Synovectomy Of Joints Research Articles

Arthroscopy and arthroscopic synovectomy of finger joints in rheumatoid arthritis

Arthroscopy and arthroscopic synovectomy of finger joints in rheumatoid arthritis

Thulium-170-labeled microparticles for local radiotherapy: preliminary studies.

The present article describes the preparation, characterization, and biological evaluation of Thulium-170 ((170)Tm) [T1/2 = 128.4 days; Eβmax = 968 keV; Eγ = 84 keV (3.26%)] labeled tin oxide microparticles for its possible use in radiation synovectomy (RSV) of medium-sized joints. (170)Tm was produced by irradiation of natural thulium oxide target. 170Tm-labeled microparticles were synthesized with high yield and radionuclidic purity (> 99%) along with excellent in vitro stability by following a simple process. Particle sizes and morphology of the radiolabeled particles were examined by light microscope, dynamic light scattering, and transmission electron microscope and found to be of stable spherical morphology within the range of 1.4-3.2 μm. The preparation was injected into the knee joints of healthy Beagle dogs intraarticularly for biological studies. Serial whole-body and regional images were taken by single-photon-emission computed tomography (SPECT) and SPECT-CT cameras up to 9 months postadministration, which showed very low leakage (< 8% of I.D.) of the instilled particles. The majority of leaked radiocolloid particles were found in inguinal lymph nodes during the 9 months of follow-up. All the animals tolerated the treatment well; the compound did not show any possible radiotoxicological effect. These preliminary studies showed that 170Tm-labeled microparticles could be a promising nontoxic and effective radiopharmaceutical for RSV applications or later local antitumor therapy.

Erbium-169 labeled hydroxyapatite particulates for use in radiation synovectomy of digital joints – a preliminary investigation

Abstract Erbium-169 [T 1/2 = 9.4 d, E β( max ) = 342 keV (45%) and 351 keV (55%), E γ = 110.5 KeV (0.0014%)] is the most preferred radionuclide for radiation synovectomy (RSV) of digital joints. Radiolabeled particulates of appropriate size, wherein the radionuclide is irreversibly attached to the preformed particles, offer distinct advantages as the radiopharmaceuticals for use in RSV over other radiotherapeutic agents in terms of minimal leakage of radioactivity from the joint cavity. Hyroxyapatite (HA) particles, regarded as one of the most suitable carrier moiety for radiosynoviortheses applications, have been envisaged for labeling with 169Er with an aim to developing an agent for RSV of digital joints. Erbium-169 was produced with a specific activity of 415 ± 23 MBq/mg and radionuclidic purity of 99.22 ± 0.17% (both at the end of bombardment) by thermal neutron irradiation of enriched (98.2% in 168Er) erbium target at a flux of ∼ 8 · 1013 n/cm2 s for 21 d. HA particles (1–10 micrometer size), synthesized in-house, were labeled with 169Er in high yield and radiochemical purity (&gt; 99%) using 5 mg of HA particulates at pH 7.5. The radiolabeled particulates showed excellent in vitro stability in normal saline and human serum. Biodistribution and imaging studies (using 171Er-HA) carried out in normal Wistar rats following intra-articular injection of 169Er-HA particulates in the knee joint showed near-complete retention of injected radioactivity within the synovial cavity with almost no activity leaching out to the other organs/tissue.

Preparation and preliminary biological evaluation of 177Lu-labelled hydroxyapatite as a promising agent for radiation synovectomy of small joints

Lutetium-(177)Lu) is considered to be a promising radionuclide for use in radiation synovectomy of small-sized joints owing to its favourable decay characteristics [t(1/2)=6.73 days, E(beta)(max)=0.49 MeV, E(gamma)=113 keV (6.4%), 208 keV (11%)] and feasible and cost-effective production route. Hydroxyapatite particles are regarded as one of the most suitable carriers for applications in radiation synovectomy, and labelling with (177)Lu has been envisaged. The present work describes the preparation and preliminary biological evaluation of (177)Lu-labelled hydroxyapatite particles. (177)Lu-labelled hydroxyapatite particles were prepared using (177)Lu produced by thermal neutron irradiation of a natural (2.6% (177)Lu) Lu(2)O(3) target and hydroxyapatite particles (particle size, 2-10 microm) prepared in-house. The biological efficacy of the radiolabelled preparation was tested by recording serial gamma scintigraphic images after injecting the agent in both normal and arthritic knee joints of Wistar rats. (177)Lu-hydroxyapatite was prepared with high yield and high radiochemical purity (approximately 99%) and the radiolabelled particles showed excellent in-vitro stability at room temperature. Serial scintigraphic images of normal and arthritic Wistar rats showed complete retention of activity within the synovial cavity, with no measurable activity leaching out from the joint until 168 h post-injection. Studies with (177)Lu-hydroxyapatite indicate its potential for use as an agent for radiation synovectomy of digital joints, as a viable alternative to (169)Er-based agents. The results also demonstrate the possibility of preparing a large number of patient doses of (177)Lu-hydroxyapatite from indigenously produced (177)Lu using a natural target.

175Yb-labeled hydroxyapatite: a potential agent for use in radiation synovectomy of small joints

The preparation of 175Yb-labeled hydroxyapatite (HA) particle is described for possible use as an agent for radiation synovectomy (RS) of small-sized joints. 175Yb was produced by thermal neutron irradiation of enriched (98.6% in 174Yb) ytterbium target at a flux of approximately 3 x 10(13) n/cm(2)/s for 7 days. Specific activity of 5.5-6.0 GBq/mg and a very high radionuclidic purity to the extent of approximately 100% were obtained. In the work reported herein, HA could be labeled with 175Yb in very high radiochemical purity (>99%) using 10 mg of HA particle at pH approximately 7. The radiolabeled particulates showed excellent in vitro stability at room temperature. Serial scintigraphic images of normal as well as arthritis-bearing Wistar rats following intra-articular injection of 175Yb-HA particles in the knee joint showed complete retention of activity within the synovial cavity with no measurable activity leaching out from the joint till 144 h post-injection.

