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Der Nuklearmediziner 2006; 29(1): 5-14
DOI: 10.1055/s-2006-921331
CME-Beitrag

© Georg Thieme Verlag Stuttgart · New York

Grundlagen und Technik der Radiosynoviorthese

Principles and Practice of Radiation SynovectomyW. Brenner1
  • 1Klinik und Poliklinik für Nuklearmedizin, Zentrum für Bildgebende Diagnostik und Intervention, Universitätsklinikum Hamburg-Eppendorf
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Publication History

Publication Date:
02 March 2006 (online)

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Zusammenfassung

In der Behandlung chronisch entzündlicher Gelenkerkrankungen hat neben medikamentösen und arthroskopisch/chirurgischen Maßnahmen auch die nukleramedizinische Gelenktherapie, die Radiosynoviorthese (RSO), ihren festen Stellenwert. In Deutschland zur Therapie zugelassen sind die β-Strahler Yttrium-90, Rhenium-186 und Erbium-169 in Form kolloidaler Suspensionen zur intraartikulären Applikation. Die vorliegende Übersichtsarbeit soll sowohl die theoretischen Grundlagen der RSO, Indikationen, Kontraindikationen sowie potenzielle Nebenwirkungen und Komplikationen darstellen als auch praktische Anregungen zur Patientenvorbereitung, RSO-Durchführung und Nachsorge liefern. Überlegungen zum Strahlenschutz für Patient und Personal sollen das Bild abrunden.

Abstract

Radiation synovectomy is an established therapeutic tool for the treatment of chronic inflammatory joint disease in addition to standard systemic pharmacotherapy, local drug application, and arthroscopic or surgical procedures. Approved radiopharmaceuticals in Germany are the β-emitters yttrium-90, rhenium-186, and erbium-169 in colloidal suspensions for intra-articular administration. This review will give an overview of the basic physiology, indications, contraindications, potential side effects, and complications of radiation synovectomy as well as practical information on patient preparation, treatment procedure, and patient follow-up. Radiation safety considerations for both the patient and the personnel will complete this review.

Schlüsselwörter

Radiosynoviorthese - Erbium-169 - Rhenium-186 - Yttrium-90 - Gelenktherapie

Key words

radiation synovectomy - Erbium-169 - Rhenium-186 - Yttrium-90 - treatment of joints

