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Introduction: Radiosynovectomy is an established treatment for chronic synovitis in patients with haemophilia. Although its role in rheumatological diseases has diminished, it remains an accepted therapy for haemophilic synovitis. Aim: The aim of this scoping review was to map and summarise the evidence surrounding radiosynovectomy in haemophilic knees, identify gaps in the literature and inform future research. Results: Forty‐three manuscripts and abstracts were identified for this review. Evidence was limited to observational studies and Yttrium‐90 was the most studied licensed radioisotope. Radiosynovectomy was associated with a reduction in bleeding frequency and pain, improvements in range of motion and a reduction in the use of factor replacement. Conclusion: The literature reviewed lacks studies of sufficient methodological quality to permit systematic review and meta‐analysis. Systematic review using risk of bias assessment for observational studies should be undertaken to better evaluate the efficacy and safety of radiosynovectomy. A causal relationship between RSV and key clinical outcomes remains undetermined. [ABSTRACT FROM AUTHOR]

Local injection therapy (LIT) is an important component of the complex treatment of musculoskeletal disorders (MSD), which is widely used in real clinical practice. Glucocorticoids, hyaluronic acid drugs (HA), autologous cell drugs, botulinum toxin type A, radioactive isotopes, etc. are used for LIT. LIT makes it possible to achieve a pronounced symptomatic effect, while in some cases, for example, repeated HA treatments in patients with osteoarthritis, the possibility of slowing the progression of the disease and reducing the need for surgical treatment is discussed.The performance of LIT requires special skills and abilities of the physician, careful compliance with the rules of asepsis and antisepsis, and instrumental visualization. LIT can be associated with serious complications and therefore must be performed according to strict indications.The Expert Council was devoted to defining the basic principles of LIT. The indications for the use of certain types of this therapies, the evidence base for its efficacy and safety, the order of application of different drugs, and the need to combine LIT with other drug and non-drug treatments of MSD were reviewed.

Introduction Radiosynovectomy (RSV) is a minimally invasive method of treating and controlling joint inflammation refractory to conventional pharmacotherapy. It consist in intraarticular injection of radioactive colloids which irradiate the inflamed synovial membrane to cause its subsequent involution. Despite the fact that the hip joint involvement is quite common in systemic inflammatory arthropathies, hip joint RSVs are rarely performed. The aim of this paper is to assess safety and efficacy of hip joint radioisotope treatment. Material and methods We retrospectively analyzed the effects of 21 hip joints RSVs performed in 14 patients (10 female, 4 male; aged 8 to 79; mean age 48 years). Before the RSV, all the patients underwent clinical and ultrasound examination. The RSVs were performed using rhenium-186 sulphide under ultrasound guidance. Each patient underwent post-therapeutic scintigraphy to assess intraarticular distribution of the radiopharmaceutical. The effects of the treatment were assessed clinically and ultrasonographically during at least 2 follow-up visits 3 and 6 months after the RSV. Results In 9 cases, we observed complete resolution of symptoms 3 and 6 months after the RSV. Four patients had only a partial response and required repeated treatment, and all responded well to second RSV. In four patients the treatment had no significant effect, and no repeated treatment attempt was made. All the responders suffered from inflammatory arthropathies; the non-responders had osteoarthritis, with no history of systemic diseases. In all the patients, no significant adverse effects were observed, in particular no radiation burns or infections. All post-therapeutic scintigrams showed proper, intraarticular distribution of the radiopharmaceutical. Conclusions Radiosynovectomy of the hip joint in systemic joint diseases, especially performed using ultrasound-guidance, is a safe and effective treatment modality.

A radiosynovectomy (RS) should be indicated when recurrent articular bleeds related to chronic hemophilia synovitis (CHS) exist, established by clinical examination, and confirmed by imaging techniques that cannot be constrained with hematological prophylaxis. RS can be performed at any point in life, mainly in adolescents (>13–14 years) and adults. Intraarticular injection (IAI) of a radioactive material in children might be arduous since we need child collaboration which might include general anesthesia. RS is our initial option for management of CHS. For the knee joint we prescribe Yttrium-90, while for the elbow and ankle we prescribe Rhenium-186 (1 to 3 IAIs every 6 months). The procedure is greatly cost efficient when compared to surgical synovectomy. Chemical synovectomy with rifampicin has been reported to be efficacious, inexpensive, simple, and especially practical in developing countries where radioactive materials are not easily available. Rifampicin seems to be more efficacious when it is utilized in small joints (elbows and ankles), than when utilized in bigger ones (knees). When RS and/or chemical synovectomy fail, arthroscopic synovectomy (or open synovectomy in some cases) should be indicated. For us, surgery must be performed after the failure of 3 RSs with 6-month interims. RS is an effective and minimally invasive intervention for treatment of repeated articular bleeds due to CHS. Although it has been published that the risk of cancer does not increase, and that the amount of radioactive material used in RS is insignificant, the issue of chromosomal and/or deoxyribonucleic acid (DNA) changes remains a concern and continued surveillance is critical. As child and adulthood prophylaxis becomes more global, RS might become obsolete in the long-term. [ABSTRACT FROM AUTHOR]

Introduction. Haemophilia is a genetic haemorrhagic disorder that characterises with extensive and prolonged bleeding. In severe stages of the disease, joint haemorrhages may occur and eventually result in joint degeneration and haemophilic arthropathy. Aim of the study. Summary and evaluation of diagnostic and treatment methods of skeletal problems in patients with haemophilia. Review of patients’ knowledge about the disease. Material and methods. Review of the newest medical journal literature published on PubMed database. Results. Ultrasonography is a non-invasive imaging method used to diagnose acute hemarthrosis and early stages of joint damage. Magnetic resonance is a standard tool in evaluation and scoring of haemophilic arthropathy. X-rays and computed tomography can also be additionally used, but are ineffective in imaging soft tissue and cartilage. Substitution of clotting factors is a standard treatment in haemophilia which reduces the frequency of bleeding. Arthrocentesis, synovectomy for example radiosynovectomy are effective in case of joint disorders. Intra-joint injections of hyaluronic acid are also effective. In advanced stages of haemophilic arthropathy joint replacement is recommended. Majority of patients with haemophilia claim that they are sufficiently educated about their disease. Conclusion. Haemophilic arthropathy is a severe joint destructing condition that causes limited mobility, chronic pain and a reduced quality of life. Its early diagnosis and proper treatment is necessary to avoid total destruction of the affected joint. Multidisciplinary care of the patient is an approach of great importance. Education of patients about their disease and up-to-date treatment methods is necessary.

