To determine the efficacy of [177Lu]Lu-Hydroxyapatite radiosynovectomy (RSV) in patients with refractory chronic inflammatory arthritis of the knee joint. Overall, 24 knees in 22 patients with refractory chronic inflammatory arthritis were enrolled in this prospective study. All patients were assessed clinically for pain, tenderness, range of motion, analgesic intake, Oxford Knee Score, and scintigraphically based on blood pool activity on three-phase bone scan. Various scores were assigned to clinical these parameters. RSV of the knee joint was done using intra-articular injection of [177Lu]Lu-Hydroxyapatite. Patients were assessed clinically at 1 and 3 months, and scintigraphically at 3 months using blood pool index on three-phase bone scan. Patients were categorised as responders and non-responders on the basis of change in percentage of cumulative scores. Out of 24 knees, 18 knees were responders and 6 knees were non-responders at 3 months. There was a significant improvement in clinical scores at 1 month post-RSV, which persisted at 3 months post-RSV (p < 0.05). However, the change in blood pool activity on three-phase bone scan was not significant. Reported adverse effects were mild and not significant. This study confirmed the safety and efficacy of [177Lu]Lu-Hydroxyapatite radiosynovectomy for patients with chronic inflammatory knee joint arthritis refractory to conventional medical treatment.

Inflammatory joint diseases, such as rheumatoid, psoriatic, reactive arthritis, ankylosing spondylitis, reactive and other arthritis, lead to significant loss of quality of life and are frequent causes of disability. These diseases are accompanied by synovitis, which continues to progress despite the ongoing basic therapy. Radiosynovectomy (RSE) is one of the effective methods of treatment of such patients. A radiopharmaceutical drug based on human blood albumin microspheres with a diameter of 5-10 μm labeled with rhenium-188 for the treatment of knee arthrosis (Arthroren-MRRC) was developed at the A. Tsyb MRRC. The results of phase 1 clinical trials are presented, the aim of which is to study the tolerability, safety and pharmacokinetics of the drug during knee joint RSE (single intra-articular injection for the treatment of chronic recurrent synovitis); to study the increasing activities (370, 555, 740 and 925 MBq), to evaluate the radiation doses, the effect of RSE with the use of radiopharmaceutical on the quality of life of patients, radiation exposure to personnel. 20 patients (18-75 years old) with recurrent chronic synovitis of the knee joint underwent RSE with injection of Re-188 MCA 5-10 μm with activity ranging from 370 to 925 MBq. After injection, the following was performed: time-lapse SPECT/CT scintigraphy (1-72), radiometry of urine taken within 48 h after RSE and estimation of absorbed internal radiation doses to the synovial membrane and organs at risk. The absorbed doses formed after RSE in the knee joint in patients ranged from 17.5 to 74 Gy, and the doses to the organs at risk were many times lower than the generally accepted dose limits. High safety and good tolerability of radiopharmaceutical (188Re MCA 5-10 μm) was demonstrated. The activity of 740 MBq appeared to be optimal in terms of safety and efficacy in knee joint RSE.

Radiosynovectomy (RSV) represents an advanced therapeutic modality in nuclear medicine, designed to treat chronic inflammatory joint disorders that are unresponsive to conventional therapies. This targeted approach involves the intra-articular administration of radioactive microparticles containing a β--emitting radionuclide, selectively eradicating the inflamed synovial membrane while preserving surrounding tissues. As a minimally invasive, nonsurgical procedure routinely performed in outpatient settings, RSV offers a compelling alternative to more invasive interventions. Over time, RSV has evolved significantly, transitioning from the empirical use of radiocolloids to the development of specialized agents tailored for different joint types. Advancements in this field continue to explore a variety of β--emitting radionuclides with unique emission characteristics, integrated into novel microparticles to improve both specificity and therapeutic efficacy. The selection of an optimal radionuclide hinges on critical nuclear and chemical properties, ensuring effective binding to microparticles and delivering favorable clinical outcomes. This review examines the evolution of RSV in joint disorder management, detailing its mechanisms of action, key factors influencing radionuclide and microparticle selection, and the methodologies involved in their development and production. Additionally, it provides an overview of commonly used radionuclides and microparticles, evaluating their effectiveness within the ever-evolving landscape of RSV.

