Is corticosteroid coinjection necessary for radiosynoviorthesis of patients with hemophilia?
OBJECTIVE
Radiation synovectomy is frequently combined with intraarticular corticosteroid injection in the treatment of rheumatoid arthritis to reduce local inflammation and lymphatic clearance of radiocolloid. However, this practice is not universally accepted because corticosteroids have local and systemic toxicity such as osteonecrosis and cartilage damage and whether simultaneous corticosteroid injection together with radiocolloids is necessary in other forms of chronic synovitis like patients with hemophilia remains to be determined.


METHODS
In this study, we performed radiosynoviorthesis in 14 joints of 12 patients with hemophilia with chronic knee synovitis without corticosteroid coadministration and measured radiocolloid leakage from the joint space. Five mCi Y-90 radiocolloid was injected under local anesthesia and the needle was flushed with additional lidocaine injection instead of corticosteroid. The joint was then manipulated through a full range of extension and flexion to distribute the particles homogeneously throughout the joint space. The joint was then splinted for 48 hours to minimize leakage from the joint space. After the immobilization period, radiocolloid leakage was evaluated using a gamma camera with a 20% window centered over the maximum Bremsstrahlung photopeak of Y-90. Regions of interest were drawn to the injection site on the knee joint and to the ipsilateral inguinal lymph node area. Leakage of radiocolloid was calculated by dividing the background-corrected counts/pixel at the inguinal region by the counts/pixel at the injection site.


RESULTS
One of 12 patients who had knee arthroplasty was previously found to have a high amount of leakage. In this patient, 70% of radiocolloid at the injection site drained into the pelvic lymph nodes. In the remaining 11 patients, no lymph nodes were visualized in the groin area and the measured average leakage for these patients was 2.3% (range, 0-13).


CONCLUSIONS
We concluded that in cases of appropriate particle size and strict immobilization of knee joints, leakage of radiocolloid was minimal and steroid coinjection might not be necessary for radiosynoviorthesis of patients with hemophilia with chronic knee synovitis.
Departments of Nuclear Medicine, Hacettepe University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey. goncak@hacettepe.edu.tr
Gonca Kara
GK
Gedik
Omer
O
Uğur
Bülent
B
Atilla
Semra
S
Dündar
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D017024:Chemotherapy, Adjuvant / Q000379:methods; D002648:Child; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*; D006395:Hemarthrosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006467:Hemophilia A / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D013585:Synovitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000532:radiotherapy*; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000008:administration & dosage / Q000009:adverse effects
D000305:Adrenal Cortex Hormones; D015021:Yttrium Radioisotopes