Abstract

Since its first description in 1952, radiosynoviorthesis (RSO) is performed as a local treatment of synovitis in patients with inflammatory joint disease by intraarticular injection of beta-emitting radiocolloides. The radioactive particles are phagocytized by the superficial type-A synoviocytes and the local high-energy beta radiation with a therapeutic range of only a few millimetres results in a coagulation necrosis of the superficial synovial layers. The necrotic tissue is then repelled, the respective area is demarcated by a pronounced inflammatory reaction and finally a new synovial membrane is regenerated. Clinically, a significant reduction of both joint effusion and articular pain is noted with a consecutive improved mobility. Apart from its classical indication Rheumatoid Arthritis, RSO can be used to treat each kind of synovitis, regardless of the underlying pathology. The indication for RSO should be discussed in line with an interdisciplinary treatment regimen in cooperation between the nuclear medicine physician and a clinician experienced in rheumatology or orthopaedics, dependant on the respective patient.

Clinical results with significant pain reduction and improved joint motion are achieved in approx. 60–80% of all joints treated are published in several randomized, controlled studies on evidence level Ib in patients with rheumatoid Arthritis. The treatment is cost-effective and safe, assuming a proper patient selection and a skilful injection technique. Local complications are very rare with an overall rate of 1‰ and less.

This presentation will give an overview of the different indications for RSO, the pretherapeutic examinations and prerequisites necessary for patient selection, the procedure of the treatment itself with special aspects of radiation protection and imaging. Finally, possible side effects and complications with treatment strategies will be discussed.