Radiosynovectomy as an alternative to surgical synovectomy in patients with recurrent arthritis
R.M. Balabanova, Yu.A. Olyunin, A.M. Lila
V.A. Nasonova Research Institute of Rheumatology, Moscow
Arthritis is the leading clinical manifestation among rheumatic diseases (RD). According to the Russian clinical guidelines, RD treatment begins with the prescription of disease-modifying anti-rheumatic drugs (DMARDs) in combination with glucocorticoid (GC) or nonsteroidal anti-inflammatory drugs (NSAIDs). If these treatments have poor effectiveness, genetically engineered biological drugs (GEBD) will be used. However, there is a category of patients with recurrent arthritis (mainly of the knee joints) despite high-tech therapy presence. These patients require frequent intra-articular GC administration or surgical synovectomy. GC therapy can be complicated by the concomitant diseases’ progression, such as type 2 diabetes mellitus, hypertension, glaucoma, osteoporosis. In patients with such comorbidity, GC is not recommended at all. Surgical synovectomy requires a long hospital stay for rehabilitation measures. Besides, the comorbid diseases’ presence may complicate the postoperative follow-up of patients. Radiosynovectomy (RSE) can serve as an alternative to surgical synovectomy, which is performed using an intra-articular injection of a radioactive drug. When a radionuclide enters the joint cavity, colloidal particles are recognized as foreign and phagocytosed by synovial cells. In virtue of the synovium selective radiation, there is cytoclasis with a decrease in the number and size of synovial villi, synovial fluid production, and proinflammatory cytokines. Then the synovial membrane starts fibrosis, after which long remission remains. Using the Russian Re-188 radiopharmaceutical agent will allow this method application in patients with recurrent arthritis who do not respond to conventional medical therapy.
Keywords: rheumatic diseases, recurrent arthritis, rheumatoid arthritis, synovial membrane, rhenium 188, radiocolloid, radiosynovectomy, local therapy, glucocorticoids, radionuclide.
For citation: Balabanova R.M., Olyunin Yu.A., Lila A.M. Radiosynovectomy as an alternative to surgical synovectomy in patients with recurrent arthritis. RMJ. Medical Review. 2019;4(I):17–19.
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2. Ковалерский Г.М., Гаркави А.В., Меньшикова И.В. и др. Артроскопическая синовэктомия при ревматоидном синовите коленного сустава. Научно-практическая ревматология. 2009;4:85–89. [Kovalersky G.M., Garkavi A.V., Menshikova I.V. et al. Arthroscopic synovectomy for rheumatoid synovitis of the knee joint. Scientific-practical rheumatology. 2009;4:85–89 (in Russ.)].
3. Липина М.М., Макаров М.А., Амирджанова В.Н. и др. Влияние артроскопической синовэктомии коленного сустава на показатели качества жизни и функциональное состояние больных ревматоидным артритом. Научно-практическая ревматология. 2012;52(3):120–124. [Lipina M. M., Makarov M.A., Amirdzhanova V.N. et al. Influence of arthroscopic knee synovectomy on the quality of life and functional status of patients with rheumatoid arthritis. Scientific and practical rheumatology. 2012;52(3):120–124 (in Russ.)].
4. Роскидайло А.А., Макаров С.А., Амирджанова В.Н. Отдаленные результаты синовэктомии и дебримента локтевого сустава при ревматоидном артрите. Научно-практическая ревматология. 2011;6:65–69. [Roskidailo A.A., Makarov S.A., Amirjanova V.N. et al. Long-term results of synovectomy and debridement of elbow joint in rheumatoid arthritis. Scientific and practical rheumatology. 2011;6:65–69 (in Russ.)].
5. Heuft-Dorenbosch E., De Vet H., van der Linden S. Yttrium radiosynoviorthesis in the treatment of knee arthritis in rheumatoid arthritis: a systematic review. Ann Rheum Dis. 2000;59:583–586.
6. Jahangier Z.N., Moolenburgh J.D. The effect of radiation synovectomy in patients with persistent arthritis: a prospective study. Clin Exp Rrheumatol. 2001;19:417–424.
7. Kahan A., Modder G., Menkes C.J. 169 Erbium-citrate after failure of local MCP and PIP corticosteroid injections to treat rheumatoid arthritis affected finger joints. Clin Exp Rheumat. 2004;22:722–726.
8. Delbarre F., Cayla J., Menkes C. et al. Lasynoviorthese par les radio-isotopes. Presse Med.1968;76:1045–1050.
9. Liepe K., Zaknun J.J., Padhy A. et al. Radiosynovectomy using yittrium-90, phosphorus-32 or rhenium-188 radiocolloids versus corticoid instillation for rheumatoid arthritis of the knee. Ann Nucl Med. 2011;25(5):317–323.
