Radiosynovectomy of ankle joint synovitis in juvenile rheumatoid arthritis treated with rhenium-188 tin colloid and imaging with SPECT/CT

Koramadai Karuppusamy Kamaleshwaran,Madhav Mallia,Radhakrishnan Kalarikal,Boopathy Krishnan,Ajit S Shinto,Thirumalaisamy S Gounder

doi:10.4103/1110-161x.163949

Koramadai Karuppusamy Kamaleshwaran, Madhav Mallia + Show 4 more

Open Access

https://doi.org/10.4103/1110-161x.163949

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Abstract

Rheumatoid arthritis is a chronic disease that is mainly characterized by asymmetric erosive synovitis, particularly affecting peripheral joints. Radiation synovectomy, or radiosynovectomy, was first described in 1950s as an adjuvant treatment for rheumatoid arthritis. Radiosynovectomy is based on the irradiation of the synovial joint by means of intra-articular administration of various β-emitting radiopharmaceuticals. As a generator-produced beta-emitting radionuclide, the importance of rhenium-188 (Re-188) in radionuclide therapy is increasing rapidly. There are previous studies that used Re-188 tin colloid in knee joint synovitis, but its use in ankle joint has not yet been reported. We describe the use of Re-188 tin colloid in a 19-year-old male patient who presented with ankle joint synovitis.

Highlights

Rheumatoid arthritis (RA) is a chronic, progressive, inflammatory joint disorder, the primary treatment for which consists of medical regimens aimed at controlling synovial inflammation of the joint [1]
We describe the use of Re-188 tin colloid in a 19-year-old male patient who presented with ankle joint synovitis
Re-188 is readily available on routine bases from the tungsten-188/Re-188 generator system [3], which has a shelf-life of several months

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic, progressive, inflammatory joint disorder, the primary treatment for which consists of medical regimens aimed at controlling synovial inflammation of the joint [1]. We describe the first case of application of Re-188 tin colloid in the treatment of ankle joint synovitis in RA. Case report A 19-year-old male patient presented with right ankle joint pain and swelling for a duration of 6 months. His blood investigations revealed elevated C-reactive protein (60 mg/ml) and was diagnosed to have juvenile RA. 160 Egyptian Rheumatology & Rehabilitation joint (Fig. 3), and SPECT/CT images (Fig. 4) showed good distribution of tracer in the ankle, subtalar, and calcaneocuboid joint. His ankle was immobilized for 48 h. On follow-up after 3 months, pain and swelling of the ankle joint decreased significantly

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