Radiosynovectomy (radioisotope synovectomy) is a safe and effective method of topical treatment of non-infectious joint inflammation such as rheumatoid arthritis (RA) and psoriasis. The radiopharmaceutical administered directly to the joint destroys the inflamed synovium, reduces exudate, relieves pain and helps to restore joint mobility, and thus - improves the patient's quality of life.

Radiosynovectomy(radioisotope synovectomy) is a treatment method in the field of nuclear medicine procedures. It consists in the local treatment of non-infectious inflammations within the joints, with the growth of the inflamed synovial membrane. Treatment is carried out with the use of radiopharmaceuticals, i.e. drugs containing an appropriate radioisotope.

The radioisotopes used for treatment emit β (beta) radiation and are injected directly into the joint. The therapeutic effect of the radiopharmaceutical consists in gradual fibrosis of the inflamed synovial membrane of the joint, inhibition of exudates and elimination of inflammation in the joint cavity.

Thanks to this, inflammation does not develop, and the cartilage and bone elements in the joint are not subject to further destruction. The swelling and pain disappear, the mobility of the joint increases, and thus the patient's quality of life improves.

Contents:

  1. Radiosynovectomy (radioisotope synovectomy) - indications
  2. Radiosynovectomy (radioisotope synovectomy) - the course of the study
  3. Radiosynovectomy (radioisotope synovectomy) - effectiveness
  4. Radiosynovectomy (radioisotope synovectomy) - how to prepare?
  5. Radiosynovectomy (radioisotope synovectomy) - after surgery
  6. Radiosynovectomy (radioisotope synovectomy) - side effects
  7. Radiosynovectomy (radioisotope synovectomy) - contraindications

Radiosynovectomy (radioisotope synovectomy) - indications

- Due to the non-invasive nature and high therapeutic effectiveness of radiosynovectomy, patients with chronic inflammation of the joints with pathological synovial hyperplasia are qualified for treatment with this method - says Prof. Leszek Królicki, President of the Polish Society of Nuclear Medicine, national consultant in the field of medicinenuclear.

Radioactive yttrium therapy aims to destroy pathologically enlarged synovial membrane in the knee joint.

According to the recommendations of the European Society of Nuclear Medicine, isotope radiosynovectomy is indicated in patients whose symptoms, such as swelling, pain, or limitation of joint mobility, persist or recur despite attempts to treat with other methods.

- Treatments with the use of radiosynovectomy are used, among others, in the treatment of rheumatoid arthritis (RA), psoriatic arthritis, inflammation and chronic exudative degenerative changes - explains Prof. Leszek Królicki.

Radiosynovectomy (radioisotope synovectomy) - the course of the study

The radioisotope drug is injected precisely into the inflamed joint. Both the radiopharmaceutical and its dose depend on the size of the joint.

Often, apart from the radiopharmaceutical, the patient is also given a steroid drug, which helps to reduce inflammation and reduce pain.

After administration of the preparation, the needle is rinsed with physiological saline. From the moment of administering the radiopharmaceutical, the patient should limit the movements of the treated joint for about 48 hours.

- The stabilization of the joint after the radiosynovectomy procedure is very important because it ensures proper drug penetration into the synovium and prevents the possible withdrawal of the radiopharmaceutical into the puncture canal, which could lead to the development of dermatitis - says Prof. Leszek Królicki.

Radiosynovectomy (radioisotope synovectomy) - effectiveness

Together with the therapeutic radiopharmaceutical, a small dose of the radiopharmaceutical is administered, which allows for a scintigraphic examination. Thanks to this, it is assessed whether the administration of the drug was carried out properly.

- The effectiveness of radiosynovectomy treatment is assessed at least three months after the procedure. It is assessed whether the joint exudate has subsided, pain has reduced or subsided, or if joint mobility has improved or returned.

Radiosynovectomy is an effective treatment method, often allowing to completely heal non-infectious flooded joint conditions and avoid surgery - says prof. Leszek Królicki.

Radiosynovectomy is a minimally invasive procedure, unlike surgical procedures, it does not require rehabilitation after the procedure, it is performed on an outpatient basis, the patient returns home and normal life after the procedure.

Radiosynovectomy (radioisotope synovectomy) - how to prepare for the examination?

Three referrals from the Specialist Clinic are required:

  • referral to biphasic knee scintigraphy
  • a referral for a qualification advice
  • referral for isotope radiosynovectomy

The patient should have an ultrasound examination of the knee joints shortly before the procedure, confirming whether a Baker's cyst is present and assessing the possible presence of a valve mechanism.

Before the procedure, a biphasic knee scintigraphy is performed at the Department of Nuclear Medicine - a test that determines the patient's qualification for radiosynovectomy.

Important

Radiosynovectomy (radioisotope synovectomy) - after surgery

Due to the necessity to immobilize the joint - the patient must transport himself home and have two crutches with him.

Avoid excessive strain on the joint, including exercise and long walks, for a week after the radiosynovectomy surgery.

Ionizing radiation does not work outside the treated joint, therefore there is no need to isolate yourself from family members and other people. However - due to the fact that some radiopharmaceuticals are excreted from the body with urine or saliva for 2-3 days - it is necessary to strictly observe personal hygiene during this period. The marker is excreted in urine, so you should flush the toilet twice after each use.

The ailments usually disappear gradually a few weeks after the treatment.

Radiosynovectomy (radioisotope synovectomy) - side effects

Risk associated with any joint puncture procedure (local bleeding, infection). Theoretical risk of exposure to beta radiation:

  • local tissue necrosis at the injection site if the isotope has leaked out of the joint cavity (very rare)
  • reactive short-term inguinal lymphadenitis
  • theoretical long-term radiation risk (the dose received by a patient during a synovctomy is approximately 30 times less than in patients treated with radioiodine for hyperthyroidism)

Patients after radiosynovectomy must not become pregnant for at least 4 months.

Important

Radiosynovectomy (radioisotope synovectomy) - contraindications to the procedure

  • pregnancy and breastfeeding
  • multi-chamber Baker's cyst with valve mechanism
  • local inflammatory skin changes
  • extensive arthropathies with instability and destruction of bone tissue

Source:

1. Press materials of PolskiNuclear Medicine Societies

2. INFORMATION FOR PATIENTS ON ITREM-90 RADIOISOTOPIC SYNOTOMY, http://www.szpital-morski.pl/images/zaklady/zmn/badania/TERAPIA-Y-90.pdf

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Research