The Holmium-166 radionuclide is one of the most effective radionuclides used to treat bone marrow cancer and rheumatoid arthritis. Among the recommended radionuclides used in radiation synovectomy, 166Ho has got much attention due to suitable decay properties such as short half-life, its high beta energy, gamma-ray emission with suitable energy for nuclear imaging, and the possibility of large-scale production in medium flux reactor. One method to deliver 166Ho to the target tissue is via the 166Dy/166Ho-Chitosan in vivo generator. Compared with other similar radiopharmaceuticals, using the in vivo generator to deliver 166Ho, causes minimal non-target tissue exposure and increased absorbed dose in the target tissue. In this work, the absorbed dose of 166Dy/166Ho-Chitosan radio-complex for radio-synovectomy purposes was calculated by GEANT4 and MCNPX. The obtained results were compared with each other. In addition, the dosimetry results of the mentioned radio-complex have been compared with the common radio complexes used for radio-synovectomy.

191Os is a parent radionuclide with a 15.4 d half-life. It decays by beta emission to 191mIr, which is a radionuclidewith a 4.96s half-life. It decays by the isomeric transition to stable 191Ir, emitting a 129-keV gamma photon. In thisstudy, 191Os–phytate was developed into an in-vivo radionuclide generator for simultaneous radiosynovectomy and imaging. 191Os-hexachloroosmate was used to prepare 191Os–phytate (100 μCi/50 μl) using reaction condition optimization followed by an intraarticular injection to rat knee joints. Also, its distribution and stability were assessed. The imaging of 191Os cation and 191Os–phytate was performed by SPCET. The 191Os–phytate complex was obtained at pH=5.5 with normal saline at room temperature. Radio-TLC showed an overall radiochemical yield of 95-98%. The complex was injected into the rats’ knees, and the whole injected dose remained at the injection site even three days after injection. Due to the stability and retention of the complex in joints approved by biodistribution and imaging studies, the complex is a potential in vivo generator for cavital radiosynovectomy of minor joints.

Introduction Pigmented villonodular synovitis (PVNS) or giant cell tumour of the tendon sheath (GCTT) is a rare disorder involving the proliferation of the synovium in any joint; however, the knee, hip, and ankle joints are most commonly targeted. The aim of this study is to follow the short-term outcomes of the treatment of patients with PVNS of the knee managed by intra-articular injection of yttrium-90 or radiosynovectomy (RS) alone and a combination of RS and arthroscopic/open debulking synovectomy. Methods A cohort of eight knees from six patients was included in this study, including three knees treated with combined arthroscopic synovectomy and RS, and five knees treated with RS alone. Patients were asked to complete the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire before attending their three-month follow-up appointment. Their answers were collated and scores were calculated using the designated specific equation. Results Our results demonstrate that although patients in the combined arthroscopic synovectomy and RS arm possess on average higher pain scores and symptoms than those who underwent RS alone, the combined therapy had higher scores in activities of daily living (ADLs), sports and recreation (Sport-Rec), quality of life (QoL), and overall KOOS scores. Conclusion Neoadjuvant arthroscopic mechanical debridement is a safe and quick procedure with minimal side effects, with improved overall KOOS scores., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Al-Janabi et al.)

Objectives: Radiosynovectomy can be an effective treatment for difficult-to-treat monoarthritis resistant to systemic and local standard therapy. The objective of our study was to determine predictors of good response to radiosynovectomy in routine care and give an overview of this underused technique. Methods: Retrospective observational study of all the patients who underwent radiosynovectomy during a 6-year inclusion period. All the procedures were ultrasound guided and the radiopharmaceutical used was chosen according to joint size. The patient was considered to have an effective response to radiosynovectomy if the attending physician reported a positive outcome and there was no need to increase local and or systemic treatment due to arthritis in the affected joint during the next 12 months following the procedure. Results: We included 67 patients who underwent radiosynovectomy in the knee (73.1%), wrist (16.4%), and elbow (10.5%). Overall, 44 (65.7%) procedures were considered effective. In the multivariate analysis, infiltration of wrists (odds ratio = 0.192; confidence interval = 0.046–0.79) and pigmented villonodular synovitis (odds ratio = 0.13; confidence interval = 0.021–0.82) were independently associated with a noneffective response. No patients experienced complications associated with radiosynovectomy during follow-up. Conclusion: Infiltrations of wrists with joint damage seem less likely to have a response to radiosynovectomy. In pigmented villonodular synovitis, radiosynovectomy as an adjuvant therapy for relapse might not be effective when performed more than 6 months after surgery. Overall, radiosynovectomy is an effective and safe treatment for persistent monoarthritis. [ABSTRACT FROM AUTHOR]

