radiation synovectomy
TRANSCRIPT
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Radiation Synovectomy
Budour, Wasaif, Aqeela, Sara
EANM Procedure Guidelines for Radiosynovectomy
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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.
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Indications
Rheumatoid arthritis is the main indication.
Hemophilic arthopathy.
Synovial inflammation associated with infected joint prosthesis.
Activated arthrosis.
Polyarthrosis of fingers.
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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.
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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??
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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.
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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
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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).
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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.
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Radiosynovectomy of the elbow joint synovitis in rheumatoid arthritis treated with Lutetium - 177 labeled hydroxylapatite (Lu-177 HA) particulates
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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)
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The response rate
high and benefits to the patient if : increase joint movement
Reduce swelling
Reduce effusion
Pain reduced
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advantages
Minor investigation
Outpatient procedure
No rehabilitation needed
Multiple joint may be treated simultaneously
Possible retreatment
Good cost - effectiveness ratio
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Side effects
Early
Late
Increased synovitis temporary
Radionecrosis rare
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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.
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hank ou