Radiosynovectomy (RS), which uses beta particle-emitting radiocolloids, has proven highly effective in significantly reducing the occurrence of haemarthroses and breaking the cycle of bleeding and synovitis. This study now presents the long-term outcomes of repeated RS in individuals with haemophilia. Repeated RS was administered to 48 joints in 37 people with haemophilia (PwHs) diagnosed with chronic haemophilic synovitis. The frequency of bleeding episodes was meticulously recorded during the 6-month periods preceding and following each of the initial and subsequent RS procedures. Treatment failure was designated by the necessity for additional RS injections. The results for 48 joints were analysed. The mean bleeding frequency of the joints was 12.5±7.29 (median 10) within the last 6 months in the pre-treatment evaluation and after the treatment, the mean bleeding frequency of the joints decreased to 2.25±3.82 (median 0.5) for the first 6 months (p<0.001) after the first RS. The mean survival of the first intervention was 40.52±33.79 months (range, 1-124 months). In the second RS, the mean bleeding frequency of the joints was 10.29±7.66 (median 8) within the last 6 months in the pre-treatment evaluation and after the treatment, and the mean bleeding frequency of the joints decreased to 0.93±1.69 (median 0) for the first 6 months (p<0.001). The survival rate of the second RS was 94% at 12 months, and 87% at 36 months. Repeated RS was proven to be an effective and safe treatment for Pwh with recurrent bleeding episodes during long-term follow up. Thirty-six months survival rate was 87% (42 of 48 joints).

Introduction Pigmented villonodular synovitis (PVNS) or giant cell tumour of the tendon sheath (GCTT) is a rare disorder involving the proliferation of the synovium in any joint; however, the knee, hip, and ankle joints are most commonly targeted. The aim of this study is to follow the short-term outcomes of the treatment of patients with PVNS of the knee managed by intra-articular injection of yttrium-90 or radiosynovectomy (RS) aloneand a combination of RS and arthroscopic/open debulking synovectomy. Methods A cohort of eight knees from six patients was included in this study, including three knees treated with combined arthroscopic synovectomy and RS, and five knees treated with RS alone. Patients were asked to complete the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire before attending their three-month follow-up appointment. Their answers were collated and scores were calculated using the designated specific equation. Results Our results demonstrate that although patients in the combined arthroscopic synovectomy and RSarm possess on average higher pain scores and symptoms than those who underwent RSalone, the combined therapy had higher scores in activities of daily living (ADLs), sports and recreation (Sport-Rec), quality of life (QoL), and overall KOOS scores. Conclusion Neoadjuvant arthroscopic mechanical debridement is a safe and quick procedure with minimal side effects, with improved overall KOOS scores.

Introduction. A characteristic symptom of hemophilia is joint hemorrhage (hemarthroses).Aim: to evaluate the possibilities of radiosynovectomy in hemophilic arthropathies.Main findings. Radiosynovectomy (RSE) or radiosynoviorthesis (RSO) is a technique that achieves a long-lasting effect in chronic synovitis and hemophilic arthropathy. It consists of intra-articular injection of radiopharmaceuticals (RFLP) in the form of colloidal solutions, macroaggregates or microspheres containing radioactive isotopes, which are rapidly phagocytized by the covering cells of the synovial membrane. After such capture, the synovial sheath is subjected to intensive “internal” irradiation, which results in superficial fibrosis of synovial tissue and persistent suppression of joint inflammation.

