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Kampen WU, Boddenberg-Pätzold B, Fischer M, Gabriel M, Klett R, Konijnenberg M, Kresnik E, Lellouche H, Paycha F, Terslev L, Turkmen C, van der Zant F, Antunovic L, Panagiotidis E, Gnanasegaran G, Kuwert T, Van den Wyngaert T. The EANM guideline for radiosynoviorthesis. Eur J Nucl Med Mol Imaging 2022; 49:681-708. [PMID: 34671820 PMCID: PMC8803784 DOI: 10.1007/s00259-021-05541-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/23/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Radiosynoviorthesis (RSO) using the intraarticular application of beta-particle emitting radiocolloids has for decades been used for the local treatment of inflammatory joint diseases. The injected radiopharmaceuticals are phagocytized by the superficial macrophages of the synovial membrane, resulting in sclerosis and fibrosis of the formerly inflamed tissue, finally leading to reduced joint effusion and alleviation of joint pain. METHODS The European Association of Nuclear Medicine (EANM) has written and approved these guidelines in tight collaboration with an international team of clinical experts, including rheumatologists. Besides clinical and procedural aspects, different national legislative issues, dosimetric considerations, possible complications, and side effects are addressed. CONCLUSION These guidelines will assist nuclear medicine physicians in performing radiosynoviorthesis. Since there are differences regarding the radiopharmaceuticals approved for RSO and the official indications between several European countries, this guideline can only give a framework that must be adopted individually.
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Affiliation(s)
- W U Kampen
- Nuklearmedizin Spitalerhof, Radiologische Allianz, Spitalerstraße 8, 20095, Hamburg, Germany
| | | | - M Fischer
- Praxis Für Radiologie Und Nuklearmedizin, Friedrich-Ebert-Straße 50, 34117, Kassel, Germany
| | - M Gabriel
- Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital Linz GmbH, Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz and Krankenhausstrasse 9, 4020, Linz, Austria
| | - R Klett
- ÜBAG Für Nuklearmedizin, Hanau-Frankfurt-Offenbach-Gießen, Standort Gießen, Paul-Zipp-Str. 171-173, 35398, Gießen, Germany
| | - M Konijnenberg
- Erasmus MC, Nucleaire geneeskunde, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - E Kresnik
- Privatklinik Villach, Institut Für Nuklearmedizin, Dr.-Walter-Hochsteinerstrasse 4, 9504, Warmbad Villach, Austria
| | - H Lellouche
- Unité Rhumatologique de Affections de La Main, Centre Viggo Petersen, Hôpital Lariboisiere, 2 rue Ambroise Paré, 75010, Paris, France
- Institut de Rhumatologie Interventionnelle, 13 rue Thouin, 75005, Paris, France
| | - F Paycha
- Service de Médecine Nucléaire, Hôpital Lariboisière, Assistance Publique- Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France
| | - L Terslev
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Valdemar Hansens Vej 17, 2600, Glostrup, Denmark
| | - C Turkmen
- Department of Nuclear Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, 34390, Turkey
| | - F van der Zant
- Nucleaire Geneeskunde, Noordwest Ziekenhuisgroep, Postbus 501, 1800 AM, Alkmaar, Netherlands
| | - L Antunovic
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Milan, 20089, Rozzano, Italy
| | - E Panagiotidis
- Department of Nuclear Medicine, Oncology Center 'Theageneio', Al Symeonidis 2 str, P.C 54007, Thessaloniki, Greece
| | - G Gnanasegaran
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - T Kuwert
- Clinic of Nuclear Medicine, Friedrich-Alexander-University, Erlangen-Nürnberg, Erlangen, Germany.
| | - T Van den Wyngaert
- Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
- Molecular Imaging Center Antwerp (MICA - IPPON), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Salini V, Abate M. Percutaneous steroidal treatment in relapses of chronic tendinopathies: a pilot study. Int J Immunopathol Pharmacol 2011; 24:211-6. [PMID: 21496380 DOI: 10.1177/039463201102400125] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Relapses are frequently observed in subjects with chronic tendinopathies. Corticosteroid injections are usually performed with positive results, but are uncomfortable for the patient and not free from side effects. The aim of this pilot study is to evaluate the short-term efficacy and tolerability of an occlusive Betamethasone Valerate medicated Plaster (BMVP). Fifteen subjects with relapses of chronic tendinopathies (clinical and ultrasound diagnosis) were enrolled, and treated according to RICE (Rest - Ice - Compression - Elevation) protocol. An BMVP plaster was also applied on the affected tendon. Clinical examination, at baseline and after 7, 14, 21 and 28 days, included pain (VAS at rest and during activities) and functional evaluation. Local side effects on the area and drop-outs were also recorded. Pain, both at rest and during activities, significantly decreased at 28 days (from 3.7 ± 2.7 to 1.1 ± 1.7 p < 0.01, and from 7.3 ± 1.7 to 3.3 ± 1.4 p < 0.0000, respectively). Moreover, the patients reported a significant improvement in the functional limitation. Five subjects dropped out of the study. No side effects were reported. The release of the steroid in pharmacologically-active concentrations over 12 - 24 hours and the good penetration of the drug in subcutaneous tissues explain the positive results. BMVP application may be considered a reliable first therapeutic approach in relapses of chronic tendinopathies.
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Affiliation(s)
- V Salini
- Department of Human Movement Science, University of Chieti-Pescara, Chieti, Italy
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