Literatur

  • 1 Hollander J L, Brown E M, Jessar R A, Brown C Y. Hydrocortisone and cortisone injected into arthritic joints; comparative effects of and use of hydrocortisone as a local antiarthritic agent.  J Am Med Assoc. 1951;  147 1629-1635
    CrossrefPubMedGoogle Scholar
  • 2 Barrueco J L, Gazquez A, Redondo E, Regodon S. Changes in the coxofemoral articular cartilage in Wistar rats after systemic administration of corticoids.  Anat Anz. 1993;  175 47-51
    PubMedGoogle Scholar
  • 3 Fubini S L, Todhunter R J, Burton-Wurster N, Vernier-Singer M, MacLeod J N. Corticosteroids alter the differentiated phenotype of articular chondrocytes.  J Orthop Res. 2001;  19 688-695
    CrossrefPubMedGoogle Scholar
  • 4 Robion F C, Doize B, Boure L. et al . Use of synovial fluid markers of cartilage synthesis and turnover to study effects of repeated intra-articular administration of methylprednisolone acetate on articular cartilage in vivo.  J Orthop Res. 2001;  19 250-258
    CrossrefPubMedGoogle Scholar
  • 5 Podbielski A, Raiss R. Dose related effects of dexamethasone treatment on the ultrastructure of articular cartilage in rats.  Agents Actions. 1986;  17 322-324
    CrossrefPubMedGoogle Scholar
  • 6 Fellinger K, Schmid J. [Local therapy of rheumatic diseases.].  Wien Z Inn Med. 1952;  33 351-363
    PubMedGoogle Scholar
  • 7 Delbarre F, Cayla J, Menkes C. et al . [Synoviorthesis with radioisotopes].  Presse Med. 1968;  76 1045-1050
    PubMedGoogle Scholar
  • 8 Noble J, Jones A G, Davies M A. et al . Leakage of radioactive particle systems from a synovial joint studied with a gamma camera. Its application to radiation synovectomy.  J Bone Joint Surg [Am]. 1983;  65 381-389
    PubMedGoogle Scholar
  • 9 Pavelka K, Meier-Ruge W, Muller W, Fridrich R. Histological study of effects of colloidal 90 yttrium on knee joint tissues of rabbits.  Ann Rheum Dis. 1975;  34 64-69
    PubMedGoogle Scholar
  • 10 Myers S L, Slowman S D, Brandt K D. Radiation synovectomy stimulates glycosaminoglycan synthesis by normal articular cartilage.  J Lab Clin Med. 1989;  114 27-35
    PubMedGoogle Scholar
  • 11 Kerschbaumer F, Kandziora F, Herresthal J, Hertel A, Hor G. [Combined arthroscopic and radiation synovectomy in rheumatoid arthritis].  Orthopade. 1998;  27 188-196
    CrossrefPubMedGoogle Scholar
  • 12 Clunie G, Ell P J. A survey of radiation synovectomy in Europe, 1991-1993.  Eur J Nucl Med. 1995;  22 970-976
    PubMedGoogle Scholar
  • 13 Gobel D, Gratz S, Rothkirch T von, Becker W. [Chronic polyarthritis and radiosynoviorthesis: a prospective, controlled study of injection therapy with erbium 169 and rhenium 186].  Z Rheumatol. 1997;  56 207-213
    CrossrefPubMedGoogle Scholar
  • 14 Gobel D, Gratz S, Rothkirch T von, Becker W, Willert H G. Radiosynoviorthesis with rhenium-186 in rheumatoid arthritis: a prospective study of three treatment regimens.  Rheumatol Int. 1997;  17 105-108
    CrossrefPubMedGoogle Scholar
  • 15 Boussina I, Toussaint M, Ott H, Hermans P, Fallet G H. A double-blind study of erbium 169 synoviorthesis in rheumatoid digital joints. Results after one year.  Scand J Rheumatol. 1979;  8 71-74
    PubMedGoogle Scholar
  • 16 Menkes C J, Go A L, Verrier P, Aignan M, Delbarre F. Double-blind study of erbium 169 injection (synoviorthesis) in rheumatoid digital joints.  Ann Rheum Dis. 1977;  36 254-256
    PubMedGoogle Scholar
  • 17 Deutsch E, Brodack J W, Deutsch K F. Radiation synovectomy revisited.  Eur J Nucl Med. 1993;  20 1113-1127
