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Chrabański O, Kluczewska E, Gołąb T, Gorczewska I. Assessment of the Effectiveness of Knee Joints Treatment With the Use of 90 Y : Prospective Ultrasound and Clinical Analysis. Clin Nucl Med 2023; 48:404-408. [PMID: 36947794 PMCID: PMC10082054 DOI: 10.1097/rlu.0000000000004618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/13/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE The purpose of this prospective study was to assess the effectiveness of knee joints treatment by radiosynoviorthesis with the use of 90 Y based on ultrasound and clinical analysis. MATERIALS AND METHODS Ninety-seven patients were qualified for treatment from October 2016 to June 2017, and observation period lasted until December 2017. Bioethics Committee of the Medical University of Silesia approved this study. The effectiveness of knee joints treatment with the use of 90 Y was based on 927 ultrasound measurements of fluid and 927 synovial thickness in 3 sites of the suprapatellar recess, 309 assessments of patient's disability documented in Lequesne questionnaire, 309 assessments of pain on visual analog scale, as well as 103 overall self-assessment. Statistical methods were used to process the results. RESULTS A reduction in fluid was found in 62.14% of the knees; synovial thickness reduction was observed in 97.09% of all knees. The greatest benefit from the therapy was experienced by patients complaining of morning stiffness lasting more than 15 minutes (in 85.71% of joints). There was reduction in pain at rest in 94.52% of knee joints and in 80.39% of joints with pain while walking. At the second follow-up visit after treatment, the percentage of improvement in self-assessment was 74.76%. CONCLUSIONS Statistically significant decreases in the amount of fluid and thickness of the synovial membrane as well as the level of disability and the intensity of pain after radiosynoviorthesis 90 Y treatment were demonstrated.
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Affiliation(s)
- Olgierd Chrabański
- From the Department of Radiodiagnostics, Interventional Radiology and Nuclear Medicine, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Ewa Kluczewska
- Department of Radiology and Radiodiagnostics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Tomasz Gołąb
- Department of Nuclear Medicine, Clinica Medica, Tychy
| | - Izabela Gorczewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Skodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
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van der Zant FM, Knol RJ, Broos WA. Radiosynoviorthesis: almost seventy years of experience but still somewhat fameless. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:293-303. [PMID: 35708601 DOI: 10.23736/s1824-4785.22.03470-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Radiosynoviorthesis (RSO) or radiation synovectomy has been practiced for more than half a century, but in many parts of the world, it is still relatively unknown and not used to its full potential in the standard care for chronic, persistent or recurrent synovitis. The working mechanism of RSO is simple yet elegant. Radiopharmaceutical particles are, after injection in the affected synovial joint, gobbled up by phagocytizing subsynovial inflammatory cells. As a consequence, the synovium will be irradiated locally resulting in synovial cell necrosis and inhibition of cell proliferation, which eventually leads to a decrease in the inflammatory response in the joint cavity. In this review RSO is once again brought to the attention and common indications for RSO are discussed. Also, appropriate activities of the administrated radiopharmaceuticals and coadministrated glucocorticoids are provided. Furthermore, a detailed database-assisted chronological overview of published literature of RSO in inflammatory and non-inflammatory diseases, like rheumatoid arthritis, psoriatic arthritis, osteoarthritis and osteochrondomatosis, hemophilic hemarthrosis and pigmented villonodular synovitis (PVNS) is provided. Based upon the published literature an indication of level of evidence of RSO is discussed. There is evidence that RSO is effective in persistent synovitis in patients with a variety of causes for synovitis, although the effectiveness seems to decrease over time. In these patients, RSO may not be used to its full potential in many parts of the world. Results in of RSO in hemophilia patients with hemarthrosis are favourable, however the evidence for the effectiveness of RSO in these patients is less firm and mainly based on case series. The evidence for the efficacy of RSO as adjuvant therapy in PVNS is, at best, of very low quality.
