Grundlagen und Technik der Radiosynoviorthese

Zusammenfassung

In der Behandlung chronisch entzündlicher Gelenkerkrankungen hat neben medikamentösen und arthroskopisch/chirurgischen Maßnahmen auch die nukleramedizinische Gelenktherapie, die Radiosynoviorthese (RSO), ihren festen Stellenwert. In Deutschland zur Therapie zugelassen sind die β-Strahler Yttrium-90, Rhenium-186 und Erbium-169 in Form kolloidaler Suspensionen zur intraartikulären Applikation. Die vorliegende Übersichtsarbeit soll sowohl die theoretischen Grundlagen der RSO, Indikationen, Kontraindikationen sowie potenzielle Nebenwirkungen und Komplikationen darstellen als auch praktische Anregungen zur Patientenvorbereitung, RSO-Durchführung und Nachsorge liefern. Überlegungen zum Strahlenschutz für Patient und Personal sollen das Bild abrunden.

Abstract

Radiation synovectomy is an established therapeutic tool for the treatment of chronic inflammatory joint disease in addition to standard systemic pharmacotherapy, local drug application, and arthroscopic or surgical procedures. Approved radiopharmaceuticals in Germany are the β-emitters yttrium-90, rhenium-186, and erbium-169 in colloidal suspensions for intra-articular administration. This review will give an overview of the basic physiology, indications, contraindications, potential side effects, and complications of radiation synovectomy as well as practical information on patient preparation, treatment procedure, and patient follow-up. Radiation safety considerations for both the patient and the personnel will complete this review.

Radiosynoviorthese - Erbium-169 - Rhenium-186 - Yttrium-90 - Gelenktherapie

radiation synovectomy - Erbium-169 - Rhenium-186 - Yttrium-90 - treatment of joints