Arthritis is an inflammatory disorder that affects one or more joints of the body for various reasons, including autoimmune disorders, trauma, or infection. In many cases, traditional long-term treatment with various drug combinations (NSAIDs, diseasemodifying antirheumatic drugs, systemic corticosteroids, etc.) can provide relief, but many joints require additional local treatment. Radiosynovectomy (RSV) is an alternative method to current treatment options. Both the global supply shortage of 90Y in recent years and the increasing use of 177Lu-labeled radiopharmaceuticals in the field of nuclear medicine have made it possible to develop 177Lu-labeled microparticles and test them in small groups as RSV agents. This study aimed to develop the 177Lu labeled tin colloid formulation and demonstrate its invivo characterization. Particle size, shape, and labelling efficiency of the four formulations developed were determined. The formula with the highest labelling efficiency was selected for further studies. The quality of the formulation was evaluated based on radionuclidic, radiochemical, and microbial purity. In-vitro stability was evaluated by determining the labelling efficiency. In-vitro stability was tested in PBS and synovial fluid. The biological characterization was assessed using SPECT/CT after injecting the formulation into the normal knee joints of the rabbits. Aggregated colloidal particles were spherical with a particle size of <5 μm. Labelling efficiency and radiochemical purity were >95 and 97.65% (Rf=0.2), respectively. The formulation was stable in vitro for up to 72 hours, both in PBS and synovial fluid. The formulation was homogeneously distributed in the joint at 0 and 1 hour after injection, and radioactivity- related involvement and inguinal lymph node involvement due to possible leakage were not detected in the late period. No pyrogenic/allergic side effects were observed during this period. 177Lu-tin-colloid was successfully prepared under optimized reaction conditions with high binding efficiency and radiochemical purity. The radiolabeled colloid was found to be stable in-vitro both in PBS and synovial fluid at room temperature. Serial PCET/CT images revealed that the activity was completely retained within the synovial cavity, with no activity leakage out of the joint until 48 hours after the injection. With the support of the results from further clinical studies, it may be possible for the formulation to enter clinical use.

Radiosynovectomy (RSV) is a minimally invasive method of treating and controlling joint inflammation refractory to conventional pharmacotherapy. It consist in intraarticular injection of radioactive colloids which irradiate the inflamed synovial membrane to cause its subsequent involution. Despite the fact that hip joint involvement is quite common in systemic inflammatory arthropathies, hip joint RSVs are rarely performed. The aim of this paper is to assess to safety and efficacy of hip joint radioisotope treatment. We retrospectively analyzed the effects of 21 hip joint RSVs performed in 14 patients (10 female, 4 male; aged 8 to 79; mean age 48 years). Before the RSV, all the patients underwent clinical and ultrasound examination. The radiosynovectomies were performed using rhenium-186 sulfide under ultrasound guidance. Each patient underwent post-therapeutic scintigraphy to assess intraarticular distribution of the radiopharmaceutical. The effects of the treatment were assessed clinically and ultrasonographically during at least 2 follow-up visits 3 and 6 months after the RSV. In 9 cases, we observed complete resolution of symptoms 3 and 6 months after the RSV. Four patients had only a partial response and required repeated treatment, and all responded well to the second RSV. In 4 patients the treatment had no significant effect, and no repeated treatment attempt was made. All the responders suffered from inflammatory arthropathies; the non-responders had osteoarthritis, with no history of systemic diseases. In all the patients, no significant adverse effects were observed; in particular there were no radiation burns or infections. All post-therapeutic scintigrams showed proper, intraarticular distribution of the radiopharmaceutical. Radiosynovectomy of the hip joint in systemic joint diseases, especially performed using ultrasound-guidance, is a safe and effective treatment modality.

Radiosynovectomy (RSO) describes the internal low-dose radiotherapy of the synovia via intra-articular administration of small radioactive particles. Since the introduction of biologics, the main aetiology of arthritic joints for RSO changed to mostly osteoarthritis with concordant change in typically affected joints. Thus, the effect of RSO in thumb basal joint arthritis (BJTh) with focus on osteoarthritis needs to be explored. From 2017 to 2020, 219 BJTh were treated in 125 patients, 17 patients with rheumatoid arthritis (RA) and 108 patients with osteoarthritis (OA). The therapeutic effect was assessed using a four-step subjective scoring. 20% of the treated joints were symptom free, 48% had a very good response, 16% slight and 16% no response. RSO was performed in 71 patients singularly and in 54 patients repetitively. The mean response duration was 6.8months with a maximum of 48months. 35% of patients had post-therapeutic pain relief followed by relapse after 3months. Response duration showed no significant difference the between first and repetitive therapy, primary responder and primary non-responder and RA and OA. In thumb basal joint arthritis, RSO leads to response rates from 66 to 79%, mean response duration from 6 to 12months and individual response duration 48months. The present results are in line with previously published response rates in smaller joints. In respect to 35% of patients with relapse within 3months post-therapy, we recommend a primary follow-up after 3-4months.