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Affiliation(s)
| | - Remco J Knol
- Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | - Wouter A Broos
- Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
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Prospective evaluation of phosphorus-32 radiation synovectomy in patients with severe and chronic rheumatoid arthritis unresponsive to conventional medical treatment. Nucl Med Commun 2019; 41:65-72. [PMID: 31764591 DOI: 10.1097/mnm.0000000000001116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To determine the efficacy of Phosphorus-32 radiation synovectomy in the treatment of patients with severe rheumatoid arthritis (RA) unresponsive to systematic or local medical therapy. METHODS Twenty-three knees in 16 patients with severe chronic RA were prospectively treated by intra-articular installation of Phosphorus-32 and evaluated at 1, 3, 6, and 12 months. The Western Ontario and McMaster Universities Arthritis index (WOMAC), visual analog scale (VAS), Health Assessment Questionnaire (HAQ), pain scale, and grade of joint effusion and tenderness were assessed. At the 12-month time interval, the treated knees were classified into four categories: excellent response (no symptoms), good response (significant reduction of symptoms), moderate response (slight decrease), and poor response (no change or worsening). RESULTS Excellent response or good response was observed in 13/23 (56.5%) of the treated knees, moderate response in 2/23 (8.7%) of the treated knees, and poor response in 8/23 (34.8%) of the treated knees. The grades of effusion and tenderness were significantly decreased one-month posttreatment (P< 0.05); however, these changes did not persist at other time intervals (P > 0.05). There was a significant improvement in the HAQ, WOMAC, VAS, and pain scores at all time points compared with baseline, including at the 12-month time interval (P < 0.05). CONCLUSION Phosphorus-32 radiosynovectomy is an effective therapeutic treatment for patients with RA of the knee unresponsive to conventional pharmacotherapy.
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Szentesi M, Nagy Z, Géher P, Papp I, Kampen WU. A prospective observational study on the long-term results of 90Yttrium citrate radiosynoviorthesis of synovitis in osteoarthritis of the knee joint. Eur J Nucl Med Mol Imaging 2019; 46:1633-1641. [DOI: 10.1007/s00259-019-04350-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/16/2019] [Indexed: 01/21/2023]
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Gortzak Y, Vitenberg M, Frenkel Rutenberg T, Kollender Y, Dadia S, Sternheim A, Morag G, Farkash U, Rath E, Kramer M, Drexler M. Inconclusive benefit of adjuvant 90Yttrium hydroxyapatite to radiosynovectomy for diffuse-type tenosynovial giant-cell tumour of the knee. Bone Joint J 2018; 100-B:984-988. [DOI: 10.1302/0301-620x.100b7.bjj-2017-0867.r3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Aims Intra-articular 90Yttrium (90Y) is an adjunct to surgical treatment by synovectomy for patients with diffuse-type tenosynovial giant-cell tumour (dtTGCT) of the knee, with variable success rates. Clinical information is, however, sparse and its value remains unclear. We investigated the long-term outcome of patients who underwent synovectomy with and without adjuvant treatment with 90Yttrium. Patients and Methods All patients with dtTGCT of the knee who underwent synovectomy between 1991 and 2014 were included in the study. Group A patients underwent synovectomy and an intra-articular injection of 90Yttrium between six and eight weeks after surgery. Group B patients underwent surgery alone. Results There were 34 patients in group A and 22 in group B. Recurrence of dtTGCT was identified by MRI, which was undertaken in patients with further symptoms. At a mean follow-up of 7.3 years (2.5 to 25.4), there was residual disease in 15 patients in group A and 11 in group B (p < 0.363). The mean Musculoskeletal Tumor Society (MSTS) score at final follow-up was 85% and 83%, respectively (p < 0.91). Conclusion There were no significant differences in outcome between patients treated surgically for dtTGCT of the knee with or without an adjuvant intra-articular injection of 90Yttrium. We were unable to provide conclusive evidence of any benefits derived from the adjuvant treatment. Cite this article: Bone Joint J 2018;100-B:984–8.
