for RSO are Rheumatoid Arthritis, Seronegative Spondarthropathy, hemarthrosis in haemophiliac, recurrent joint effusions (i.e. after arthroscopy), Pigmented villonodular synovi- tis, activated arthrosis (Osteoarthritis), after joint pros- thesis (polyethylene disease) and undifferentiated arthritis. The most common radiopharmaceuticals used for RSO are [90Y] yttrium-citrate colloid for knee joints, [186Re] rhenium sulphide colloid for middle-sized joints, and [169Er] erbium citrate colloid for small joints. Diagnostic studies prior to RSO include ultrasound and multiphase scintigraphy (with soft tissue scintigraphy as the best tool for detecting synovitis). Performance of RSO requires a good puncture technique as essential. Apart from the knee, all joints have to be punctured for RSO by fluoroscopy and often by arthrography. Side effects are very rare. Response rates range from about 60 to [80% for all joints, often with greater success for rheumatoid diseases than for osteoarthritis, also depend- ing on stage of joint damage. Many studies relating to RSO during the last 40 years do not fulfil the criteria of modern evidence-based medicine, but recently a number of well-designed trials have been carried out evaluating the efficacy of RSO. Close cooperation with orthopaedists and rheumatologists is necessary to con- sider RSO in each patient to ensure optimal medical care.