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Szentesi M, VAN DEN Wyngaert T, Géher P, Farbaky Z, Takács E, Csőre G, Kampen WU. Long-term clinical results from 10 years follow-up after radiosynoviorthesis: a prospective observational study. 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; 66:324-333. [PMID: 36106912 DOI: 10.23736/s1824-4785.22.03473-2] [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
BACKGROUND The aim of this study was to assess the long-term anti-inflammatory effect and safety of 90-Yttrium and 166-Holmium radiosynoviorthesis (RSO) for treating chronic knee synovitis of various origins. METHODS A total of 820 patients were included in this study and were followed up to 10 years after the procedure for objective and subjective changes in signs and symptoms of inflammation. RESULTS Five years after RSO, excellent and good results were seen in 71% (95% CI 67-74%) of patients. Six, seven, eight and nine years following RSO, efficacy did not decrease significantly. Ten years after RSO, the effectiveness of the therapy fell to 65% (95% CI 59-71%). Overall, 64% of patients did not need another joint puncture ten years after RSO. We achieved excellent to good results at 5 years in 79% of patients with rheumatoid arthritis, 59% with ankylosing spondylitis, and 62% with osteoarthritis. Efficacy was mainly affected by the local X-ray stage of the knee joint. A significant association was also found between the diagnosis of the underlying disease and the success of radiosynoviorthesis. Efficacy, however, was not substantially affected by any of the following factors: the duration of synovitis, the number of punctures before radiosynoviorthesis, the number of intraarticular steroid injections before the procedure, or the number of interventions before radiosynoviorthesis (radiotherapy, surgery). CONCLUSIONS Radiosynoviorthesis is an effective long-term method of treating chronic synovitis. The treatment showed the most favorable effects in patients with rheumatoid arthritis and those with mild to moderate degenerative osseous changes.
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Affiliation(s)
- Margit Szentesi
- Department of Rheumatology and Clinical Immunology, Polyclinic of the Hospitaller Brothers of St. John in God, Semmelweis University, Budapest, Hungary -
| | - Tim VAN DEN Wyngaert
- Nuclear Medicine UZA, Edegem, Belgium
- Faculty of Medicine and Health Sciences (MICA - IPPON), University of Antwerp, Wilrijk, Belgium
| | - Pál Géher
- Department of Rheumatology and Clinical Immunology, Polyclinic of the Hospitaller Brothers of St. John in God, Semmelweis University, Budapest, Hungary
| | - Zsófia Farbaky
- Department of Radiology, Polyclinic of the Hospitaller Brothers of St. John in God, Budapest, Hungary
| | - Edit Takács
- Department of Nuclear Medicine, Polyclinic of the Hospitaller Brothers of St. John in God, Budapest, Hungary
| | - Gyula Csőre
- St. Andrew Clinics of Rheumatology, Hévíz, Hungary
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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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