Literatur

• 1 Hollander J L, Brown E M, Jessar R A, Brown C Y. Hydrocortisone and cortisone injected into arthritic joints; comparative effects of and use of hydrocortisone as a local antiarthritic agent.  J Am Med Assoc. 1951;  147 1629-1635
• 2 Barrueco J L, Gazquez A, Redondo E, Regodon S. Changes in the coxofemoral articular cartilage in Wistar rats after systemic administration of corticoids.  Anat Anz. 1993;  175 47-51
• 3 Fubini S L, Todhunter R J, Burton-Wurster N, Vernier-Singer M, MacLeod J N. Corticosteroids alter the differentiated phenotype of articular chondrocytes.  J Orthop Res. 2001;  19 688-695
• 4 Robion F C, Doize B, Boure L. et al . Use of synovial fluid markers of cartilage synthesis and turnover to study effects of repeated intra-articular administration of methylprednisolone acetate on articular cartilage in vivo.  J Orthop Res. 2001;  19 250-258
• 5 Podbielski A, Raiss R. Dose related effects of dexamethasone treatment on the ultrastructure of articular cartilage in rats.  Agents Actions. 1986;  17 322-324
• 6 Fellinger K, Schmid J. [Local therapy of rheumatic diseases.].  Wien Z Inn Med. 1952;  33 351-363
• 7 Delbarre F, Cayla J, Menkes C. et al . [Synoviorthesis with radioisotopes].  Presse Med. 1968;  76 1045-1050
• 8 Noble J, Jones A G, Davies M A. et al . Leakage of radioactive particle systems from a synovial joint studied with a gamma camera. Its application to radiation synovectomy.  J Bone Joint Surg [Am]. 1983;  65 381-389
• 9 Pavelka K, Meier-Ruge W, Muller W, Fridrich R. Histological study of effects of colloidal 90 yttrium on knee joint tissues of rabbits.  Ann Rheum Dis. 1975;  34 64-69
• 10 Myers S L, Slowman S D, Brandt K D. Radiation synovectomy stimulates glycosaminoglycan synthesis by normal articular cartilage.  J Lab Clin Med. 1989;  114 27-35
• 11 Kerschbaumer F, Kandziora F, Herresthal J, Hertel A, Hor G. [Combined arthroscopic and radiation synovectomy in rheumatoid arthritis].  Orthopade. 1998;  27 188-196
• 12 Clunie G, Ell P J. A survey of radiation synovectomy in Europe, 1991-1993.  Eur J Nucl Med. 1995;  22 970-976
• 13 Gobel D, Gratz S, Rothkirch T von, Becker W. [Chronic polyarthritis and radiosynoviorthesis: a prospective, controlled study of injection therapy with erbium 169 and rhenium 186].  Z Rheumatol. 1997;  56 207-213
• 14 Gobel D, Gratz S, Rothkirch T von, Becker W, Willert H G. Radiosynoviorthesis with rhenium-186 in rheumatoid arthritis: a prospective study of three treatment regimens.  Rheumatol Int. 1997;  17 105-108
• 15 Boussina I, Toussaint M, Ott H, Hermans P, Fallet G H. A double-blind study of erbium 169 synoviorthesis in rheumatoid digital joints. Results after one year.  Scand J Rheumatol. 1979;  8 71-74
• 16 Menkes C J, Go A L, Verrier P, Aignan M, Delbarre F. Double-blind study of erbium 169 injection (synoviorthesis) in rheumatoid digital joints.  Ann Rheum Dis. 1977;  36 254-256
• 17 Deutsch E, Brodack J W, Deutsch K F. Radiation synovectomy revisited.  Eur J Nucl Med. 1993;  20 1113-1127
• 18 Kresnik E, Mikosch P, Gallowitsch H J. et al . Clinical outcome of radiosynoviorthesis: a meta-analysis including 2 190 treated joints.  Nucl Med Commun. 2002;  23 683-688
• 19 Boerbooms A M, Buijs W C, Danen M, van de Putte L B, Vandenbroucke J P. Radio-synovectomy in chronic synovitis of the knee joint in patients with rheumatoid arthritis.  Eur J Nucl Med. 1985;  10 446-449
• 20 Spooren P F, Rasker J J, Arens R P. Synovectomy of the knee with 90Y.  Eur J Nucl Med. 1985;  10 441-445
• 21 Bowen B M, Darracott J, Garnett E S, Tomlinson R H. Yttrium-90 citrate colloid for radioisotope synovectomy.  Am J Hosp Pharm. 1975;  32 1027-1030
• 22 Kampen W U, Brenner W, Kroeger S. et al . Long-term results of radiation synovectomy: a clinical follow-up study.  Nucl Med Commun. 2001;  22 239-246
• 23 Menkes C J. Radioisotope synoviorthesis in rheumatoid arthritis.  Rheumatol Rehabil. 1979;  Suppl 45-46
• 24 Gregoir C, Menkes C J. The rheumatoid elbow: patterns of joint involvement and the outcome of synoviorthesis.  Ann Chir Main Memb Super. 1991;  10 243-246
• 25 Kat S, Kutz R, Elbracht T, Weseloh G, Kuwert T. Radiosynovectomy in pigmented villonodular synovitis.  Nuklearmedizin. 2000;  39 209-213