Objective: Radiosynovectomy (RSO) describes the internal low-dose radiotherapy of the synovia via intra-articular administration of small radioactive particles. Since the introduction of biologics, the main aetiology of arthritic joints for RSO changed to mostly osteoarthritis with concordant change in typically affected joints. Thus, the effect of RSO in thumb basal joint arthritis (BJTh) with focus on osteoarthritis needs to be explored. Design: From 2017 to 2020, 219 BJTh were treated in 125 patients, 17 patients with rheumatoid arthritis (RA) and 108 patients with osteoarthritis (OA). The therapeutic effect was assessed using a four-step subjective scoring. Results: 20% of the treated joints were symptom free, 48% had a very good response, 16% slight and 16% no response. RSO was performed in 71 patients singularly and in 54 patients repetitively. The mean response duration was 6.8 months with a maximum of 48 months. 35% of patients had post-therapeutic pain relief followed by relapse after 3 months. Response duration showed no significant difference the between first and repetitive therapy, primary responder and primary non-responder and RA and OA. Conclusion: In thumb basal joint arthritis, RSO leads to response rates from 66 to 79%, mean response duration from 6 to 12 months and individual response duration 48 months. The present results are in line with previously published response rates in smaller joints. In respect to 35% of patients with relapse within 3 months post-therapy, we recommend a primary follow-up after 3–4 months. [ABSTRACT FROM AUTHOR]

Pigmented villo-nodular synovitis (PVNS), also known as giant cell tumor of the tendon sheath or benign synovial histiocytoma, is a benign yet locally aggressive tumor of the synovium that affects both the large joints and the tendon sheaths. The most common site for the tumor includes knees, hip, ankle, and wrist joints; shoulder joint being a very unusual site for the occurrence of this tumor. We present here an unusual case of diffuse PVNS of shoulder joint with eroded humerus head treated with surgical synovectomy and adjuvant radiosynovectomy to prevent recurrence. This case report highlights the natural history of this rare disease due to late presentation, difficulty in the diagnosis, and management of recurrence.

Abstract Background & aim: Rheumatoid arthritis is one of the most widespread and disabling diseases in the society that causes chronic inflammation of the synovial layer and joint destruction. Numerous pharmacological and non-pharmacological therapies are suggested for the treatment of this disease, including radiocinectomy as an effective and safe treatment with beta-particle radiolucent in patients who do not respond to or receive drug therapy. The aim of this study was to determine the histologic evaluation of radionuclide yttrium-90- hydroxyapatite in rheumatoid arthritis induced by rheumatoid arthritis in the rat knee joint. Methods: In the present experimental study, 40 Wistar rats (3 months old) were used by intraperitoneal injection of Enrofloxacin (20mg / kg) for the development of an animal model of rheumatoid arthritis. Subsequently, a dose of 50 microliters of yttrium-90-hydroxyapatite with 100-microcurie activities was injected into the left knee joint of the studied animals.Then, the rate of leakage of yttrium-90 radiotracer after 24 hours and its therapeutic effects were evaluated by histologic findings through specific staining, 2 weeks and 2 months after injection. The collected data were analyzed using Shapiro–Wilk method. Results: Statistically significant changes in parameters such as articular cartilage thickness, chondrocyte count, proteoglycan level, calcium deposition, and knee arthroplasty rate two weeks after 90Y-HA injection showed cellular damage due to particle irradiation. An increase in the thickness of articular cartilage and the number of chondroblasts two months after injection may indicate therapeutic effects of yttrium-90 radiocolloids on the knee joint of rats with rheumatoid arthritis. Conclusion: It seems that radiosynovectomy of yttrium-90-hydroxyapatite may be one of the effective therapeutic modalities in reducing inflammatory factors and improving rheumatoid arthritis induced in rats.

Introduction: Radiosynovectomy (RS) with 90Y-hydroxyapatite (90Y-HyA) aims to control knee hemarthrosis in hemophiliac patients to prevent secondary arthropathy. However, knee RS using 153Sm-hydroxyapatite (153Sm-HyA) is considered less suitable due to the lower average soft tissue range and energy of 153Sm for large joints, such as the knees. Purpose: The objective of this investigation was to assess the efficacy and safety of knee RS with 153Sm-HyA, compared to 90Y-HyA. Methods: Forty patients were prospectively assigned to undergo knee RS with 153Sm-HyA (n = 19) or with 90Y-HyA (n = 21). The frequency of hemarthrosis episodes before and after treatment were compared. Results: After six months of knee RS, 153Sm-HyA and 90Y-HyA promoted a similar reduction of hemarthrosis episodes (50% and 66.7%, respectively). However, after 12 months of knee RS, the reduction of hemarthrosis episodes was significantly (p = 0.037) higher using 153Sm-HyA (87.5%) compared to 90Y-HyA (50.0%). This discrepancy was more pronounced (p = 0.002) for 153Sm-HyA compared to 90Y-HyA in adults/adolescents. Conclusion: Knee radiosynovectomy with 153Sm-HyA is safe, reduces hemarthrosis episodes after 12 months of treatments, especially in adults/adolescents and even with grades III/IV arthropathy, similar to 90Y-HyA. 90Y-HyA seems to promote better hemarthrosis control in small children. [ABSTRACT FROM AUTHOR]

