Our experience with radiosynoviorthesis and re-radiosynoviorthesis of knees

Full text: In this paper the authors present their experience with radiosynoviorthesis (RSO) and re-radiosynoviorthesis (re-RSO) of knees. The objectives of this study were to compare treatment results between first RSO and re-RSO. Before RSO an ultrasonography (USG), an X-ray, a three-phase bone scintigraphy (TPBS). The treatment effect (TE) can be expected if a synovitis is proved by these examinations. To knees we inject 200 MBq of the yttrium citrate. TE is evaluated by the clinical examination, USG and TPBS. If the effect of RSO is not satisfying, RSO can be repeated no sooner than 6 months later. Among our patients we have high percentage of re-RSO. A rate between single RSO and re-RSO was 11:8. From 1986 to December 2004 we treated 1267 knees with Yttrium Citrate 37.9% patients had gonarthrosis, 26.1% chronic synovitis, 20.3% rheumatoid arthritis, 4.6% relapsing fluid, 3.9% psoriatic arthropathy, 3.3% ankylozing spondylarthritis and 1.3% hemophilic arthropathy. The evaluation of TE by patients in 294 RSO (170 patients with single RSO and 124 pts with re-RSO an influence on a pain and a fluid formation after single RSO: 10.9% no influence, 42.2% substantial and long-term effect, 46.9% partial TE and after re-RSO: 8.2% no influence, 36.6% the substantial and long-term TE, 55,2% the partial TE. The best results evaluated by patients were in patients with the rheumatoid arthritis and haemophilia. Worst results were in osteoarthritis in case of considerable radiological changes. Clinical follow up of 110 pts with single RSO and 70 pts with re-RSO: after single RSO: after 6 months in 77% swelling and a filling reduction and in 86% pain reduction, after 1 year in 53% the swelling and the filling reduction and in 62% the pain reduction, after 2 yrs in 28% the swelling and the filling reduction and in 48% the pain reduction; after re-RSO: after 6 months in 62% the swelling and the filling reduction and in 75% the pain reduction, after 1 year in 43% the swelling and the filling reduction and in 61% the pain reduction, after 2 yrs in 35% the swelling and the filling reduction and in 51% the pain reduction. After RSO we have observed a significant reduction of blood pool activity and synovial swelling with further improvement in the following months. There is a strong correlation between the reduction of blood pool activity (apparent on TPBS), synovial swelling (apparent on USG) and improvement of pain. Ultrasonography finding: Single RSO: before therapy: marked filling and synovial reaction with villus; after 6 months, 1 year and 2 years: without treatment effect - the same ultrasonographic finding; partial effect - the reduction of the filling, synovial villus and synovitis have not diffuse character; substantial effect minimal filling without synovial reaction. Re-RSO: before therapy: marked filling and synovial reaction with villus; after 6 months, 1 year and 2 years: without treatment effect - similar ultrasonographic finding as before treatment with some ligamentous reaction; partial effect - the reduction of the filling, synovial villus and the synovitis have not diffuse character with synovial ligamentous reaction; substantial effect - without filling and minimal synovial reaction with sporadic occurrence of synovial villus, synovial ligamentous reaction. Radiographic finding: Before therapy it depends on the primary diagnosis. After single RSO: without therapeutic effect - after 6 months: it does not change or it impairs; after 1 and 2 years: it impairs; partial treatment effect: after 6 months: it does not change, after 1 and 2 years: it does not change or it can impair; substantial effect: after 6 month, 1 and 2 years: radiographic finding does not impair, it does not change. After re-RSO: entirely the same radiographic finding as after single RSO. TPBS: The finding before single RSO and re-RSO: positive the first two phases of TPBS. After single RSO: without therapeutic effect - after 6 months, 1 and 2 years: it does not change with higher blood pool, partial treatment effect: after 6 months, 1 and 2 years: blood pool can be higher but not so much as before treatment; substantial effect: after 6 month, 1 and 2 years: normalization of blood pool. After re-RSO: entirely the same blood-pool finding as after single RSO. We have observed side effects of the therapy in 5% patients in the form of a radiation synovitis which has subsided after 2 or 3 weeks during combined symptomatic therapy with anti-rheumatic, orthesis and subsequent rehabilitation. RSO is effective, simple and for patients the convenient treatment procedure with a low occurrence of undesirable effects. Repeated RSO were as effective as single RSO, and its repeated use does not decrease the expected TE. (author)