Radiation Synovectomy of the Ankle with 75 MBq Colloidal ¹⁸⁶Rhenium-Sulfide: Effect, Leakage, and Radiation Considerations

FRISO M. van der ZANT, Z. NAZIRA Z. JAHANGIER, J. DANIEL MOOLENBURGH, WIEBE van der ZEE, ROBBERT O. BOER, and JOHANNES W.G. JACOBS

ABSTRACT.

Objective. In a retrospective study we evaluated the effect, duration of effect, and safety of radiosynoviorthesis of the ankle in patients with persistent synovitis, refractory to disease modifying antirheumatic drugs (DMARD) and intraarticular glucocorticoid injections. We estimated leakage and dose to target and non-target organs.

Methods. Radiation synovectomy was performed by injection of 75 MBq ¹⁸⁶rhenium colloid and 20 mg triamcinolone-hexacetonide mixed in a volume of about 1.5 ml. About 24 hours after injection, leakage of the radionuclide was measured with a single-head gamma camera, with views of the ankle joint, regional (inguinal) lymph nodes, and liver. Leakage was expressed as counts in the target region of interest corrected for background relative to total counts corresponding with percentage of injected dose. The effect of radiosynoviorthesis was scored into 3 categories: (1) No effect, i.e., persistent synovitis or only minimal reduction of swelling and/or pain, or the need of intraarticular glucocorticoid injection within 3 months or arthrodesis of the treated joint within 6 months. (2) Moderate effect, i.e., significant reduction of swelling, pain, and improvement of function. (3) Good effect, i.e., complete or almost complete remission of synovitis.

Results. The mean age of patients (28 women, 12 men) at the time of treatment was 58 years (range 33–76); 54 consecutive procedures in ankles of the 40 patients were evaluated. No effect was found in 12 of 54 (22%) treated joints; moderate effect in 12 (22%), with a mean duration of effect of 34 months (range 12–49); and good effect in 30 (56%), with a mean duration of effect of 41 months (range 21–75). Mean effect-duration did not differ significantly between the moderate and good effect groups. Mean leakage did not differ significantly between the effect groups.

Conclusion. Radiation synovectomy of the ankle is a safe and effective treatment in persistent synovitis, although all patients eventually experienced recurrence of arthritis. (J Rheumatol 2004;31:896-901)

Key Indexing Terms:

RADIOSYNOVIORTHESIS
RADIATION SYNOVECTOMY
ANKLE
COLLOIDAL ¹⁸⁶RHENIUM-SULFIDE
RHEUMATOID ARTHRITIS
LEAKAGE

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From the Department of Nuclear Medicine, Department of Rheumatology, and Department of Radiotherapy, Medical Centre Alkmaar, Alkmaar; and the Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.

F.M. van der Zant, MD; R.O. Boer, MD, Department of Nuclear Medicine; J.D. Moolenburg, MD, PhD, Department of Rheumatology; W. van der Zee, MSc, Department of Radiotherapy, Medical Centre Alkmaar; Z.N. Jahangier, MD; J.W.G. Jacobs, MD, PhD, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht.

Address reprint requests to Dr. F.M. van der Zant, Department of Nuclear Medicine 0030, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands. E-mail: f.zant@mca.nl

Submitted April 7, 2003; revision accepted November 13, 2003.

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