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Intra-articular radiation synovectomy.

C B Sledge, R W Atcher, S Shortkroff

    Clinical Orthopaedics and Related Research
    |January 1, 1984
    PubMed
    Summary
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    Radiation synovectomy using dysprosium-165 effectively treated rheumatoid arthritis (RA) knees, with 80% showing improvement. This minimally invasive treatment offers comparable longevity to surgery, especially in early disease stages.

    Area of Science:

    • Orthopedics
    • Nuclear Medicine
    • Rheumatology

    Background:

    • Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting joints.
    • Severe RA often leads to significant joint pain, effusion, and inflammation.
    • Current treatments may have limitations or side effects.

    Purpose of the Study:

    • To evaluate the efficacy and safety of intra-articular radionuclide therapy for rheumatoid arthritis.
    • To assess the leakage rates and radiation doses associated with the procedure.
    • To correlate treatment outcomes with disease stage and clinical/scintigraphic findings.

    Main Methods:

    • Fifty-three knees in 44 patients with severe RA received intra-articular dysprosium-165 (165Dy) coupled with ferric hydroxide macroaggregate.
    • Leakage rates, total body dose, and liver dose were measured.

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  • Patients were assessed for improvement in pain, effusion, and inflammation.
  • Radiographic staging and technetium-99m (99mTc)-pertechnetate flow scintigraphy were used for correlation.

    • Main Results:

    • Mean leakage rate of 165Dy was 0.3%, with minimal radiation exposure (0.4 rad total body, 2.5 rad liver).
    • Eighty percent of treated knees showed improvement maintained up to one year.
    • Early radiographic stages (I and II) correlated with better one-year outcomes.
    • Clinical improvement correlated well with improved 99mTc-pertechnetate flow scintigraphy.

    Conclusions:

    • Intra-articular radionuclide therapy (radiation synovectomy) is an effective method for managing RA inflammation, effusion, and pain.
    • The procedure demonstrates low leakage and acceptable radiation doses.
    • Radiation synovectomy is most beneficial in early stages of RA, similar to surgical synovectomy.
    • Long-term efficacy appears comparable to surgical interventions, though duration is variable.