Background:Radiosynovectomy (RS) is a useful for treating inflammatory arthritis that fail conventional treatments. The main isotope used is Yttrium-90 on large joints as knees, whereas Erbium-169 and Renium-186 are more common in small and medium sized joints respectively.RS is a safe procedure since the isotopes cannot escape the synovial capsule or be absorbed into circulation. It is, however, lethal against cells within the inflamed joint.The most common rheumatic disease treated with RS is rheumatoid arthritis (RA), followed by axial spondyloarthritis (SpA) and idiopathic juvenile arthritis (JIA). It has also been used on persistent synovitis after joint replacements, pigmented villonodular synovitis (PVNS) and undifferentiated arthritis.Objectives:To describe the experience in RS of a tertiary rheumatology center and compare patients with and without clinical response to treatment in the following 12 months.Methods:Observational retrospective study between May 31st 2013 and October 31st 2019. We collected demographic variables, data about the disease of the patient, the joints affected, isotope utilized, presence of Baker’s cyst, systemic treatment received, need of additional infiltrations (before and after), complications and any changes in medication up to a year after the procedure.All the RS were performed ambulatory and the radioisotope infiltration was guided by ultrasound, with 40mg of triamcinolone infiltrated after.SPSS v23 was used for statistical analysis; with Chi2 for qualitative variables and Student’s T distribution for quantitative variables.Results:We evaluated 67 joints in 49 patients in total. All of them were refractory to conventional treatment. 44 patients (65.7%) were women, median of 53.4 years of age (IQ 43.4-67.1).The median disease duration was 12.5 years and RS seemed to fare better the longer the patient had the disease (median of 13.5 years vs 6.5 years p&lt;0.001).The joints infiltrated where 46 (68.6%) knees, 14 (20.9%) wrists and 7 (15.2%) elbows. Out of the knees, 16 (34.8%) belonged to RA patients with effective response in 14 (87,5%). 100% of elbows had an effective response, of them 6 (85.7%) had RA. However, even when 9 (64.2%) wrists also had RA as diagnosis, only 3 (21.4%) were effective.Of the PVNS, 6 out of 8 (75%) had no clinical response, as shown in Table 1.Table 1.RS response compared to clinical diagnosis.TOTALEFFECTIVEINEFFECTIVEp 67 (100%)46 (68.6%)21 (31.3%)Inflammatory Arthritides(RA + PsA + SpA + sJIA), (%)52 (77.6)39 (75%)13 (25%)&lt;0.0001RA (%)30 (44.7)22 (73.3)8 (26.6)&lt;0.001RA positive ACPA/FR21 (70)15 (71.4)6 (28.6)&lt;0.0001Psoriasic arthritis (PsA) (%)6 (9)4 (66.6)2 (33.3)0.42SpA (%)10 (14.9)8 (80)2 (20)0.45sJIA (%)6 (9)5 (83.3)1 (16.6)0.55PVNS (%)8 (11.9)2 (25)6 (75)&lt;0.001Inespecific monoarthritis (%)3 (4.4)3 (100)0 (0)0.23OA + Calcium Pyrophosphate Deposition (CPPD) (%)4 (5.9)2 (50)2 (50)0.33Intra articular corticosteroids were needed before RS, with no differences in effective and ineffective joints; however after RS it was significantly lower in effective joints in the first six months (0% vs 43% p&lt;0.0001) and remained so in the following 6 months (0% vs 19% p&lt;0.0001)Only 13 (28%) patients with effective RS needed to change systemic treatment compared to 10 (43%) of those ineffective (p&lt;0.0001). None of the patients with RS had any complication after the procedure during follow up.Conclusion:Our study showed that knees were the main joint infiltrated and they had an overall good response to treatment, especially if the diagnosis was RA.Patients with effective procedures needed leest treatment changes and significantly less corticosteroids infiltrations.In our study, RS in PVNS was significantly less effective than in inflammatory arthritis (25% vs 75% p&lt;0.0001) and RA seemed to have the best response overall.

