Radiation synovectomy involves injecting radioactive material directly into an inflamed joint to alleviate pain and swelling from conditions like rheumatoid arthritis. Common radiopharmaceuticals used include 32P chromic phosphate, 90Y silicate/citrate, and 186Re sulfur colloid. The procedure provides benefits such as increased joint movement, reduced swelling and pain, with minimal risks or side effects. It is most effective when performed early in the disease before significant cartilage damage occurs.

1. Radiation Synovectomy
Budour, Wasaif, Aqeela, Sara
EANM Procedure Guidelines for Radiosynovectomy

2. Beta-emitting radiopharmaceuticals have been used
for a number of years as local treatment of chronic
inflammatory joint disease, and to alleviate the pain
and swelling of rheumatoid arthritis.

3. Indications
Rheumatoid arthritis is the main indication.
 Hemophilic arthopathy.
 Synovial inflammation associated with infected
joint prosthesis.
 Activated arthrosis.
 Polyarthrosis of fingers.

4. What is Rheumatoid arthritis ?
 Is a systemic disease.
 The systemic treatment should be performed for at least 6
months.
 If there is no adequate improvement show, then radiation
synovectomy must be done.

5. Prior to radiation synovectomy
Diagnosis with:
 Medical history, clinically, radiographic.
 US : evaluate space, thickness and structure of joint.
 3 phase bone scintigraphy: useful in patients with
synovium inflammation, especially in polyartheritis .
WHAT we use for a 3phase bone scan??

6. Radiopharmaceuticals
169Er citrate186Re sulphide
90Y
silicate/citrate
99mTc - sulfur
colloid
32P - chromic
phosphate
9.4 days3.7 days2.7 days6 hours14.26 daysT1/2
0.34 MeV
1.07 MeV beta
137 KeV gamma
2.27MeV140 keV694.9 keVEnergy
β- , Beta emitter
β- , Beta emitter
γ , gamma ray
β- , Beta emitterγ , gamma rayβ- , Beta emitter
Type of
emission
Injection through needle placement into a joint (synovial) cavity.
Method of
Administration
The most commonly used agent is 32P chromic phosphate, but as of 2000 no
therapeutic agent has been approved by the United States Food and Drug
Administration, and this procedure is not widely available in the United States.

7. Adult Dose Range
>40 kg25–40 kg10–25 kg
1.000 mCi0.750 mCi0.500 mCiknee
0. 500 mCi0.375 mCi0.250 mCielbow/ankle
32P - chromic phosphate
99mTc - sulfur colloid
Knee or elbow joint: 1 mCi

8. 90Y colloids
– suitable for the knee joint only (5–6 mCi).
186Re sulphur colloid
– suitable for hip, shoulder, elbow, wrist, ankle and subtalar joints.
– The total activity at single session should not exceed (10 mCi).
169Er citrate colloid
– suitable for metacarpophalangeal, metatarsophalangeal and
digital interphalangeal joints.
– The total activity at single session (20mCi).

9. Procedure
Consists of a direct injection of the radiopharmaceutical into the
joint capsule. where it is in contact with the inflamed,
hyperplastic synovium.
As the radionuclide decays, the beta particles deliver a
therapeutic dose of radiation to the synovium.

10. Radiosynovectomy of the elbow joint synovitis in rheumatoid arthritis treated with
Lutetium - 177 labeled hydroxylapatite (Lu-177 HA) particulates

11. contraindication
Pregnancy, lactation (absolute) .
Local skin infection (absolute) .
Children, if the benefit of treatment is likely to outweigh the
potential hazards (relative)
Evidence of significant cartilage loss within the joint (relative)

12. The response rate
high and benefits to the patient if :
 increase joint movement
 Reduce swelling
 Reduce effusion
 Pain reduced

13. advantages
 Minor investigation
 Outpatient procedure
 No rehabilitation needed
 Multiple joint may be treated simultaneously
 Possible retreatment
 Good cost - effectiveness ratio

14. Side
effects
Early
Late
Increased synovitis
temporary
Radionecrosis
rare

15. conclusion
This therapy should be performed at an early stage of
the disease, where cartilage damage is minimal.
The effective dose to the whole body is very low.

16. hank ou