The use of radiosynovectomy in patients with juvenile idiopathic arthritis. Assessment of treatment efficacy and safety

Objectives The aim of the study was to evaluate the usefulness of knee joint radiosynovectomy (RS) in patients suffering from juvenile idiopathic arthritis (JIA). Material and methods One hundred RS procedures performed in 58 patients with JIA in average age 10.4 years were evaluated. Results After 6 weeks, a decrease in the number of cases with joint pain from 90.3% to 29%, with joint oedema from 100% to 74.5%, with joint exudate from 100% to 60.6%, with gait disorders from 19.4% to 3.2%, with joint mobility disorders from 51.1% to 26.6% in the RS cases was observed. A reduction of the score in the Colorado scale from 10.9 to 4.66, in the pain visual analogue scale (VAS) from 50 to 10, in the illness VAS assessed by the patient/parent from 69.9 to 32.4, in the illness VAS assessed by the physician from 68.8 to 36.9 was observed. Six months after the RS procedure, a reduction in the number of cases with joint pain from 89.5% prior to the procedure to 29.5%, with oedema from 100% to 58.3%, with exudate from 100% to 46.9%, with gait disorders from 20% to 2.1%, with joint motility disorders from 51.1% to 26.1% was achieved. The score in the Colorado scale was reduced from 10.9 to 4.04, in the pain VAS from 40 to 0, in the illness VAS assessed by the patient/parent from 69.7 to 27.9, in the illness VAS assessed by the physician from 68.8 to 32.4. In ultrasound examinations, the greatest improvement compared to the initial condition was recorded in the 6th month after the RS. Radiosynovectomy was positively evaluated by parents and patients in 34 anonymous surveys. Early and late observations (average 1473 days) did not show lesions at the isotope injection site, and no neoplastic lesions were observed. Conclusions Radiosynovectomy is a valuable therapeutic option for local treatment in patients with JIA.

[1]  A. Tukiendorf,et al.  The results of 394 consecutive cases of knee joint radiation synovectomy (radiosynoviorthesis) using 90Y , 2019, Annals of Nuclear Medicine.

[2]  L. Królicki,et al.  FRI0089 SAFETY AND EFFICACY OF RADIONUCLIDE SYNOVECTOMY IN PATIENTS WITH PERSISTENT INFLAMMATORY OF SINGLE JOINT IN THE COURSE OF BIOLOGICAL THERAPY , 2019, Poster Presentations.

[3]  M. Płazińska,et al.  Beta burns following radionuclide synovectomy , 2018, Reumatologia.

[4]  R. Pujol,et al.  Persistent cutaneous ulcers after Yttrium‐90 synovectomy, an unusual complication: two case reports and a review of the literature , 2017, International wound journal.

[5]  S. Jeka,et al.  Efficacy of radiation synovectomy (radiosynovectomy or radiosynoviorthesis) with yttrium-90 in exudative inflammation of synovial membrane of knee joints in patients with rheumatic diseases – preliminary report , 2016, Reumatologia.

[6]  L. Valentino,et al.  Safety of radiation exposure after radiosynovectomy in paediatric patients with haemophilia , 2015, Haemophilia : the official journal of the World Federation of Hemophilia.

[7]  L. Knut Radiosynovectomy in the Therapeutic Management of Arthritis , 2015, World journal of nuclear medicine.

[8]  V. Jiménez‐Yuste,et al.  Radiosynovectomy in haemophilia: long-term results of 500 procedures performed in a 38-year period. , 2014, Thrombosis research.

[9]  V. Jiménez‐Yuste,et al.  Radiosynovectomy: review of the literature and report from two haemophilia treatment centers , 2013, Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis.

[10]  K. Liepe Efficacy of radiosynovectomy in rheumatoid arthritis , 2012, Rheumatology International.

[11]  V. Jiménez‐Yuste,et al.  Radiosynovectomy in hemophilia: quantification of its effectiveness through the assessment of 10 articular parameters , 2011, Journal of thrombosis and haemostasis : JTH.

[12]  M. Dondi,et al.  Radiosynovectomy using yttrium-90, phosphorus-32 or rhenium-188 radiocolloids versus corticoid instillation for rheumatoid arthritis of the knee , 2011, Annals of nuclear medicine.

[13]  M. Ozdemir,et al.  The effectiveness of radioisotope synovectomy for chronic synovitis in Turkish paediatric haemophiliacs: Ankara experience , 2010, Haemophilia : the official journal of the World Federation of Hemophilia.

[14]  A. Bassiony,et al.  Treatment of Diffuse Pigmented Villonodular Synovitis of the Knee with Combined Surgical and Radiosynovectomy , 2009, HSS Journal.

[15]  H. Öztürk,et al.  Treatment of skin necrosis after radiation synovectomy with yttrium-90: a case report , 2008, Rheumatology International.

[16]  B. Das Role of radiosynovectomy in the treatment of rheumatoid arthritis and hemophilic arthropathies , 2007, Biomedical imaging and intervention journal.

[17]  Y. Rycke,et al.  Better results with rhenium-186 radiosynoviorthesis than with cortivazol in rheumatoid arthritis (RA): a two-year follow-up randomized controlled multicentre study. , 2004, Clinical and experimental rheumatology.

[18]  M. Suarez‐Almazor,et al.  International League of Associations for Rheumatology: International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001 , 2004 .

[19]  M. Fischer,et al.  EANM Procedure Guidelines for Radiosynovectomy , 2003, European Journal of Nuclear Medicine and Molecular Imaging.

[20]  P. Mikosch,et al.  Clinical outcome of radiosynoviorthesis: a meta-analysis including 2190 treated joints , 2002, Nuclear medicine communications.

[21]  T. Abshire,et al.  Radionuclide Synovectomy for Hemophilic Arthropathy: A Comprehensive Review of Safety and Efficacy and Recommendation for a Standardized Treatment Protocol , 2002, Thrombosis and Haemostasis.

[22]  J. Jacobs,et al.  The effect of radiation synovectomy in patients with persistent arthritis: a prospective study. , 2001, Clinical and experimental rheumatology.

[23]  Farley,et al.  Isotopic synovectomy with P‐32 in paediatric patients with haemophilia , 2000, Haemophilia : the official journal of the World Federation of Hemophilia.

[24]  K. Fellinger,et al.  [Local therapy of rheumatic diseases]. , 1952, Wiener Zeitschrift fur innere Medizin und ihre Grenzgebiete.

[25]  M. Majdan,et al.  [Methods of efficacy assessment of the knee joint radiosynoviorthesis- personal experience]. , 2018, Wiadomosci lekarskie.

[26]  J. Bijlsma,et al.  Radiation synovectomy with (90)Yttrium, (186)Rhenium and (169)Erbium: a systematic literature review with meta-analyses. , 2009, Clinical and experimental rheumatology.

[27]  C. Reiners,et al.  Radiosynovectomy in rheumatology, orthopedics, and hemophilia. , 2005, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[28]  T. Löfqvist,et al.  Synoviorthesis in young patients with hemophilia and inhibitory antibodies. , 1992, Pediatric hematology and oncology.