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Affiliation(s)
- Y. Gortzak
- National Unit of Orthopedic Oncology,
Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel, affiliated to
the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - M. Vitenberg
- Sackler Faculty of Medicine,
Tel-Aviv University, Tel-Aviv, Israel
| | | | - Y. Kollender
- National Unit of Orthopedic Oncology,
Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel, affiliated to
the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - S. Dadia
- National Unit of Orthopedic Oncology,
Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel, affiliated to
the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A. Sternheim
- National Unit of Orthopedic Oncology,
Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel, affiliated to
the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - G. Morag
- Orthopedic Surgery Division and Tel-Aviv
Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine,
Tel-Aviv University, Tel-Aviv, Israel
| | - U. Farkash
- Orthopedic Surgery Department, Assuta
Ashdod University Hospital, Ashdod, Israel, affiliated to the Beer Sheva
Faculty of Medicine, Beer Sheva University, Beer
Sheva, Israel
| | - E. Rath
- Orthopedic Surgery Division and Tel-Aviv
Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine,
Tel-Aviv University, Tel-Aviv, Israel
| | - M. Kramer
- Orthopedic Surgery Department, Assuta
Ashdod University Hospital, Ashdod, Israel, affiliated to the Beer Sheva
Faculty of Medicine, Beer Sheva University, Beer
Sheva, Israel
| | - M. Drexler
- Assuta
Ashdod University Hospital, Ashdod, Israel, affiliated to the Beer
Sheva Faculty of Medicine, Beer Sheva University, Beer
Sheva, Israel
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Abstract
Radioisotope synovectomy has been extensively used to treat patients with chronic inflammatory joint disease but has moved to a less prominent position since the introduction of new and highly effective drugs. Remaining indications are refractory synovitis, pigmented villonodular synovitis as an adjunct to surgery, and hemophilic arthropathy. The three main radioisotopes used are yttrium-90, rhenium-186, and erbium-189. Radioisotope synovectomy should be performed only by highly experienced professionals, to minimize the risk of injection-related complications. The available safety data, in particular regarding the risk of malignancy, are reassuring. The efficacy of yttrium-90 in chronic inflammatory joint disease remains controversial.
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Al-Mayouf SM, Almutairi N, Alismail K. The Efficacy of Yttrium-90 Radiosynovectomy in Patients with Camptodactyly-Arthropathy-Coxa Vara-Pericarditis Syndrome. Mol Imaging Radionucl Ther 2017; 26:33-37. [PMID: 28291008 PMCID: PMC5350503 DOI: 10.4274/mirt.29484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
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 non-inflammatory 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.
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Affiliation(s)
- Sulaiman Mohammed Al-Mayouf
- King Faisal Specialist Hospital and Research Center, Clinic of Pediatric Rheumatology, Riyadh, Saudi Arabia Phone: +996114427761 E-mail:
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Karaman I, Guney A, Dogar F, Kafadar IH, Bilal O, Oner M, Kula M. Comparison of arthroscopic, radioactive and combined synovectomy in the treatment of chronic non-specific knee synovitis. Med Princ Pract 2014; 23:551-5. [PMID: 25196268 PMCID: PMC5586937 DOI: 10.1159/000365635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 07/02/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To compare the outcomes of arthroscopic, radioactive and combined synovectomies in patients with chronic non-specific recurrent synovitis who did not respond to conservative therapy. SUBJECTS AND METHODS Twenty-nine patients enrolled between 2007 and 2011 were divided into 3 groups: group 1 was treated with arthroscopy, group 2 received a radioactive drug and group 3 received a combined (radioactive and arthroscopic) synovectomy. Treatment efficacy was evaluated by comparing pre- and post-operative Lysholm knee scores (LKS), night pain, resting pain, activity pain and effusions using visual analogue scales (VAS). Patient satisfaction