Radiation synovectomy of the ankle with 75 MBq colloidal 186rhenium-sulfide: effect, leakage, and radiation considerations.
OBJECTIVE
In a retrospective study we evaluated the effect, duration of effect, and safety of radiosynoviorthesis of the ankle in patients with persistent synovitis, refractory to disease modifying antirheumatic drugs (DMARD) and intraarticular glucocorticoid injections. We estimated leakage and dose to target and non-target organs.


METHODS
Radiation synovectomy was performed by injection of 75 MBq 186rhenium colloid and 20 mg triamcinolone-hexacetonide mixed in a volume of about 1.5 ml. About 24 hours after injection, leakage of the radionuclide was measured with a single-head gamma camera, with views of the ankle joint, regional (inguinal) lymph nodes, and liver. Leakage was expressed as counts in the target region of interest corrected for background relative to total counts corresponding with percentage of injected dose. The effect of radiosynoviorthesis was scored into 3 categories: (1) No effect, i.e., persistent synovitis or only minimal reduction of swelling and/or pain, or the need of intraarticular glucocorticoid injection within 3 months or arthrodesis of the treated joint within 6 months. (2) Moderate effect, i.e., significant reduction of swelling, pain, and improvement of function. (3) Good effect, i.e., complete or almost complete remission of synovitis.


RESULTS
The mean age of patients (28 women, 12 men) at the time of treatment was 58 years (range 33-76); 54 consecutive procedures in ankles of the 40 patients were evaluated. No effect was found in 12 of 54 (22%) treated joints; moderate effect in 12 (22%), with a mean duration of effect of 34 months (range 12-49); and good effect in 30 (56%), with a mean duration of effect of 41 months (range 21-75). Mean effect-duration did not differ significantly between the moderate and good effect groups. Mean leakage did not differ significantly between the effect groups.


CONCLUSIONS
Radiation synovectomy of the ankle is a safe and effective treatment in persistent synovitis, although all patients eventually experienced recurrence of arthritis.
van der Zant
Friso M
FM
Department of Nuclear Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands. f.zant@mca.nl
Jahangier
Z Nazira Z
ZN
Moolenburgh
J Daniel
JD
van der Zee
Wiebe
W
Boer
Robbert O
RO
Jacobs
Johannes W G
JW
D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000473:pathology / Q000528:radiation effects / Q000601:surgery*; D001822:Body Burden; D002712:Chlorides / Q000627:therapeutic use*; D003102:Colloids; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D011868:Radioisotopes / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D012211:Rhenium / Q000627:therapeutic use*; D013440:Sulfides; D000074402:Synovectomy; D013583:Synovial Membrane / Q000473:pathology / Q000528:radiation effects; D013585:Synovitis / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016896:Treatment Outcome
D002712:Chlorides; D003102:Colloids; D011868:Radioisotopes; D013440:Sulfides; C400124:rhenium sulfide; D012211:Rhenium