10. Karavida N., Notopoulos A. Radiation synovectomy: an effective alternative treatment for inflamed small joints. Hippokratia. 2010;14(1):22–27.
11. Олюнин Ю.А., Балабанова Р.М., Дроздовский Б.Я., Иконников А.И. Радиоизотопная синовэктомия в комплексном лечении ревматоидного артрита. Терапевтический архив. 1989;5:58–62. [Olyunin Y.A., Balabanova R.M., Drozdovsky B. Ya., Ikonnikov A.I. Radioisotope synovectomy in treatment of rheumatoid arthritis. Therapeutic archive. 1989;5:58–62 (in Russ.)].
12. Дроздовский Б.Я., Иконников А.И., Крылов В.В. Радиосиновиортез в лечении больных ревматоидным артритом. Медицинская радиология. 1990;7:6–9. [Drozdovsky B. Ya., Ikonnikov A.I., Krylov V.V. Radiosynoviorthesis in the treatment of patients with rheumatoid arthritis. Medical Radiology.1990;7:6–9 (in Russ.)].
13. Kampen W.U., Voth M., Pinkert J. et al. Therapeutic status of radiosynovorthesis of the knee with yttrium (90Y) colloid inrheumatoid arthritis and related indications. Rheumatology (Oxford). 2007;46(1):16–24.
14. Liepe K. Efficacy of radiosynovectomy in rheumatoid arthritis. Rheumatol. Int. 2012;32:3219–3224. DOI: 10.1007/s00296-011-2143-0.
15. Крылов В.В., Лиепе К. Радиосиновортез в лечении воспалительных заболеваний суставов. Научно-практ. ревматол. 2013,6:714–720. [Krylov V.V., Liepe K. Radiosinovortez in the treatment of inflammatory diseases of the joints. Rheumatology Science and Practice. 2013;51(6):714–720 (in Russ.)].
16. Lee E.B., ShrinK.C., Lee Y.I. et al. 188Re-tin-colloid as a new therapeutic agents for rheumatoid arthritis, Nucl Med Commun. 2003;24(6):689–696.
17. Wang S.J., Lin W.Y., Chen M.N. et al. Histologic study of effects of radiationsynovectomy with Rhenium 188 microsphere. Nucl.Med.Biol. 2001;28(6):727–732.
18. Clunie G., Fisher M. EANM procedure guidelines for radiosynovectomy. Eur J Nucl Med Mol imaging. 2003;30(3):12–16.
19. Siegel H.J., Luck V.J. Jr, Siegel M.E. Advances in radionuclide therapeutic in orthopedics. J Am AcadOrthop Surg. 2004;12:55–64.
20. Cwicla J.B., Zbikowski P., Kwiatkowska B.A. Radiosynovectomy in rheumatic diseases. J Ultrasonogr. 2014;14(58):241–251. DOI: 10.15557/Jju.2014.0024.
21. Kresnik E., Mikosch P., Gallowitsch N.J. Clinical outcome of radiosynoviorthesis: a meta-analysis including 2190 treated joints. Nucl Med Comm. 2002,23: b683–688.
22. Van der Zant F.M., Jahangier Z.N., Moolenburgh J.D. Clinical effect of radiation synovectomy of the upper extremity joints: a randomized, double-blind, placebo-controlled study. Eur J Nucl Med Mol imaging. 2007;34:212–218.
23. Zalewska J., Wegierska M., Barezynska T. et al. Efficacy of radiation synovectjmy with yittrium-90 in exudative inflammation of of synovial membrane of knee joints in patients with rheumatic disoders- preliminary report. Rheumatol. 2016;15(3):206–208.
24. Kampen W.U., Brenner W., Kroeger S. et al. Long-term results of radiation synovectomy a clinical follow-up study. Nucl.Med. Commun. 2001;22(2):239–246.
25. Klett R., Lange U., Haas H. et al. Radiosynoviorthesis of medium-sized joints with rhenium 186-sulphide colloid: a review of the literature. Rheumatol (Oxford). 2007;46(10):1531–1537. DOI: 10.1093/rheumatology/kem155.
26. Kamaleshwaran K.K., Rajamani V., Krishnan B. et al. Radiosynovectomy of proximal interphalangeal joints synovitis in rheumatoid arthritis treated with rhenium 188 labeled Tin-colloid and imaging with single-photon emission computerized tomography. World J Nucl Med. 2015;14(3):216–218.
27. Зверев А.В., Крылов В.В., Ханов А.Г. и др. Радиосиновэктомия — метод лечения воспалительных заболеваний суставов с помощью изотопов. РМЖ. Медицинское обозрение. 2017;1:36–41. [Zverev V.A., Krylov V.V., Khan A.G. et al. Radiosynovectomy is a method of treating inflammatory diseases of the joints with isotopes. RMJ. Medical Review. 2017;1:36–41 (in Russ.)].
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