was assessed using the visual analogue patient satisfaction scale (VAPSS). RESULTS The mean age of the study participants was 41.5 ± 5.2 years (range 14-76), and the mean follow-up period was 33.6 ± 3.2 months (range 17-78). Before treatment, the mean LKS was 41.4 ± 3.4 in group 1, 39.6 ± 3.3 in group 2 and 37.1 ± 4.6 in group 3. After treatment, the corresponding mean LKS were 77.7 ± 2.1, 81.6 ± 2.8 and 91.3 ± 2.7 in groups 1, 2 and 3, respectively; the increase was statistically significant (p < 0.05). The VAS scores before and after treatment decreased significantly (p < 0.05). The mean VAPSS score, a measure of patient satisfaction, was 5.1 ± 1.7, 5.8 ± 1.5 and 7.4 ± 1.8 in groups 1, 2 and 3, respectively, and the difference between groups 1 and 2 was not statistically significant, while that between group 3 and the other two groups was significant (p < 0.05). CONCLUSION This study showed that the three methods used in individuals with chronic non-specific recurrent synovitis were effective; however, arthroscopic synovectomy in combination with radioactive synovectomy was more effective than the other methods and superior in terms of patient satisfaction.
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Affiliation(s)
- Ibrahim Karaman
- Department of Orthopaedics and Traumatology, Erciyes University Medical Faculty, Kayseri, Turkey
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9
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Abstract
Diarthrodial joints are well suited to intra-articular injection, and the local delivery of therapeutics in this fashion brings several potential advantages to the treatment of a wide range of arthropathies. Possible benefits over systemic delivery include increased bioavailability, reduced systemic exposure, fewer adverse events, and lower total drug costs. Nevertheless, intra-articular therapy is challenging because of the rapid egress of injected materials from the joint space; this elimination is true of both small molecules, which exit via synovial capillaries, and of macromolecules, which are cleared by the lymphatic system. In general, soluble materials have an intra-articular dwell time measured only in hours. Corticosteroids and hyaluronate preparations constitute the mainstay of FDA-approved intra-articular therapeutics. Recombinant proteins, autologous blood products and analgesics have also found clinical use via intra-articular delivery. Several alternative approaches, such as local delivery of cell and gene therapy, as well as the use of microparticles, liposomes, and modified drugs, are in various stages of preclinical development.
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Affiliation(s)
- Christopher H Evans
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN-115, Boston, MA 02215, USA
| | - Virginia B Kraus
- Duke University Medical Center, Department of Medicine, Box 3416, Durham, NC 27710, USA
| | - Lori A Setton
- Department of Biomedical Engineering, Duke University, Room 136 Hudson Hall, Box 90281, Durham, NC 27708, USA
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Wong Y, Cherk MH, Powell A, Cicuttini F, Bailey M, Kalff V. Efficacy of yttrium-90 synovectomy across a spectrum of arthropathies in an era of improved disease modifying drugs and treatment protocols. Int J Rheum Dis 2013; 17:78-83. [DOI: 10.1111/1756-185x.12182] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yiisong Wong
- Department of Nuclear Medicine; Monash University; Melbourne Victoria Australia
| | - Martin H. Cherk
- Department of Nuclear Medicine; Monash University; Melbourne Victoria Australia
- Department of Medicine; Monash University; Melbourne Victoria Australia
| | - Anne Powell
- Department of Rheumatology; Monash University Alfred Hospital; Melbourne Victoria Australia
| | - Flavia Cicuttini
- Department of Medicine; Monash University; Melbourne Victoria Australia
- Department of Rheumatology; Monash University Alfred Hospital; Melbourne Victoria Australia
| | - Michael Bailey
- Department of Epidemiology and Preventative Medicine; Monash University Alfred Hospital; Melbourne Victoria Australia
| | - Victor Kalff
- Department of Nuclear Medicine; Monash University; Melbourne Victoria Australia
- Department of Medicine; Monash University; Melbourne Victoria Australia