Radiosynovectomy (RS) with 90Y-hydroxyapatite (90Y-HyA) aims to control knee hemarthrosis in hemophiliac patients to prevent secondary arthropathy. However, knee RS using 153Sm-hydroxyapatite (153Sm-HyA) is considered less suitable due to the lower average soft tissue range and energy of 153Sm for large joints, such as the knees. The objective of this investigation was to assess the efficacy and safety of knee RS with 153Sm-HyA, compared to 90Y-HyA. Forty patients were prospectively assigned to undergo knee RS with 153Sm-HyA (n = 19) or with 90Y-HyA (n = 21). The frequency of hemarthrosis episodes before and after treatment were compared. After six months of knee RS, 153Sm-HyA and 90Y-HyA promoted a similar reduction of hemarthrosis episodes (50% and 66.7%, respectively). However, after 12months of knee RS, the reduction of hemarthrosis episodes was significantly (p = 0.037) higher using 153Sm-HyA (87.5%) compared to 90Y-HyA (50.0%). This discrepancy was more pronounced (p = 0.002) for 153Sm-HyA compared to 90Y-HyA in adults/adolescents. Knee radiosynovectomy with 153Sm-HyA is safe, reduces hemarthrosis episodes after 12months of treatments, especially in adults/adolescents and even with grades III/IV arthropathy, similar to 90Y-HyA. 90Y-HyA seems to promote better hemarthrosis control in small children.

After knee replacement, therapy resistant, persistent synovitis is a common issue, which causes effusion and pain, and leads to loosing. It has been hypothesized that radiosynovectomy (RSO) is useful in these patients. A cohort of 55 patients with 57 knee replacements and persistent synovitis underwent RSO using 4.9 ± 0.24 mCi (182 ± 9 MBq) of Y-citrate. The number of RSOs ranged from 1 to 4. Bone scans before and 3 months after every RSO were performed. Long-term follow-up ranged from 0.8 to 7.6 years with a mean of 23.2 months. For qualitative analysis, an established 4 steps scoring was used. For quantification, the uptake was determined within the Tc-MDP scintigraphy blood pool phase before and after therapy. Long-term response was in 27% with excellent, 24% good, 30% weak, and 20% no response. The duration of response was 12.0 ± 12.0 months (maximum, 54 months). In patients with repeated treatment, the effect after the first therapy was lesser than in patients who received a single treatment in total. However, 3 months after the last RSO, patients with repeated treatment showed a similar effectiveness than single treated patients. At the end of long-term follow-up, patients with repeated RSOs had a higher effectiveness at similar duration response. In bone scan, 65% of patients showed a reduction of uptake. When comparing subjective and objective response, 78% of patients showed a concordance in both symptoms and scintigraphy. Pilot histological analysis revealed that the synovitis is triggered by small plastic particles. We concluded that RSO is an effective therapy in patients with knee replacement and persistent synovitis with high long-term response. Repeated treatment leads to a stronger long-time response.

ObjectivesThe aim of the study was to evaluate the usefulness of knee joint radiosynovectomy (RS) in patients suffering from juvenile idiopathic arthritis (JIA).Material and methodsOne hundred RS procedures performed in 58 patients with JIA in average age 10.4 years were evaluated.ResultsAfter 6 weeks, a decrease in the number of cases with joint pain from 90.3% to 29%, with joint oedema from 100% to 74.5%, with joint exudate from 100% to 60.6%, with gait disorders from 19.4% to 3.2%, with joint mobility disorders from 51.1% to 26.6% in the RS cases was observed. A reduction of the score in the Colorado scale from 10.9 to 4.66, in the pain visual analogue scale (VAS) from 50 to 10, in the illness VAS assessed by the patient/parent from 69.9 to 32.4, in the illness VAS assessed by the physician from 68.8 to 36.9 was observed. Six months after the RS procedure, a reduction in the number of cases with joint pain from 89.5% prior to the procedure to 29.5%, with oedema from 100% to 58.3%, with exudate from 100% to 46.9%, with gait disorders from 20% to 2.1%, with joint motility disorders from 51.1% to 26.1% was achieved. The score in the Colorado scale was reduced from 10.9 to 4.04, in the pain VAS from 40 to 0, in the illness VAS assessed by the patient/parent from 69.7 to 27.9, in the illness VAS assessed by the physician from 68.8 to 32.4. In ultrasound examinations, the greatest improvement compared to the initial condition was recorded in the 6th month after the RS. Radiosynovectomy was positively evaluated by parents and patients in 34 anonymous surveys. Early and late observations (average 1473 days) did not show lesions at the isotope injection site, and no neoplastic lesions were observed.ConclusionsRadiosynovectomy is a valuable therapeutic option for local treatment in patients with JIA.

