Radiation Synovectomy

Budour, Wasaif, Aqeela, Sara

EANM Procedure Guidelines for Radiosynovectomy

Beta-emitting radiopharmaceuticals have been used for a number of years as local treatment of chronic

inflammatory joint disease, and to alleviate the pain and swelling of rheumatoid arthritis.

Indications

Rheumatoid arthritis is the main indication.

Hemophilic arthopathy.

Synovial inflammation associated with infected joint prosthesis.

Activated arthrosis.

Polyarthrosis of fingers.

What is Rheumatoid arthritis ?

Is a systemic disease.

The systemic treatment should be performed for at least 6 months.

If there is no adequate improvement show, then radiation synovectomy must be done.

Prior to radiation synovectomy

Diagnosis with: Medical history, clinically, radiographic. US : evaluate space, thickness and structure of joint. 3 phase bone scintigraphy: useful in patients with

synovium inflammation, especially in polyartheritis . WHAT we use for a 3phase bone scan??

Radiopharmaceuticals 169Er citrate 186Re sulphide

90Y silicate/citrate

99mTc - sulfur colloid

32P - chromic phosphate

9.4 days 3.7 days 2.7 days 6 hours 14.26 days T1/2

0.34 MeV 1.07 MeV beta

137 KeV gamma 2.27MeV 140 keV 694.9 keV Energy

β- , Beta emitter β- , Beta emitter γ , gamma ray

β- , Beta emitter γ , gamma ray β- , Beta emitter Type of emission

Injection through needle placement into a joint (synovial) cavity. Method of

Administration

The most commonly used agent is 32P chromic phosphate, but as of 2000 no therapeutic agent has been approved by the United States Food and Drug

Administration, and this procedure is not widely available in the United States.

Adult Dose Range

>40 kg 25–40 kg 10–25 kg

1.000 mCi 0.750 mCi 0.500 mCi knee

0. 500 mCi 0.375 mCi 0.250 mCi elbow/ankle

32P - chromic phosphate

99mTc - sulfur colloid Knee or elbow joint: 1 mCi

90Y colloids

– suitable for the knee joint only (5–6 mCi).

186Re sulphur colloid

– suitable for hip, shoulder, elbow, wrist, ankle and subtalar joints.

– The total activity at single session should not exceed (10 mCi).

169Er citrate colloid

– suitable for metacarpophalangeal, metatarsophalangeal and digital interphalangeal joints.

– The total activity at single session (20mCi).

Procedure

Consists of a direct injection of the radiopharmaceutical into the joint capsule. where it is in contact with the inflamed, hyperplastic synovium.

As the radionuclide decays, the beta particles deliver a therapeutic dose of radiation to the synovium.

Radiosynovectomy of the elbow joint synovitis in rheumatoid arthritis treated with Lutetium - 177 labeled hydroxylapatite (Lu-177 HA) particulates

contraindication

Pregnancy, lactation (absolute) .

Local skin infection (absolute) .

Children, if the benefit of treatment is likely to outweigh the potential hazards (relative)

Evidence of significant cartilage loss within the joint (relative)

The response rate

high and benefits to the patient if : increase joint movement

Reduce swelling

Reduce effusion

Pain reduced

advantages

Minor investigation

Outpatient procedure

No rehabilitation needed

Multiple joint may be treated simultaneously

Possible retreatment

Good cost - effectiveness ratio

Side effects

Early

Late

Increased synovitis temporary

Radionecrosis rare

conclusion

This therapy should be performed at an early stage of the disease, where cartilage damage is minimal.

The effective dose to the whole body is very low.

hank ou