Radiation synovectomy radiosynovectomy or radiosynoviorthesis Joanna Zalewska Definition

Radiation synovectomy (radiosynovectomy or radiosynoviorthesis) Joanna Zalewska

Definition Radiosynovectomy is a radiopharmaceutical admission of colloidal solution to cavity joints.

Types SYNOVECTOMY chemical radioisotopic • 3% Aethoxysklerol • yttrium, rhenium, erbium, gold Admission to cavity joint surgical -Artroscopy - Open surgery

Radiosynovectomy - history 1952 - Karl Fellinger (Austria) - patients with RA 1963 - USA- patients with RA 1971 - Ahlberg i Pettersson (Sweden) - patients with hemophilia 1980 - prof. I. Fiedorowicz- Fabrycy (Poland)

Characteristics of radioisotope Erbium – 169 Rhenium – 186 Yttrium - 90 T ½ (days) 9, 5 3, 7 2, 7 Radiation β β γ β Max energy β (Me. V) γ (ke. V) 0, 34 0, 98 2, 26 Average size nm circa 10 5 -10 circa 10 Average distance of radiation mm 0, 3 (0, 7) 1, 2 (3, 6) 3, 6 (11) 137

Mechanism Phagocytosis of colloid particles Sclerotisation and fibrination prof. Schneider, Journal of Nucl. Med. 2005

Indication • • RA psoriatic arthritis spondyloarthropathies osteoarthrosis reactive arthritis hemophilia pigmented villonodular synovitis

Method Admission of colloidal solution to cavity joints, using ultrasound, after puncture of joint. • Y-90 - knee • Er-169 - MCP, PIP, MTP • Re-186 – shoulder, hip, wrist, elbow

After procedure • Immobilization of joint – minimum 72 h

What we expect? Decrease of inflammation: • effusion • synovitis • rheumatoid granuloma

Contraindications • • • pregnancy lactation Baker cyst infection of skin Reactive arthritis

Synovitis The best results- the patients with RA in early stage of disease. • Decrease of synovitis- 31 - 53%

Effusion • Decrease of effusion- 23 -51% .

Power color Doppler • Decrease of vascularization