    PubMedGoogle Scholar
  • 18 Kresnik E, Mikosch P, Gallowitsch H J. et al . Clinical outcome of radiosynoviorthesis: a meta-analysis including 2 190 treated joints.  Nucl Med Commun. 2002;  23 683-688
    CrossrefPubMedGoogle Scholar
  • 19 Boerbooms A M, Buijs W C, Danen M, van de Putte L B, Vandenbroucke J P. Radio-synovectomy in chronic synovitis of the knee joint in patients with rheumatoid arthritis.  Eur J Nucl Med. 1985;  10 446-449
    PubMedGoogle Scholar
  • 20 Spooren P F, Rasker J J, Arens R P. Synovectomy of the knee with 90Y.  Eur J Nucl Med. 1985;  10 441-445
    PubMedGoogle Scholar
  • 21 Bowen B M, Darracott J, Garnett E S, Tomlinson R H. Yttrium-90 citrate colloid for radioisotope synovectomy.  Am J Hosp Pharm. 1975;  32 1027-1030
    PubMedGoogle Scholar
  • 22 Kampen W U, Brenner W, Kroeger S. et al . Long-term results of radiation synovectomy: a clinical follow-up study.  Nucl Med Commun. 2001;  22 239-246
    CrossrefPubMedGoogle Scholar
  • 23 Menkes C J. Radioisotope synoviorthesis in rheumatoid arthritis.  Rheumatol Rehabil. 1979;  Suppl 45-46
    PubMedGoogle Scholar
  • 24 Gregoir C, Menkes C J. The rheumatoid elbow: patterns of joint involvement and the outcome of synoviorthesis.  Ann Chir Main Memb Super. 1991;  10 243-246
    PubMedGoogle Scholar
  • 25 Kat S, Kutz R, Elbracht T, Weseloh G, Kuwert T. Radiosynovectomy in pigmented villonodular synovitis.  Nuklearmedizin. 2000;  39 209-213
    PubMedGoogle Scholar
  • 26 Shabat S, Kollender Y, Merimsky O. et al . The use of surgery and yttrium 90 in the management of extensive and diffuse pigmented villonodular synovitis of large joints.  Rheumatology (Oxford). 2002;  41 1113-1118
    CrossrefPubMedGoogle Scholar
  • 27 Ahlberg A, Pettersson H. Synoviorthesis with radioactive gold in hemophiliacs. Clinical and radiological follow-up.  Acta Orthop Scand. 1979;  50 513-517
    PubMedGoogle Scholar
  • 28 Fernandez-Palazzi F, Caviglia H. On the safety of synoviorthesis in haemophilia.  Haemophilia. 2001;  7 (Suppl 2) 50-53
    CrossrefPubMedGoogle Scholar
  • 29 Siegel H J, Luck J V, Siegel M E, Quinones C. Phosphate-32 colloid radiosynovectomy in hemophilia: outcome of 125 procedures.  Clin Orthop Relat Res. 2001;  392 409-417
    PubMedGoogle Scholar
  • 30 Silva M, Luck J V, Siegel M E. 32P chromic phosphate radiosynovectomy for chronic haemophilic synovitis.  Haemophilia. 2001;  7 (Suppl 2) 40-49
    CrossrefPubMedGoogle Scholar
  • 31 Moedder G. Radiosynoviorthesis in patients with knee prosthesis (abstract).  Nuklearmedizin. 1994;  33 A39
    PubMedGoogle Scholar
  • 32 Moedder G, Moedder-Reese R. Radiosynoviorthesis after total knee replacement: effective therapy of “polyethylene disease” (in German).  Der Nuklearmediziner. 2001;  24 97-103
    PubMedGoogle Scholar
  • 33 Kampen W U, Hellweg L, Massoudi-Nickel S. et al . Clinical efficacy of radiation synovectomy in digital joint osteoarthritis.  Eur J Nucl Med Mol Imaging. 2005;  32 575-580
    CrossrefPubMedGoogle Scholar
  • 34 Chin K R, Barr S J, Winalski C, Zurakowski D, Brick G W. Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee.  J Bone Joint Surg [Am]. 2002;  84 2192-2202
    PubMedGoogle Scholar
  • 35 Klett R, Steiner M, Puille M, Bauer R. Einfluss der Radiosynoviorthese des Kniegelenks auf bestehende Bakerzysten (abstract).  Nuklearmedizin. 2000;  39 A90
    PubMedGoogle Scholar
  • 36 Gratz S, Gobel D, Becker W. [Radiosynoviorthesis in inflammatory joint diseases].  Orthopade. 2000;  29 164-170
