Radiosynoviorthesis

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]

Radiosynoviorthesis

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
  1. Kampen, W. U.; Boddenberg-Pätzold, B.; Fischer, M.; Gabriel, M.; Klett, R.; Konijnenberg, M.; Kresnik, E.; Lellouche, H.; Paycha, F.; Terslev, L.; Turkmen, C.; van der Zant, F.; Antunovic, L.; Panagiotidis, E.; Gnanasegaran, G.; Kuwert, T.; Van den Wyngaert, T. (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. PMC 8803784. PMID 34671820.
  2. Scanzello, Carla R.; Goldring, Steven R. (2012-08-01). "The role of synovitis in osteoarthritis pathogenesis". Bone. 51 (2): 249–257. doi:10.1016/j.bone.2012.02.012. ISSN 8756-3282. PMC 3372675. PMID 22387238.
  3. Wojdasiewicz, Piotr; Poniatowski, Łukasz A.; Szukiewicz, Dariusz (2014-04-30). "The Role of Inflammatory and Anti-Inflammatory Cytokines in the Pathogenesis of Osteoarthritis". Mediators of Inflammation. 2014: e561459. doi:10.1155/2014/561459. ISSN 0962-9351. PMC 4021678. PMID 24876674.
  4. 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.
  5. 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. S2CID 211213340.
  6. 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. S2CID 164217251.
  7. 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. S2CID 250218877.
  8. Aulakh, Karanvir S.; Lopez, Mandi J.; Hudson, Caleb; Gaschen, Lorrie; Fabiani, Michelle; Beale, Brian; Andrews, Frank M.; Liu, Chin-Chi; Lattimer, Jimmy (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. PMC 8187093. PMID 34113552.
  9. 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. Bibcode:2021PLoSO..1654613D. doi:10.1371/journal.pone.0254613. ISSN 1932-6203. PMC 8289027. PMID 34280212.
  10. 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. S2CID 254620186.
  11. 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. PMC 8691448. PMID 34950571.
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