Introduction: People with haemophilia (PwH) with inhibitors have an increased risk of bleeding and early development of progressive arthropathy. Radiosynovectomy (RS) has been effective in dramatically reducing the frequency of haemarthroses. In the present study, the mid‐ and long‐term results of the efficacy of RS in PwHs with inhibitors and prognostic factors that influence success and failure of RS were presented. Material and Method: Radiosynovectomy was performed in 51 joints of 22 PwHs with inhibitors diagnosed with chronic haemophilic synovitis between January 2000 and December 2018. Two patients were lost to follow‐up and four joints were excluded. Number of bleeding episodes within the pre‐ and post‐treatment 6 months were documented. Treatment failure was defined as need for repeat RS injection. Results: Results of 47 RS were analysed. The mean bleeding frequency of the joints was 11.2 ± 6.2 (median 9) within the last 6 months in the pre‐treatment evaluation. After the treatment, the mean bleeding frequency of the joints decreased to 1.2 ± 2.8 (median 0) for first 6 months (P <.0001). The cumulative survival rate at 12 months was 87% and 78% at 36 months. The receiver operating characteristic (ROC) curve analysis revealed that cut‐off points of 12 bleeding episodes within the last 6 months (sensitivity, 71.4; specificity, 81.8 P =.0022) and an inhibitor titre of 63.4 BU (sensitivity, 57.1; specificity, 75.8; P =.31) were threshold levels for a predisposition for failure. Conclusion: Radiosynovectomy is an effective and safe intervention in PwHs with inhibitors. Bleeding frequency is a prognostic marker for the success of RS treatment. Patients who have more than 12 bleeding episodes within the last 6 months before the RS treatment have a higher rate of failure. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the treatment results of 90Y radiation synovectomy for chronic exudative synovitis of knee joints.Methods: The retrospective data consist of 394 consecutive knee radiation synovectomies performed using 6 mCi (222 MBq) of 90Y. The assessment included 3-point custom pain and joint mobility scale, evaluation of joint's circumference, binary joint's temperature evaluation, patellar ballottement test, indications for puncture and its volume in applicable cases. 21 cases had to be forfeited due to missing data regarding follow-up.Results: The final analysis of 373 treatment procedures performed in 253 patients yielded following results-at 6 months after treatment, 80.9% of the patients reported at least partial pain relief (including 33.3% with complete pain relief), which increased to 86.7% at one year. The pain intensity decreased over time, however, the outcomes were worse in older patients. The probability of pain recurrence was 15% at 6 months, and 28% at one year. It was highest in post-traumatic synovitis, and lowest in pigmented villonodular synovitis. The circumference of the treated knee joints decreased over the course of follow-up, however, the decrease was significantly lower in older patients. The fraction of patients with full knee joint mobility increased from 34.6 to 40.6% at 6 months and 49.2% at one year. The percentage of patients that required articular puncture decreased from 62.8% at baseline to about 35.6% at 6 months, and 32.8% at one year. Positive patellar ballottement was found in 68.5% before treatment and remained at about 40-50% during the course of follow-up. The increased temperature of the joint was reported in 51.2% at baseline and decreased to 33% at 6 months and 28.3% at one year.Conclusions: (1) Radiation synovectomy is a safe and effective method of treatment in patients with exudative synovitis, however, the pain recurrence rate is significantly higher in post-traumatic exudative synovitis compared to pigmented villonodular, undifferentiated, and rheumatoid arthritis. (2) Our results suggest that older patients have worse treatment results with radiation synovectomy compared to younger patients. [ABSTRACT FROM AUTHOR]

The aim of the present study was to introduction of hydroxyapatite/chitosan nanocomposite as a new radiosynovectomy agent with excellent properties. In this work, the nanocomposite was prepared through a reliable method and characterized using different techniques to elucidate its chemical structure and physiochemical properties. The prepared nanocomposite was successfully radiolabeled with 153Sm under optimal conditions and with high radiolabelling yield (99 %). The radiochemical purity of the prepared radiopharmaceutical was found to be >99 % as determined by ITLC technique. In vitro stability studies in saline solution and in human serum showed that the radiolabeled nanocomposite retained its stability for at least 6 days. The biodistribution and imaging studies in wild-type rats revealed high retention of the agent into the synovial joints of the knee even at 96 h post-injection, thereby indicating excellent in vivo stability of 153Sm labeled hydroxyapatite-chitosan nanocomposite. Therefore, the prepared radiopharmaceutical would be a potential therapeutic agent for use in radiosynovectomy procedure. [ABSTRACT FROM AUTHOR]

One of the key features of good practice in medicine is the doctor‐patient communication. Radiation protection standards for radiosynovectomy (RS) is limited. Yttrium‐90 is a beta‐emitting radioisotope used in RS to treat joint pain from haemophilic arthritis. ICRP 94 states that if a patient is treated with up to 200 MBq, there is no need for further precautions when it comes to public exposure, however, activities can go up to 370 MBq in RS for the knee. This study analysed 119 family members' safety (16.7% pregnant women). The ambient dose equivalent rate was measured within four distances. A survey was carried analysing risk groups and time spent next to patients. Results showed that family members should be advised to remain at 1.0 m from the patient to decrease accumulated dose by 97.6%. The dose per activity factors estimated in this study is also a useful tool during the risk assessment and doctor/patient communication. Pamphlets were distributed with radiation protection recommendations. Ambient dose equivalent was low enough to show that RS is a safe procedure for family members, which is essential to promote adherence to RS in countries where it is needed but not performed due to lack of information on radiation safety. [ABSTRACT FROM AUTHOR]

Radiosynovectomy (RS) is a simple, effective and safe procedure for the control of haemophilic synovitis that causes repetitive haemarthrosis. It must be done after confirming clinically (hard and painless mass on palpation) and by ultrasonography the existence of synovitis in a joint with recurrent haemarthrosis. RS should be the first invasive option (instead of arthroscopic synovectomy) for treatment of chronic synovitis. The technique is highly cost effective in comparison to arthroscopic synovectomy. The indication for RS is the presence of repeated haemarthroses associated with synovitis (confirmed clinically and by imaging techniques) that cannot be controlled by means of haematological treatment. No increase in the risk of cancer has been published and the dose of radiation utilized in RS is minimal. In haemophilic patients with recurrent haemarthrosis, RS should be performed under factor coverage as soon as possible, once the existence of synovitis has been confirmed by ultrasonography. RS should really be considered as a useful adjunctive procedure to the primary intervention, which is intensive replacement therapy. [ABSTRACT FROM AUTHOR]

Radionuclide synovectomy is a minimally invasive method of treating persistent joint inflammation. It involves intra-articular injection of radioactive colloids which induce necrosis and fibrosis of hypertrophic synovial membrane. The most common indication for radiosynovectomy is rheumatoid arthritis, although patients with seronegative spondyloarthropathies, unclassified arthritis, haemophilic arthropathy and other less common arthropathies can also benefit from this method. Radiosynovectomy is safe, well tolerated and efficacious. About 70–80% of patients respond well to the therapy. However, the therapeutic effects are considerably worse in patients with co-existent osteoarthritis and advanced joint degeneration. Despite its advantages, radionuclide synovectomy is not performed as often as it could be, so greater knowledge and understanding of this method are needed. The authors present the most important facts about radiosynovectomy that may help rheumatologists in their daily clinical practice.

