Abstract
PurposeRadiosynoviorthesis (RSO) using the intraarticular application of beta-particle emitting radiocolloids has for decades been used for the local treatment of inflammatory joint diseases. The injected radiopharmaceuticals are phagocytized by the superficial macrophages of the synovial membrane, resulting in sclerosis and fibrosis of the formerly inflamed tissue, finally leading to reduced joint effusion and alleviation of joint pain.MethodsThe European Association of Nuclear Medicine (EANM) has written and approved these guidelines in tight collaboration with an international team of clinical experts, including rheumatologists. Besides clinical and procedural aspects, different national legislative issues, dosimetric considerations, possible complications, and side effects are addressed.ConclusionThese guidelines will assist nuclear medicine physicians in performing radiosynoviorthesis. Since there are differences regarding the radiopharmaceuticals approved for RSO and the official indications between several European countries, this guideline can only give a framework that must be adopted individually.
Highlights
Intraarticular therapy using colloidal beta-emitting radionuclides, radiosynoviorthesis or RSO, is known for almost 70 years and is indicated in patients suffering from various inflammatory joint diseases [1]
RSO is effective in controlling symptoms of persistent synovitis in rheumatoid arthritis (RA) patients
RSO provides acceptable clinical results in selected patients with OA according to the severity of degenerative changes
Summary
Intraarticular therapy using colloidal beta-emitting radionuclides, radiosynoviorthesis or RSO, is known for almost 70 years and is indicated in patients suffering from various inflammatory joint diseases [1]. Three-phase bone scintigraphy, MRI, ultrasound, or histology after surgical synovectomy (e.g., in patients suffering from intraarticular diffuse-type giant cell tumor/pigmented villonodular synovitis) can be used for this purpose. The term “radiosynovectomy,” frequently found in the literature, should not be used because the synovial membrane is not “resected” (which is meant by the Greek word “ectome”) by injection of a radiocolloid. The mechanism of action of RSO starts with phagocytosis of the colloidal radiopharmaceuticals by the superficial lining cells of the inflamed synovial membrane [2]. The three approved radiopharmaceuticals [90Y]yttrium citrate, [186Re]rhenium sulfide, and [169Er]erbium citrate deliver their high-energy beta erbium-169 rhenium-186 yttrium-90
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