The radionuclide 117mSn (tin-117m) embedded in a homogeneous colloid is a novel Radio Synovi Orthesis (RSO) device for Intra-Articular (IA) administration to treat synovial inflammation and mitigate Osteo Arthritis (OA) in dogs. A study to evaluate tin-117m colloid treatment response in dogs with OA was conducted at two centers, the School of Veterinary Medicine at Louisiana State University, and at a referral practice in Houston, Texas. The tin-117m colloid was administered per-protocol to 14 client-owned dogs with radio graphically confirmed grade 3 OA in one or both elbow joints. Dog owners and attending clinicians assessed the level of pain at Base Line (BL) and the posttreatment pain response at 90-day intervals for one year. Owners assessed treatment response according to a Pain Severity Score (PSS) and a Pain Interference Score (PIS) as defined by the Canine Brief Pain Inventory. Clinicians reported a lameness score using a 0-5 scale, from no lameness to continuous non-weight bearing lameness, when observing dogs at a walk and a trot. The rate of treatment success as determined by improved mean PSS and PIS scores reported by dog owners was >70% at all-time points. Clinicians reported an improved mean pain score from BL at post-treatment Days 90 (p<0.05), 180, and 270. The dog owner and clinician assessments of treatment success were significantly correlated (p>0.05) at Day 90 and Day 180 time points. Results indicated that a single IA dose of tin-117m colloid provided a significant reduction in pain and lameness and improved functionality for up to a full year, with no adverse treatment related effects, in a high percentage of dogs with advanced, clinical OA of the elbow joint.

People with haemophilia (PwH) with inhibitors have an increased risk of bleeding and early development of progressive arthropathy. Radiosynovectomy (RS) has been effective in dramatically reducing the frequency of haemarthroses. In the present study, the mid- and long-term results of the efficacy of RS in PwHs with inhibitors and prognostic factors that influence success and failure of RS were presented. Radiosynovectomy was performed in 51 joints of 22 PwHs with inhibitors diagnosed with chronic haemophilic synovitis between January 2000 and December 2018. Two patients were lost to follow-up and four joints were excluded. Number of bleeding episodes within the pre- and post-treatment 6months were documented. Treatment failure was defined as need for repeat RS injection. Results of 47 RS were analysed. The mean bleeding frequency of the joints was 11.2±6.2 (median 9) within the last 6months in the pre-treatment evaluation. After the treatment, the mean bleeding frequency of the joints decreased to 1.2±2.8 (median 0) for first 6months (P<.0001). The cumulative survival rate at 12months was 87% and 78% at 36months. The receiver operating characteristic (ROC) curve analysis revealed that cut-off points of 12 bleeding episodes within the last 6months (sensitivity, 71.4; specificity, 81.8 P=.0022) and an inhibitor titre of 63.4 BU (sensitivity, 57.1; specificity, 75.8; P=.31) were threshold levels for a predisposition for failure. Radiosynovectomy is an effective and safe intervention in PwHs with inhibitors. Bleeding frequency is a prognostic marker for the success of RS treatment. Patients who have more than 12 bleeding episodes within the last 6months before the RS treatment have a higher rate of failure.

Background:The treatment of patients with rheumatoid arthritis (RA) has been spectaculary changed since the 1950’s. Introduction of the steroid compounds and their local application, the chemical and radionuclide synovectomy, surgical synovectomy, use of non steroid drugs, the basic treatment and the spread of biological therapy are the most important steps. Introduction of the biological therapy has changed the quality of life for these patients.Objectives:During biological therapy sometimes 1 or 2 joints could be affected by inflammation. In this cases always the question is how to solve the problem. Change of the biological or basic therapy, use surgical synovectomy or radiosynovectomy (RSO)?Methods:In our reumatological department 2100 patients with RA were treated with biological therapy between 2002 and 2018. In 100 patients we applied RSO because of the inflammation of the knee joint during biological therapy. We made a long term follow-up in 82 patient. All participants provided written informed consent. 82 participants inflammatory knee joint disease was diagnosed on the basis of the American College of Rheumatology. 70 of 82 patients with rheumatoid arthritis were seropositive, 12 seronegative. Steinbrocker functional stadium II was observed in 72, stadium III in 10. Mean age of 18 male and 76 female patients was 51.4 years (range 24-79) years. In 42 patients the right knee, in 40 the left knee was treated by radiosynovectomy. Mean duration of disease was 8.3 years (range 0.5-25), of synovitis (6.3month (range 3-8) Mean number of punctions of the treated joint prior to radiosynovectomy was 4,2 per patient and of steroid administrations prior to radiosynovectomy 3,0. In 15 patients a systemic steroid therapy has been performed.Results:During the study period, inflammation decreased. In the first 3 years excellent and good results were recorded in 81,2%. 3 years after radiosynoviorthesis 82.2% of patients did not need another punction.Before the knee inflammation patients were in complete remission which status has been achieved after RSO as well. DAS: 2,4+-0,4.Conclusion:1. RSO is an effective method to treat the inflammation of the knees.2. The RSO performed during biological tehrapy is as effective as in the case of patients without biological therapy.3. In case of a successful RSO there is no need for biological or basic therapy neither for surgical synovectomy.4. However an intraarticular injection has a low risk for infection it is recommended to avoid the biological therapy during the RSO.