Objectives : Hypertrophic and exudative synovitis of the knee is one of the earliest symptoms in rheumatic diseases. In the case of pharmacotherapy failure, other methods which directly remove the inflamed synovial membrane are used – synovectomies. Radiosynovectomy (RSV) is the radiopharmaceutical application of colloidal solution to joint cavities. In this study, the authors assessed the efficacy of knee radiosynovectomy with yttrium-90 (Y-90) in several groups of patients divided into certain rheumatic diseases. Material and methods : The study group consisted of 70 patients aged from 29 to 65 years with hypertrophic and exudative synovitis of the knee in rheumatic diseases such as rheumatoid arthritis, osteoarthrosis and spondyloarthropathies. Radiopharmaceutical colloid of Y-90, with a radiation dose of 185-222 MBq in a volume of 2-3 ml, was administered to joint. Then the knee joint was immobilized for 72 h. During visits V1, V2, V3 and V4, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured and ultrasound of the knee was performed. Disease activity was evaluated by the WOMAC scale, HAQ and 100-mm visual analog scale (VAS). Results : The most significant difference of synovial hypertrophy, before and after the procedure, was obtained in patients with rheumatoid arthritis. Variability of effusion before and after the procedure in all groups was comparable and statistically significant. The greatest improvement in variability of inflammatory parameters, before and 4 weeks after radiosynovectomy, was observed in patients with rheumatoid arthritis. Conclusions : In the therapeutic algorithm radiosynovectomy should be located between conservative treatment and operative procedures. Radiosynovectomy does not require hospitalization or prolonged rehabilitation. Radiosynoviorthesis affects the patient’s general condition, which is associated with eliminating pain and restoring joint function.

Introduction: Arthritis is an inflammatory disorder that affects one or more joints of the body for various reasons, including autoimmune disorders, trauma, or infection. In many cases, traditional long-term treatment with various drug combinations (NSAIDs, diseasemodifying antirheumatic drugs, systemic corticosteroids, etc.) can provide relief, but many joints require additional local treatment. Radiosynovectomy (RSV) is an alternative method to current treatment options. Both the global supply shortage of 90 Y in recent years and the increasing use of 177 Lu-labeled radiopharmaceuticals in the field of nuclear medicine have made it possible to develop 177 Lu-labeled microparticles and test them in small groups as RSV agents. This study aimed to develop the 177 Lu labeled tin colloid formulation and demonstrate its invivo characterization., Materials and Methods: Particle size, shape, and labelling efficiency of the four formulations developed were determined. The formula with the highest labelling efficiency was selected for further studies. The quality of the formulation was evaluated based on radionuclidic, radiochemical, and microbial purity. In-vitro stability was evaluated by determining the labelling efficiency. In-vitro stability was tested in PBS and synovial fluid. The biological characterization was assessed using SPECT/CT after injecting the formulation into the normal knee joints of the rabbits., Results: Aggregated colloidal particles were spherical with a particle size of <5 μm. Labelling efficiency and radiochemical purity were >95 and 97.65% (Rf=0.2), respectively. The formulation was stable in vitro for up to 72 hours, both in PBS and synovial fluid. The formulation was homogeneously distributed in the joint at 0 and 1 hour after injection, and radioactivity- related involvement and inguinal lymph node involvement due to possible leakage were not detected in the late period. No pyrogenic/allergic side effects were observed during this period., Conclusion: 177 Lu-tin-colloid was successfully prepared under optimized reaction conditions with high binding efficiency and radiochemical purity. The radiolabeled colloid was found to be stable in-vitro both in PBS and synovial fluid at room temperature. Serial PCET/CT images revealed that the activity was completely retained within the synovial cavity, with no activity leakage out of the joint until 48 hours after the injection. With the support of the results from further clinical studies, it may be possible for the formulation to enter clinical use., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Chronic recurrent hemarthrosis, defined as repeated intra-articular hemorrhage, can lead to a disabling arthropathy. We herein report on a 26-year-old patient presenting with recurrent, postoperative, serious knee hemarthrosis refractory to conventional treatment, including systemic and intra-articular steroid injections as well as chemical synovectomy with osmic acid. The patient was finally treated with a twice performed knee radiosynovectomy with yttrium-90 and showed an extraordinary good clinical outcome with a symptom-free period of 4 years. In cases of refractory hemarthrosis, radiosynovectomy should have a place in the therapeutic armamentarium of the treating physician, as a minimally invasive, safe, and efficient therapeutic tool. [ABSTRACT FROM AUTHOR]

Arthritis, especially rheumatoid arthritis is a common, chronic disease and systemic and local drug treatments are used. Radiosynovectomy is the best therapeutic option for the local treatment of arthritis. Rheumatic conditions tend to involve pain, aching, stiffness, and swelling in and around one or more joints. In radiosynovectomy radioactive labeled particles with a size of 0.05-2 µm are applied directly in the articular cavity. The radioactive particles are transported in the depth of synovia and phagocytized from macrophages and other inflammatory cells. The first treatment of arthritis using radioactive gold (198AU). The problem of 198AU in radiosynovectomy is the high leakage rate after treatment caused by the small sizes of particles. In the last 20 years the radiosynovectomy showed a renaissance using erbium-169 citrate (169Er) in small joints. Several constant synovitis of interdigital joints opposed to to suitable conventional anti-inflammatory treatment could benefit from radio-synoviorthesis through erbium-169. Erbium-169 synoviorthesis be technically simple to perform and free of side effects. [ABSTRACT FROM AUTHOR]

