Radiosynoviorthesis

The radiation synovectomy (RSO, of radio radioactive isotope, and synoviorthesis , synovium obliteration [bloodless obliteration of the synovium by chemical or radioactive substances] of synovium joint mucosa, orthosis recovery in short RSO ), Anglo-American synovectomy radiation , is a nuclear medical methods for the treatment of chronic inflammatory joint diseases , e.g. B. rheumatoid arthritis or activated osteoarthritis .

Here are beta emitters injected into joints, such as ⁹⁰ Yttrium for large joints, especially the knee , ¹⁸⁶ rhenium for medium-sized joints such as the elbow or shoulder joint and ¹⁶⁹ erbium small joints, particularly finger joints . In Germany, the RSO has been practicable on an outpatient basis since 1993 (revised version of the radiation protection guidelines in medicine ). Only doctors specializing in nuclear medicine are authorized to bill the service for those with statutory health insurance.

The term radiosynoviorthesis comes from the Parisian rheumatologist Florian Delbarre as a modification of the previously common chemical synoviorthesis with cytostatics. The isotope gold-198 used at the beginning was replaced by yttrium-90 because of its high proportion of gamma rays and unfavorable pharmacodynamic properties.

nuclide	Half-life	Max Energy (Beta)	Max. Range	Joints	activity	Distribution scintigram
Yttrium -90	2.7 days	2.26 MeV	11 mm	knee	185 MBq	yes (bremsstrahlung)
Rhenium -186	3.7 days	0.98 MeV	3.7 mm	Shoulder, elbow, wrist, ankle	37-74 MBq	yes (gamma portion)
Erbium -169	9.5 days	0.34 MeV	1.0 mm	Fingers, metatarsal and toe joints	15-37 MBq	No

Contraindications are pregnancy and breastfeeding. In addition to the anamnesis and clinical examination, X-rays of the affected joints and a multiphase bone scintigraphy should be available, as well as an ultrasound of the knee joint. The injection itself is usually carried out under fluoroscopy . Sterile procedures are important to prevent the dreaded complication of joint infection; this risk is given in the literature as 1: 35,000. After an RSO there is apparently no increased risk of cancer development.

In the case of larger joints, the needle position can be secured by pre-injection of contrast medium . A corticoid solution or air is injected in order to keep the puncture channel free. After rhenium and yttrium injections, distribution scintigrams can be made to check the correct distribution of the nuclide in the joint space. The destructive effect of beta rays leads to a connective tissue transformation of the synovial membrane . This can take up to 3 months. In the literature, improvement rates for rheumatic joint pain of 40 to 100% of patients are given.

literature

• Büll u. a. (Ed.): Nuclear Medicine . Stuttgart 2001, ISBN 3-13-128123-5 .
• Gynter Mödder : The Radiosynoviorthesis. Truly, Meckenheim 1995, ISBN 3-930376-03-2 .

Web links

• Guideline for the Radiosynoviorthese of the German Society for Nuclear Medicine
• Radiosynoviorthesis - joint therapy with radioisotopes. (PDF) Leaflet of the Rheuma League

Individual evidence

1. ↑ F. Delbarre et al. a .: Synoviorthesis with radioisotopes. In: Presse Med , 76, 196, pp. 1045-1050. PMID 5648676 .
2. ↑ C. Infante-Rivard, GE Rivard, F. Derome, A. Cusson, R. Winikoff, R. Chartrand, JP Guay: A retrospective cohort study of cancer incidence among patients treated with radiosynoviorthesis. In: Haemophilia. Volume 18, Number 5, September 2012, pp. 805-809, doi: 10.1111 / j.1365-2516.2012.02802.x , PMID 22500891 .
3. ^ Gynter Mödder : The Radiosynoviorthesis. Truely, Meckenheim 1995, ISBN 3-930376-03-2 , pp. 34-38.

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