• 26 Shabat S, Kollender Y, Merimsky O. et al . The use of surgery and yttrium 90 in the management of extensive and diffuse pigmented villonodular synovitis of large joints.  Rheumatology (Oxford). 2002;  41 1113-1118
• 27 Ahlberg A, Pettersson H. Synoviorthesis with radioactive gold in hemophiliacs. Clinical and radiological follow-up.  Acta Orthop Scand. 1979;  50 513-517
• 28 Fernandez-Palazzi F, Caviglia H. On the safety of synoviorthesis in haemophilia.  Haemophilia. 2001;  7 (Suppl 2) 50-53
• 29 Siegel H J, Luck J V, Siegel M E, Quinones C. Phosphate-32 colloid radiosynovectomy in hemophilia: outcome of 125 procedures.  Clin Orthop Relat Res. 2001;  392 409-417
• 30 Silva M, Luck J V, Siegel M E. 32P chromic phosphate radiosynovectomy for chronic haemophilic synovitis.  Haemophilia. 2001;  7 (Suppl 2) 40-49
• 31 Moedder G. Radiosynoviorthesis in patients with knee prosthesis (abstract).  Nuklearmedizin. 1994;  33 A39
• 32 Moedder G, Moedder-Reese R. Radiosynoviorthesis after total knee replacement: effective therapy of “polyethylene disease” (in German).  Der Nuklearmediziner. 2001;  24 97-103
• 33 Kampen W U, Hellweg L, Massoudi-Nickel S. et al . Clinical efficacy of radiation synovectomy in digital joint osteoarthritis.  Eur J Nucl Med Mol Imaging. 2005;  32 575-580
• 34 Chin K R, Barr S J, Winalski C, Zurakowski D, Brick G W. Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee.  J Bone Joint Surg [Am]. 2002;  84 2192-2202
• 35 Klett R, Steiner M, Puille M, Bauer R. Einfluss der Radiosynoviorthese des Kniegelenks auf bestehende Bakerzysten (abstract).  Nuklearmedizin. 2000;  39 A90
• 36 Gratz S, Gobel D, Becker W. [Radiosynoviorthesis in inflammatory joint diseases].  Orthopade. 2000;  29 164-170
• 37 Savaser A N, Hoffmann K T, Sorensen H, Banzer D H. [Radiosynoviorthesis in the treatment plan of chronic inflammatory joint diseases].  Z Rheumatol. 1999;  58 71-78
• 38 Kolarz G, Thumb N. Methods of nuclear medicine in rheumatology. Schattauer, Stuttgart 1982
• 39 Peters W, Lee P. Radiation necrosis overlying the ankle joint after injection with yttrium-90.  Ann Plast Surg. 1994;  32 542-543
• 40 Neves M, Waerenborgh F, Patricio L. Palladium-109 and holmium-166 potential radionuclides for synoviotherapy-radiation absorbed dose calculations.  Int J Rad Appl Instrum [A]. 1987;  38 745-749
• 41 Manil L, Voisin P, Aubert B. et al . Physical and biological dosimetry in patients undergoing radiosynoviorthesis with erbium-169 and rhenium-186.  Nucl Med Commun. 2001;  22 405-416
• 42 Ruotsi A, Hypen M, Rekonen A, Oka M. Erbium-169 versus triamcinolone hexacetonide in the treatment of rheumatoid finger joints.  Ann Rheum Dis. 1979;  38 45-47
• 43 Gratz S, Gobel D, Behr T M, Herrmann A, Becker W. Correlation between radiation dose, synovial thickness, and efficacy of radiosynoviorthesis.  J Rheumatol. 1999;  26 1242-1249
• 44 Klett R, Puille M, Matter H P. et al . [Activity leakage and radiation exposure in radiation synovectomy of the knee: influence of different therapeutic modalities].  Z Rheumatol. 1999;  58 207-212
• 45 Daker M G. Prospective chromosomal study of 30 patients undergoing 90Y synovectomy.  Rheumatol Rehabil. 1979;  Suppl 41-44
• 46 Houvenagel E, Debouvry L, Leloire O. et al . [Cytogenetic anomalies after isotope synoviorthesis in rheumatoid polyarthritis].  Rev Rhum Mal Osteoartic. 1991;  58 31-34
• 47 Prosser J S, Izard B E, Brown J K. et al . Induction of micronuclei in peripheral blood lymphocytes of patients treated for rheumatoid or osteo-arthritis of the knee with dysprosium-165 hydroxide macroaggregates or yttrium-90 silicate.  Cytobios. 1993;  73 7-15
• 48 Vuorela J, Sokka T, Pukkala E, Hannonen P. Does yttrium radiosynovectomy increase the risk of cancer in patients with rheumatoid arthritis?.  Ann Rheum Dis. 2003;  62 251-253
• 49 IRCP .IRCP-60: Recommendations of the IRCP. International Commission on Radiation Protection 1991
• 50 Havlik E, Pirich C, Preitfellner J. et al . Radiation exposure from patients treated with 165Dy-ferric hydroxide.  Nucl Med Commun. 2001;  22 79-82
• 51 Liepe K, Andreeff M, Mielcarek J. et al . [Beta-radiation exposure at the finger tips during the radionuclide synovectomy].  Nuklearmedizin. 2003;  42 104-108
• 52 Rodel R, Ebert A, Reichmann K. et al . [Effectiveness of syringe shieldings using radionuclides in radiation synovectomy].  Nuklearmedizin. 2003;  42 50-53