Radionuclide synovectomy (RSV) is a form of minimally invasive treatment of persistent joint in- flammation. The procedure has a high safety profile and the occurrence of serious adverse events, such as full-thickness skin radiation necrosis, is rare. Less severe radiation events, while more common, are usually benign and self-limiting. We present two cases of low-grade beta burns that developed after RSV, despite proper injection technique. The potential long-term risk of such exposure is also discussed, with reference to historical radiation incidents. While low-grade beta burns after RSV usually pose little danger to the patient, any clinician involved in radionuclide treatment of arthritis should be aware of their existence and management. [ABSTRACT FROM AUTHOR]

Radiosynovectomy is a safe and repeatable treatment method of chronic synovitis with synovial overgrowth and refractory chronic or acute inflammatory joint effusion. It consist in the intraarticular administration of a radioactive isotope in the form of a colloid causing the extinguishing of active synovitis. The radiocolloid causes permanent irradiation of the synovium with beta ray electron beams, which ultimately leads to its fibrosis and extinguishes the inflammatory process destroying the joint. The main indications for radiosynovectomy include chronic and acute arthritis in the course of systemic diseases, intraarticular bleeding in hemorrhagic diatheses (hemophilia), selected cases of osteoarthritis, recurrent effusions following surgery, e.g. arthroplasty, or other iatrogenic post-surgery complications causing arthritis. Radiosynovectomy is also performed in pigmented villonodular synovitis and crystal synovitis. The most common method used to determine the eligibility for radiosynovectomy is an ultrasound, which shows the location and activity of the thickened synovium. The administration of a radiocolloid into the joint, sheath or bursa should also be performed under the control of the ultrasound image, as this ensures a precise location of the puncture needle and full control of the isotope administration process. Clinical efficacy of radiosynovectomy depends on the proper qualification of patients for the procedure. The success rate of radiosynovectomy in common indications is 65–80%. It is confirmed by the visualization of avascular (fibrotic) synovium in follow-up ultrasound tests. The aim of this article is to present techniques and indications for the radiosynovectomy treatment.

Introduction Radionuclide synovectomy/synoviorthesis ( RS) to manage proliferative synovitis in persons with bleeding disorders has been utilized for decades; however, aggregate US results are limited. Aim To determine the prevalence of RS utilization, patient and procedure related demographics and functional outcomes in United States haemophilia treatment centres ( HTCs). The ATHNdataset includes US patients with bleeding disorders who have authorized the sharing of their demographic and clinical information for research. Methods We performed a multi-institutional, observational cohort study utilizing this dataset through 2010. Cases treated with RS procedure were compared to controls within the dataset. Standard template for data collection included patient and procedure related demographics as well as functional outcomes including range of motion ( ROM) of the affected joint. Normative age- and sex-matched control ROM was obtained from published data. Results In the ATHNdataset there were 19 539 control-patients and 196 case-patients treated with RS. Patients with severe haemophilia were more likely to have had RS compared to those with mild/moderate haemophilia, although the proportion of RS performed was similar between severe HA and HB. Inhibitory antibodies, HIV and hepatitis C infection were significantly more common in cases. There were 362 RS procedures captured with 94 cases having >1 RS procedures. Conclusions Right-sided joint procedures were more prevalent than left-sided procedures. Overall, case-patients had worse joint ROM compared to control-patients and published normative values. Geographically, there was regional variation in RS utilization, as the Southeast region had the largest percent of case-patients. [ABSTRACT FROM AUTHOR]

Purpose: Increased articular Tc MDP uptake on blood pool imaging (BPI) of patients with rheumatologic conditions is indicative of active inflammatory changes, and has been suggested as a strong predictor of response to radiosynoviorthesis (RSO). In this study, we aimed to assess the value of pretreatment BPI positivity (i.e. scintigraphic-apparent hyperemia) for successful RSO in hemophilic arthropathy. Methods: Thirty-four male patients with painful hemophilic arthropathy underwent RSO after failure of conservative treatment. Treated joints comprised the knee in eight, elbow in five, and ankle in 21 patients. Pretreatment triple-phase bone scintigraphy showed hyperemic joints (pathologic BPI) in 17 patients, whereas 17 patients had no increased tracer uptake on BPI. Response to RSO was evaluated 6 months post-treatment by measuring changes in intensity of arthralgia according to the visual analog scale (VAS), bleeding frequency, and range of motion. The association between hyperemia (pathologic BPI) and treatment outcome was examined using nonparametric tests for independent samples. Results: Clinically evident pain relief occurred in 26 patients (76.5 %), and the mean VAS decreased from 7.7 ± 1.1 to 4.6 ± 2.7 ( p < 0.001). Joint bleeding frequency (hemarthrosis) decreased from 4.5 ± 0.6 to 2.1 ± 0.4 during the first 6 months after RSO ( p < 0.001). For both parameters (pain relief and bleeding frequency), patients experienced a similar benefit from RSO regardless of pretreatment BPI: arthralgia ( p = 0.312) and frequency of hemarthrosis ( p = 0.396). No significant improvement was observed for range of motion, but it was significantly more restricted in hyperemic joints both before ( p = 0.036) and after treatment ( p = 0.022). Conclusions: Hemophilic arthropathy can be effectively treated with RSO regardless of pre-therapeutic BPI. Patients in whom articular hyperemia is not detectable by scintigraphy may have similar (outstanding) outcomes, and thus should not be excluded from treatment. [ABSTRACT FROM AUTHOR]

Ho is one of the most effective radionuclides used for radiosynovectomy. One method to deliver this radioisotope to target tissue is via the Dy/Ho in vivo generator system. The aim of this work was to prepare Dy/Ho-chitosan (Dy/Ho-CHIT ) in vivo generator for radiosynovectomy applications. Dy obtained by the irradiation of natural Dy target. Dy was separated from Ho by extraction chromatographic method (separation yield; 93% and separation factor;1.7). Chitosan labeling was performed in acetic acid with 99.3 ± 0.6% radiochemical purity. Biodistribution studies on intraarticular injected rats demonstrated high retention in the knee joint even 7 days showing no radioactivity leakage from the injection site into other organs as well as any translocation of the daughter nucleus after β decay of Dy. [ABSTRACT FROM AUTHOR]