    PubMedGoogle Scholar
  • 37 Savaser A N, Hoffmann K T, Sorensen H, Banzer D H. [Radiosynoviorthesis in the treatment plan of chronic inflammatory joint diseases].  Z Rheumatol. 1999;  58 71-78
    CrossrefPubMedGoogle Scholar
  • 38 Kolarz G, Thumb N. Methods of nuclear medicine in rheumatology. Schattauer, Stuttgart 1982
    Google Scholar
  • 39 Peters W, Lee P. Radiation necrosis overlying the ankle joint after injection with yttrium-90.  Ann Plast Surg. 1994;  32 542-543
    CrossrefPubMedGoogle Scholar
  • 40 Neves M, Waerenborgh F, Patricio L. Palladium-109 and holmium-166 potential radionuclides for synoviotherapy-radiation absorbed dose calculations.  Int J Rad Appl Instrum [A]. 1987;  38 745-749
    PubMedGoogle Scholar
  • 41 Manil L, Voisin P, Aubert B. et al . Physical and biological dosimetry in patients undergoing radiosynoviorthesis with erbium-169 and rhenium-186.  Nucl Med Commun. 2001;  22 405-416
    CrossrefPubMedGoogle Scholar
  • 42 Ruotsi A, Hypen M, Rekonen A, Oka M. Erbium-169 versus triamcinolone hexacetonide in the treatment of rheumatoid finger joints.  Ann Rheum Dis. 1979;  38 45-47
    CrossrefPubMedGoogle Scholar
  • 43 Gratz S, Gobel D, Behr T M, Herrmann A, Becker W. Correlation between radiation dose, synovial thickness, and efficacy of radiosynoviorthesis.  J Rheumatol. 1999;  26 1242-1249
    PubMedGoogle Scholar
  • 44 Klett R, Puille M, Matter H P. et al . [Activity leakage and radiation exposure in radiation synovectomy of the knee: influence of different therapeutic modalities].  Z Rheumatol. 1999;  58 207-212
    CrossrefPubMedGoogle Scholar
  • 45 Daker M G. Prospective chromosomal study of 30 patients undergoing 90Y synovectomy.  Rheumatol Rehabil. 1979;  Suppl 41-44
    PubMedGoogle Scholar
  • 46 Houvenagel E, Debouvry L, Leloire O. et al . [Cytogenetic anomalies after isotope synoviorthesis in rheumatoid polyarthritis].  Rev Rhum Mal Osteoartic. 1991;  58 31-34
    PubMedGoogle Scholar
  • 47 Prosser J S, Izard B E, Brown J K. et al . Induction of micronuclei in peripheral blood lymphocytes of patients treated for rheumatoid or osteo-arthritis of the knee with dysprosium-165 hydroxide macroaggregates or yttrium-90 silicate.  Cytobios. 1993;  73 7-15
    PubMedGoogle Scholar
  • 48 Vuorela J, Sokka T, Pukkala E, Hannonen P. Does yttrium radiosynovectomy increase the risk of cancer in patients with rheumatoid arthritis?.  Ann Rheum Dis. 2003;  62 251-253
    CrossrefPubMedGoogle Scholar
  • 49 IRCP .IRCP-60: Recommendations of the IRCP. International Commission on Radiation Protection 1991
    Google Scholar
  • 50 Havlik E, Pirich C, Preitfellner J. et al . Radiation exposure from patients treated with 165Dy-ferric hydroxide.  Nucl Med Commun. 2001;  22 79-82
    PubMedGoogle Scholar
  • 51 Liepe K, Andreeff M, Mielcarek J. et al . [Beta-radiation exposure at the finger tips during the radionuclide synovectomy].  Nuklearmedizin. 2003;  42 104-108
    PubMedGoogle Scholar
  • 52 Rodel R, Ebert A, Reichmann K. et al . [Effectiveness of syringe shieldings using radionuclides in radiation synovectomy].  Nuklearmedizin. 2003;  42 50-53
    PubMedGoogle Scholar

Prof. Dr. med. Winfried Brenner

Klinik und Poliklinik für Nuklearmedizin · Universitätsklinikum Hamburg-Eppendorf

Martinistr. 52

20246 Hamburg

Phone: 0 40/4 28 03 40 47

Fax: 0 40/4 28 03 93 30

Email: w.brenner@uke.uni-hamburg.de

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