Transdermal photodynamic therapy—a treatment option for rheumatic destruction of small joints?

Synovectomy of small joints is a therapeutic approach in patients suffering from rheumatoid arthritis (RA). We examined the feasibility of transdermal photodynamic therapy (tPDT) in a fibroblast-induced model of joint destruction using the novel photosensitizer (PS) tetrahydroporphyrin-tetratosylat that shows strong absorption at the near infra-red spectral region. The functionality of the PDT system was assessed in vitro. Following arthritis induction and PS application, tPDT was applied in vivo. Therapy results were evaluated by measuring joint swelling, serum amyloid A (SAA) and histologically. We were able to present a fully functional PDT in vitro. The in vivo therapy modalities were well tolerated by mice. We could demonstrate photodynamic ablation of subcutaneously located tissue (skeletal muscle) without skin damage. This study provides the basis for transdermal accessibility of tissue through a photodynamic process which may serve as a minimally invasive synovectomy strategy.

Long-term results of synovectomy of the finger joints in rheumatoid arthritis

The effectiveness of surgical synovectomy of finger joints were clinically and radiologically evaluated. One hundred and sixty-one finger joints (MP 72, PIP 70, DIP 10 and IP 9) of 64 hands of 52 patients with rheumatoid arthritis who had a surgical synovectomy were examined at an average of 6.7 years follow-up (range 5.2–17 years). The results of synovectomy in these patients were evaluated according to five factors: recurrence of synovial swelling, relief of pain progression of deformity, progression of radiological change, and changes in range of motion after surgery. Un-operated fingers which were not swollen at the time of surgery were used as the controls. Recurrence of synovial swelling was seen in 12% of the patients at the follow-up examination and pain in the finger joints had developed in 6%. In almost all patients, the anti-inflammatory effects of surgery persisted for more than 5 years. Twenty-two (14%) PIP and MP joints showed postoperative progression of clinical deformity. Fifty-seven joints (35%) showed progression of bone change or articular rheumatoid lesion upon radiological examination. Each of the four clinical factors (pain, swelling, deformity and motion) improved more in the treated fingers than the un-operated control fingers. Although only 33% of the MP and PIP joints experienced no loss of motion in the operated joints after surgery, loss of motion occurred to only a small extent (10–15°) and few patients experienced difficulties with daily activities. The results of this clinical study suggest that surgical synovectomy for rheumatoid finger joints has anti-inflammatory effects as well as a prophylactic effect on the development of deformity and the progression of bony change after surgery.

Long-term results of synovectomy of the finger joints in rheumatoid arthritis

The effectiveness of surgical synovectomy of finger joints were clinically and radiologically evaluated. One hundred and sixty-one finger joints (MP 72, PIP 70, DIP 10 and IP 9) of 64 hands of 52 patients with rheumatoid arthritis who had a surgical synovectomy were examined at an average of 6.7 years follow-up (range 5.2–17 years). The results of synovectomy in these patients were evaluated according to five factors: recurrence of synovial swelling, relief of pain progression of deformity, progression of radiological change, and changes in range of motion after surgery. Un-operated fingers which were not swollen at the time of surgery were used as the controls. Recurrence of synovial swelling was seen in 12% of the patients at the follow-up examination and pain in the finger joints had developed in 6%. In almost all patients, the anti-inflammatory effects of surgery persisted for more than 5 years. Twenty-two (14%) PIP and MP joints showed postoperative progression of clinical deformity. Fifty-seven joints (35%) showed progression of bone change or articular rheumatoid lesion upon radiological examination. Each of the four clinical factors (pain, swelling, deformity and motion) improved more in the treated fingers than the un-operated control fingers. Although only 33% of the MP and PIP joints experienced no loss of motion in the operated joints after surgery, loss of motion occurred to only a small extent (10–15°) and few patients experienced difficulties with daily activities. The results of this clinical study suggest that surgical synovectomy for rheumatoid finger joints has anti-inflammatory effects as well as a prophylactic effect on the development of deformity and the progression of bony change after surgery.

Late results of synovectomy of wrist, MP and PIP joints. Multicenter Study.

Late results of synovectomy of wrist, MP and PIP joints. Multicenter Study.

Surgical Synovectomy of Finger Joints

Surgical Synovectomy of Finger Joints

Controlled trial of synovectomy of knee and metacarpophalangeal joints in rheumatoid arthritis

In a multicentre study patients with rheumatoid arthritis judged by prevailing criteria to be suitable for synovectomy of the knee or metacarpophalangeal (MCP) joints were randomly allocated to one of two groups. One group had the operation, the other was observed without operation from a notional corresponding date. 3 years later the outcome of synovectomy was compared with that of observation without synovectomy. Synovectomy of the knee was followed by significantly less pain and tenderness, smaller effusions, and smaller and less frequent erosions and geodes. By contrast, MCP joints were no better clinically or radiographically than those treated conservatively. The results have been compared with those of two other controlled trials, one concerned with the knee and MCP joints, the other only with MCP joints. In the present trial results were more favourable in the knee but comparable in the MCP joints with those reported in the first of these two trials but less favourable in the MCP joints than those observed in the second.