Objective: Camptodactyly-arthropathy-coxa-vara-pericarditis (CACP) syndrome is an autosomal recessive disorder caused by mutations in PRG4 gene that encodes for proteoglycan 4, the main lubricant for joints and tendon surfaces. It is a noninflammatory arthropathy, characterized by joint effusions and synovial hypertrophy. So far, there is no effective treatment for this disorder. To evaluate the effectiveness of yttrium-90 radiosynovectomy in arthropathy of patients with CACP syndrome. Methods: Consecutive patients with CACP syndrome were prospectively evaluated at the enrollment and 3 months after the right knee injection with yttrium-90. The outcome variables were patient/parent and physician's global assessment measured by a 3-point scale, right knee swelling and range of motion on a 3-point scale, in addition to magnetic resonance imaging (MRI) assessment of the right knee for bone, cartilage, fluid, synovial hypertrophy and soft tissue changes. Results: Six (three boys, three girls) patients with a mean age of 12 years and mean follow-up duration of 8.5 years completed a single right knee intra-articular yttrium-90 injection with 5 mCi. The procedure was well tolerated without adverse events apart from mild and transient joint pain in two patients. There was a minimal radioisotope leakage to soft tissue in two patients. During the 3-month follow-up interval, there was no improvement in the outcome variables. Patients and parents did not notice favorable therapeutic effects and global physician assessment was unsatisfactory. There was no difference in knee joint swelling or range of motion. Furthermore, MRI findings were unchanged. However, there was a minimal increase in synovial fluid post injection. Conclusion: Yttrium-90 radiosynovectomy seems to be a safe and well tolerated procedure, however, it did not show a beneficial therapeutic effect in arthropathy of CACP syndrome with the given dosage and interval. Studies including a larger number of patients and probably repeated injections are needed to derive satisfactory results about the effectiveness of yttrium-90 in CACP syndrome patients. [ABSTRACT FROM AUTHOR]

In this study, 188-Re sulphide colloid was synthesized as a radiosynovectomy agent by reduction of sodium thiosulfate in the presence of perrhenate. The influences of the acidity, molar ratio and ultrasonic time on the colloid properties were investigated from 0.1 to 5 mol L-1; 5 to 70; and 10 to 60 min, respectively. The criteria for optimization of the influencing factors were the particle size and radiolabeling yield. Based on these factors the selected conditions were 1M HCl, thiosulfate to perrhenate molar ratio of 35 and 45 min for the ultrasonic time. The sizes of the particles were in the range of 1 to 5mm for more than 95% of the particles. The radionuclidic and radiochemical purity were found to be more than 99%. In addition, the synthesized colloid was stable for 5 days.

Radiosynovectomy is a local intra-articular injection of radionuclides in colloidal form for treatment of articular inflammatory in rheumatoid arthritis, hemophilia or orthopedic troubles. β-emitting radionuclides can be used for various joints based on radiation energy. 90Y is a pure β-emitter with a half-life of 64.1 hours that is used for treatment of the knee joint. β-radiation of this radionuclide possesses maximum energy of 2.281 MeV (99.98%), mean pathway of 3.6 mm in the soft tissue and maximum 11 mm. In this project, hydroxyapatite (HAp) is applied as a colloid maker agent that interacts with 90Y3+ ions via ion-dipole bonds and produces 90Y-HAp. The colloidal pharmaceutical is produced by adding an acidic solution of 90YCl3 to an HAp suspension in saline. Effective parameters within which the colloid is applied, such as the volume of diluent, HAp particle size and sonication effect were evaluated and tested. First, these determinative parameters were optimized in the simulated conditions and then examined in the active phase. Finally, the best procedure was determined for the production of the radiopharmaceutical. Radionuclide purity of the radiopharmaceutical according to the primary 90YCl3 solution was over 99.9%. Labeling yield and radiochemical purity were obtained over 99% using TLC method in saline solvent up to three days after production of radiopharmaceutical. Radiochemical purity of 90Y-HAp colloid was also evaluated in human serum albumin solution for three days at room temperature. The amount of released activity was between 0.3 to 2%.

La radiosinovectomía es una forma local de radioterapia utilizada como tratamiento de segunda línea en el manejo de artropatías inflamatorias y no inflamatorias con respuesta insatisfactoria a la terapia sistémica o local con corticoesteroides. Tiene una eficacia similar a la sinovectomía quirúrgica, con las ventajas de ser un tratamiento de menor costo, menos cruento y con menor tiempo de convalecencia. Su eficacia es mayor en artropatías inflamatorias caracterizadas por sinovitis, como la artritis reumatoide y artritis crónica juvenil, con compromiso mono u oligoarticular y en articulaciones de extremidades superiores. Existen múltiples isótopos que se pueden utilizar en suspensiones coloidales, siendo el sulfuro coloidal de renio-186 el utilizado para la articulación radiocarpiana. Una técnica de administración adecuada es fundamental para el éxito del tratamiento, siendo la inyección con guía ultrasonográfica adecuada para articulaciones de volumen pequeño, instancia en la que la colaboración del médico radiólogo entrenado es fundamental.Radiosynovectomy is a local form of radiotherapy used as second-line treatment in the management of inflammatory and non-inflammatory arthropathies with unsatisfactory response to local or systemic corticosteroid therapy. Its efficacy is similar to that of surgical synovectomy, with the advantages of being a low-cost and minimally- invasive treatment that requires a shorter recovery time. Its efficacy is greater in the treatment of inflammatory arthritis characterized by synovitis, such as rheumatoid arthritis and juvenile chronic arthritis with mono/ oligoarticular involvement, especially in upper extremity joints. A number of isotopes can be used in colloidal suspensions. Rhenium-186-sulphide colloid is currently indicated for the treatment of medium-sized joints. The ultrasound-guided injection is suitable for small joints, such as wrist. For proper and safe use and administration of this technique the collaboration of a trained and experienced radiologist is critical to successful treatment.

