Medicine:Radiosynoviorthesis
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Radiosynoviorthesis (RSO) is a minimally invasive therapeutic procedure for managing joint inflammation, particularly synovitis associated with osteoarthritis. Radiosynoviorthesis involves the intra-articular injection of radioactive isotopes to specifically treat the inflamed synovial membrane. Synovitis, a hallmark of various joint disorders, including osteoarthritis, manifests as inflammation within the synovial membrane lining the joints. RSO aims to suppress overactive macrophage and synovial cells responsible for the inflammatory response, providing relief from pain and improving joint functionality.[1]
Synovitis is implicated in the pathogenesis of osteoarthritis, the most prevalent form of arthritis.[2] Mechanical stress, injury, or biochemical factors trigger an inflammatory response within the synovial membrane, perpetuating chronic inflammation. This inflammatory environment contributes to the breakdown of cartilage, exacerbating joint pain and dysfunction in osteoarthritis patients.[3]
Macrophages are immune cells found within the synovial tissue which play a significant role in the development and progression of synovitis and osteoarthritis.[4] Inflamed synovial tissue attracts macrophages, which release pro-inflammatory cytokines and enzymes. These molecules perpetuate synovial inflammation, leading to cartilage degradation and further joint damage. RSO, by targeting the inflamed synovium, aims to reduce the number and activity of macrophages, thereby relieving joint inflammation and slowing down osteoarthritis progression.[5] Long-term results have been observed in human knee [6] and finger osteoarthritis.[7]
In addition to Yttrium-90 (Y-90) and Rhenium-186 (Re-186), another radioisotope used in radiosynoviorthesis is Tin-117m (Sn-117m). Tin-117m is radioisotope that is used to treat synovitis and osteoarthritis in canines with elbow dysplasia.[8][9][10][11]
References
- ↑ Kampen, W. U.; Boddenberg-Pätzold, B.; Fischer, M.; Gabriel, M.; Klett, R.; Konijnenberg, M.; Kresnik, E.; Lellouche, H. et al. (January 2022). "The EANM guideline for radiosynoviorthesis". European Journal of Nuclear Medicine and Molecular Imaging 49 (2): 681–708. doi:10.1007/s00259-021-05541-7. ISSN 1619-7089. PMID 34671820.
- ↑ Scanzello, Carla R.; Goldring, Steven R. (2012-08-01). "The role of synovitis in osteoarthritis pathogenesis" (in en). Bone 51 (2): 249–257. doi:10.1016/j.bone.2012.02.012. ISSN 8756-3282. PMID 22387238.
- ↑ Wojdasiewicz, Piotr; Poniatowski, Łukasz A.; Szukiewicz, Dariusz (2014-04-30). "The Role of Inflammatory and Anti-Inflammatory Cytokines in the Pathogenesis of Osteoarthritis" (in en). Mediators of Inflammation 2014: e561459. doi:10.1155/2014/561459. ISSN 0962-9351. PMID 24876674.
- ↑ Bondeson, Jan; Blom, Arjen B.; Wainwright, Shane; Hughes, Clare; Caterson, Bruce; van den Berg, Wim B. (2010). "The role of synovial macrophages and macrophage-produced mediators in driving inflammatory and destructive responses in osteoarthritis". Arthritis and Rheumatism 62 (3): 647–657. doi:10.1002/art.27290. ISSN 1529-0131. PMID 20187160. https://pubmed.ncbi.nlm.nih.gov/20187160/.
- ↑ Szerb, Imre; Gál, Tamás; Kiss, Dániel; Nagy, Viktória; Hangody, László (2020). "Efficacy assessment of radiosynoviorthesis on the progression of radiological osteoarthritic features of hip and ankle joint in patients with osteoarthritis and rheumatoid arthritis". Nuklearmedizin. Nuclear Medicine 59 (3): 269–275. doi:10.1055/a-1108-1187. ISSN 2567-6407. PMID 32074661. https://pubmed.ncbi.nlm.nih.gov/32074661/.
- ↑ Szentesi, Margit; Nagy, Zoltán; Géher, Pal; Papp, István; Kampen, Willm Uwe (2019). "A prospective observational study on the long-term results of 90Yttrium citrate radiosynoviorthesis of synovitis in osteoarthritis of the knee joint". European Journal of Nuclear Medicine and Molecular Imaging 46 (8): 1633–1641. doi:10.1007/s00259-019-04350-3. ISSN 1619-7089. PMID 31129693. https://pubmed.ncbi.nlm.nih.gov/31129693/.
- ↑ Ehlich, Hans; Kresnik, Ewald; Klett, Rigobert; Freudenberg, Lutz S.; Kampen, Willm Uwe (2022-11-01). "Intra-articular Treatment of Digital Osteoarthritis by Radiosynoviorthesis-Clinical Outcome in Long-term Follow-up". Clinical Nuclear Medicine 47 (11): 943–947. doi:10.1097/RLU.0000000000004322. ISSN 1536-0229. PMID 35776838. https://pubmed.ncbi.nlm.nih.gov/35776838/.
- ↑ Aulakh, Karanvir S.; Lopez, Mandi J.; Hudson, Caleb; Gaschen, Lorrie; Fabiani, Michelle; Beale, Brian; Andrews, Frank M.; Liu, Chin-Chi et al. (2021). "Prospective Clinical Evaluation of Intra-Articular Injection of Tin-117m (117mSn) Radiosynoviorthesis Agent for Management of Naturally Occurring Elbow Osteoarthritis in Dogs: A Pilot Study". Veterinary Medicine: Research and Reports 12: 117–128. doi:10.2147/VMRR.S295309. ISSN 2230-2034. PMID 34113552.
- ↑ Donecker, John; Fabiani, Michelle; Gaschen, Lorrie; Aulakh, Karanvir Singh (2021). "Treatment response in dogs with naturally occurring grade 3 elbow osteoarthritis following intra-articular injection of 117mSn (tin) colloid". PLOS ONE 16 (7): e0254613. doi:10.1371/journal.pone.0254613. ISSN 1932-6203. PMID 34280212. Bibcode: 2021PLoSO..1654613D.
- ↑ Lattimer, Jimmy; Fabiani, Michelle; Gaschen, Lori; Aulakh, Karanvir; Selting, Kimberly (2023). "Clinical effectiveness and safety of intraarticular administration of a 117m Tin radiocolloid (Synovetin OATM ) for treatment of early and intermediate grade osteoarthritis of the elbow in a dose finding study conducted in 44 dogs". Veterinary Radiology & Ultrasound 64 (2): 351–359. doi:10.1111/vru.13198. ISSN 1740-8261. PMID 36507585.
- ↑ Donecker, John; Lattimer, Jimmy C.; Gaschen, Lorrie; Aulakh, Karanvir Singh (2021). "Safety and Clinical Response Following a Repeat Intraarticular Injection of Tin-117m (117mSn) Colloid in Dogs with Elbow Osteoarthritis". Veterinary Medicine: Research and Reports 12: 325–335. doi:10.2147/VMRR.S345144. ISSN 2230-2034. PMID 34950571.
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