Yttrium-90 radiosynovectomy in knees and ankles (25 joints in 22 hemophilic patients). Short-term results

One of the key features of good practice in medicine is the doctor-patient communication. Radiation protection standards for radiosynovectomy (RS) is limited. Yttrium-90 is a beta-emitting radioisotope used in RS to treat joint pain from haemophilic arthritis. ICRP 94 states that if a patient is treated with up to 200MBq, there is no need for further precautions when it comes to public exposure, however, activities can go up to 370MBq in RS for the knee. This study analysed 119 family members' safety (16.7% pregnant women). The ambient dose equivalent rate was measured within four distances. A survey was carried analysing risk groups and time spent next to patients. Results showed that family members should be advised to remain at 1.0m from the patient to decrease accumulated dose by 97.6%. The dose per activity factors estimated in this study is also a useful tool during the risk assessment and doctor/patient communication. Pamphlets were distributed with radiation protection recommendations. Ambient dose equivalent was low enough to show that RS is a safe procedure for family members, which is essential to promote adherence to RS in countries where it is needed but not performed due to lack of information on radiation safety.

This study aims to analyze the effect of radiosynovectomy (RSO) on the radiological progression of osteoarthritis of the knee joint. The study included 207 knee joints of 181 patients (72 males, 109 females; mean age 58 years; range, 19 to 65 years) that were performed RSO between 01 April 2003 and 31 December 2015 in the Department of Orthopedics and Traumatology at Uzsoki Hospital. A total of 111 right and 96 left knees were treated. The mean duration of follow-up was 8.7 years (range, 1 to 12 years). Of the 181 patients, both knee joints were treated in 26. Of the 207 treated knee joints, 163 had the same Kellgren-Lawrence grade at the time of follow-up compared to the grade at the time of RSO, while 44 had worse outcomes. This indicated that radiological progression was not present in 79% of the treated knee joints. The intraclass correlation coefficient (ICC) showed significantly strong agreement between the pre- and post-measurements (ICC=0.835, p<0.001). Radiosynovectomy was able to impede radiological progression in 79% of the treated joints and only one-grade deterioration was observed in 39 cases during follow-up.

Objective To investigate the clinical value of eynovial membrane volume measurement by MRI in patients with hemophilic arthropathy receiving radionuclide synoviectomy. Methods Forty two patients, total 63 diseased joint, who hospitalized in the hemophilia diagnosis and treatment center of Henan Province People's Hospital were enrolled in the study after receiving both enhanced an non enhanded MRI, from May 2011 to January 2015. Sixteen patients (21 joints) were treated with 32P radionuclide synoviectomy (PRS) and followed up. The synovial membrane volume were evaluated by enhanced and non enhanded MRI before and after PRS. All data were analyzed by t test. Results The synovial membrane volume had no statistical difference by using the non enhanced (3 104.38±60.19)mm3 and enhanced (2 995.19±59.14)mm3 MRI scans (t=-1.369, P=0.191). The synovial membrane volume post PRS (2 479.45±46.48)mm3 much lower than that before PRS (2 983.30±42.87) mm3 (t=7.831, P=0.000). The magnetic resonance enhanced range after PRS (0.92±0.06) was significantly lower than that before treatment (1.17±0.07) (t=2.108, P=0.048). Conclusion Synovial membrane volume and magnetic resonance enhanced range are important index to predict clinical efficacy of PRS. Key words: Hemophilia; Osteoarthropathy, secondary hypertrophic; Clinical efficacy; Magnetic resonance imaging