Introduction: Most bleeding events in individuals with hemophilia occur within the ankle, knee, and elbow joints. Should the bleeding persist, the synovial membrane starts to hypertrophy and a vicious cycle of chronic hemophilic synovitis (CHS) occurs, leading to joint destruction., Areas Covered: This article covers the prompt diagnosis of CHS by point-of-care ultrasonography (POC-US) and its treatment by means of several types of synovectomy., Expert Opinion: It is essential to prevent, detect and treat hemophilic synovitis, because it indicates that the joint has bled and is at risk of bleeding further. Prophylaxis with standard half life (SHL) factor VIII (FVIII) concentrate is the standard of care for individuals with severe hemophilia A and can also be considered for selected patients with moderate disease. Several years of real-world experience with extended half life (EHL) FVIII, emicizumab, and other drugs in development will be needed to ascertain their final effect on bleeding and its complications. We must look for synovitis in individuals declaring joint pain and in asymptomatic patients, and POC-US is the most reasonable imaging instrument with which to carry out periodic joint screening. Radiosynovectomy, chemical synovectomy, and arthroscopic synovectomy markedly reduce bleeding events.

A variety of radionuclides continue to be investigated and/or clinically used for different therapeutic applications in nuclear medicine. The choice of a particular radionuclide with regard to appropriate emissions, linear energy transfer (LET), and physical half-life, etc., is dictated to a large extent by the character of the disease (e.g., solid tumor or metastatic disease), and by the carrier to selectively transport the radionuclide to the desired site. An impressive body of information has appeared in the recent literature that addresses many of these considerations. This article summarizes and discusses the role of high-LET electron emitters and their advantage in the treatment of cancer or for other disorders in specific situations. Areas such as bone pain palliation, bone malignancy therapy, and radiation synovectomy are covered in greater detail. Projections are made as to the future directions and progress in these areas. A discussion of the various issues related to the selection criteria that are useful for choosing the appropriate radionuclide for a particular application is included. Use of high-LET electron emitters is discussed in greater detail, with particular emphasis on the use of conversion electron emitter tin-117m for various therapeutic applications.Uma variedade de radionuclídeos continua a ser investigada e/ou clinicamente utilizada para diferentes aplicações terapêuticas em medicina nuclear. A escolha de um radionuclídeo, considerando-se sua emissão apropriada, transferência linear de energia (LET) e meia-vida física é determinada na maior parte pelo caráter da doença (p.ex., tumor sólido ou doença metastática), e pelo carreador que transporta o radionuclídeo seletivamente para o sítio desejado. Um notável conjunto de informações voltadas para essas considerações tem aparecido na literatura recente. Esse trabalho resume e discute o papel de emissores de elétrons de alta-LET e sua vantagem no tratamento do câncer ou para outras doenças em situações específicas. Abordagens relacionadas com o alívio da dor óssea, a terapia da doença óssea e a sinovectomia por radiação são apresentadas detalhadamente. Projeções para o futuro e os progressos nessas áreas são indicadas. Uma profunda discussão relacionada aos critérios de seleção que são úteis para escolher o radionuclídeo apropriado para que uma aplicação particular seja incluída. O uso de emissores de elétrons de alta-LET é discutido em grande detalhe, com particular ênfase no uso do estanho-117m, um emissor de elétron de conversão, para várias aplicações terapêuticas.

Objective: We aimed to compare the efficacies of SPECT/ CT and planar imaging of joints after radiosynovectomy. Material and Methods: Six patients with hemophylic arthropathy (HA) (5 hemophilia A, 1 hemophilia B) with a mean age 10.5 (range between 8-15) underwent radiosynovectomy in our clinic between January 2004-December 2012. Postradiosynovectomy planar and SPECT-CT imaging of 5 knee joints, 1 elbow joint and two ankle joints were obtained. Results: Distribution pattern of activity showed no difference between SPECT/CT and planar imaging methods. In one patient there was loculation of activity in suprapatellar recess detected with SPECT/CT which was not deliniated in planar image. Conclusion: Addition of SPECT/CT to the postradiosynovectomy imaging protocol might help in identification of those who are at risk for potentially serious local complications. [ABSTRACT FROM AUTHOR]

Background Radiosynovectomy (RS) reduces the number of haemarthroses and the synovial size in chronic haemophilic synovitis. The purpose of this study was to quantitatively compare the effectiveness of two types of RS (yttrium-90 vs. rhenium-186) in terms of the objective improvement of haemarthroses and synovial size. Methods Seventy RSs were performed in 70 joints (44 elbows, 26 ankles) of 70 haemophiliacs diagnosed with chronic synovitis. Yttrium-90 was used in 21 joints and rhenium-186 was used in 49 joints. The mean patient age was 20.61 years. Results RS resulted in significant improvement in the three variables studied (six months before RS vs. six months after RS), namely in the number of episodes of haemarthrosis (67.8% improvement); the size of the synovium as measured by means of a clinical scale (43.8% improvement) and imaging techniques in millimetres (26.7% improvement). We did not find significant statistical differences between yttrium-90 and rhenium-186 regarding their efficacy. No correlation was found between the results and other variables: age, joint (ankle or elbow), presence or absence of radiological involvement, type of haemophilia (A or B), grade of haemophilia (mild, moderate or severe), previous haematological treatment (on demand or prophylaxis), and the presence or absence of inhibitor Conclusions Yttrium-90 RS and rhenium-186 RS were equally effective in reducing the number of haemarthroses and the size of the synovium in ankles and elbows in the short-term (6 months). No correlation was found between the results and other patients´ characteristics. [ABSTRACT FROM AUTHOR]