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Oztemür Z, Bulut O, Korkmaz M, Gölge UH, Oztürk H, Tezeren G, Günaydın I. Surgical synovectomy combined with yttrium 90 in patients with recurrent joint synovitis. Rheumatol Int 2012; 33:1321-6. [PMID: 23132540 DOI: 10.1007/s00296-012-2540-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 10/21/2012] [Indexed: 11/30/2022]
Abstract
Radiation synovectomy (RS) is one of many therapeutic options used for recurrent joint synovitis. Our aim was to analyze the effect of the surgical synovectomy combined with yttrium 90 ((90)Y) in the treatment for recurrent joint synovitis. A surgical combined RS procedure was used on 32 knees of 30 patients. They were divided into two groups. Group 1 consisted of 7 knees of 7 patients (5 women and 2 men) with a mean age of 40.7 years in whom RS was combined with the open synovectomy. Group 2 consisted of 25 knees of 23 patients (21 men and 2 women) with a mean age of 45.5 years in whom RS was combined with the arthroscopic synovectomy. Arthroscopic synovectomy or open surgery biopsy was carried out for all cases who diagnosed of having synovitis. A scintigraphic examination was conducted within 24 h after the RS procedure to investigate the systemic leakage of (90)Y in all patients. The outcome of treatment was assessed based on self-reporting using the visual analogue scale (VAS) of night pain, rest pain, activity pain, effusion, and satisfactory scores. The average follow-up period was 4.15 years. There was a significant difference between before and after treatment in terms of outcome parameters' VAS scores in both groups (p < 0.05). But there was no statistically significant difference between open and arthroscopic synovectomy groups in terms of outcome parameters (p > 0.05). Satisfactory outcome was excellent in 3 patients (42.8 %) in group 1 and 8 patients (32 %) in group 2. Surgical synovectomy with combined (90)Y could treat recurrent joint synovitis successfully. There was no statistically significant difference between open and arthroscopic synovectomy techniques combined with RS procedure.
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Affiliation(s)
- Zekeriya Oztemür
- Department of Orthopaedics and Traumatology, Cumhuriyet University School of Medicine, Sivas, Turkey.
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¹⁵³Sm-HM for arthritic knee pain. Estimated dosimetry. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2012; 35:63-9. [PMID: 22238018 DOI: 10.1007/s13246-011-0122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 12/17/2011] [Indexed: 10/14/2022]
Abstract
Osteoarthritis is the most common type of arthropathy and after cardiovascular diseases is the most disabling disease in developing countries. The dosimetry for the clinical application of 153-samarium-hydroxymacroaggregates (¹⁵³Sm-HM) for radiation synovectomy (RSV) and palliative treatment for arthritic pain, as far as we know, has not been reported. The aim of this research was to estimate the radiation dose necessary for synovial ablation and pain palliation with minimum risk to the patient. ¹⁵³Sm-HM (370 MBq) was administered intra-articularly in a patient with severe knee pain and hindered motility. Regions of interest drawn on sequential, conjugated, anterior and posterior scintigraphy images were used to obtain the respective activity. The data was entered into a knee joint histological-geometric model designed with micrometric dimensions to represent the synovial cell layers. The Monte Carlo code was used to calculate the absorbed dose in each of the 12 model-cells representing the distance from the synovial liquid to the cartilage or bone. The absorbed dose in the synovial cavity was 114 Gy which is sufficient energy for RSV. The treated patient referred little pain and higher motility with no adverse reactions. ¹⁵³Sm-HM is a potentially valid radiopharmaceutical for RSV, which effectively palliates knee pain.
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Baker’s cysts in knees with chronic osteoarthritic pain: a clinical, ultrasonographic, radiographic and scintigraphic evaluation. Rheumatol Int 2008; 29:141-6. [DOI: 10.1007/s00296-008-0639-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Accepted: 06/15/2008] [Indexed: 11/26/2022]
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