Radiosynovectomy
What is Radiosynovectomy?
Radiosynovectomy
is a procedure using a radioactive product (Yttrium-90) to treat inflamed
knee joints, for example rheumatoid arthritis and inflammatory osteo-arthritis.
Synovitis means inflammation of the lining of a joint cavity (synovium). Radiosynovectomy means injection of a Radiopharmaceutical called Yttrium-90 silicate into the synovial cavity.
What are the benefits of this treatment?
About 60 - 80 % of patients benefit from this treatment. However an improvement is unlikely within 14 days of the injection and may be delayed for up to one month.Are there any side effects or risks from this treatment?
There is a risk of a temporary increase in synovitis following treatment. The radiopharmaceutical will not benefit other joints but some overall positive effect may be noticed if steroid is injected at the same time. The procedure can lead to local bleeding and bruising. Other side-effects are infection leading to fevers (sometimes very high) and Septic arthritis. These are the most important complications of any joint injection. The type of radioactivity used can cause a slight reddening of the skin, and as with all radioactive materials there is a very small risk of future cancer. Some X-ray contrast agents can react with the Yttrium, so if you have had an X-ray examination with contrast within 8 days of the planned treatment, you must tell us as soon as possible.
How will the treatment be done?
As it is very important that the joint(s) treated is (are) kept still for at least 48 hours after the injection, you will have to be admitted to the hospital for two to three days. When you are admitted you will have a splint fitted to your knee(s), which will help you to keep your knee(s) still. You will be asked to sign a Consent Form to show that you agree to the treatment. When you are ready for the injection the procedure we follow is:
- A local anaesthetic may be injected into the skin
- A needle is inserted into the synovial cavity.
- The cavity is drained of as much fluid as possible. The Yttrium-90 Silicate/citrate is injected.
- A long acting steroid is injected to reduce the risk/severity of acute synovitis and to improve treatment response.
Is there any risk of an over-dose?
No. Because there are strict laws covering the use of radioactive materials, the Yttrium-90 Silicate can only be handled and administered by people who are appropriately trained and qualified in the handling of radioactive materials.
Is radioactive Yttrium-90 dangerous?
The radioactivity will stay in the knee(s) if you are careful not to move the knee-joint(s), for 48 hours after the injection. The radioactivity will not cause any damage to other parts of your body, and the type of radioactivity will not irradiate any other person. Although the radiation dose from this treatment is quite high, a large Finnish study has shown that patients treated with Y-90 do not have a greater risk of getting cancer compared to patients who did not have any Y-90 treatment.
How long will the radioactivity stay in my body?
The radioactivity will have disappeared almost completely after about one month. However, following treatment, patients should avoid pregnancy for at least 4 months.
Are there any special precautions I have to take?
The only precaution you have to take is to keep your injected knee(s) still for at least 48 hours after the injection. This will make the treatment more effective and will minimise the risk of the radioactivity spreading to other parts of your body.
Will I have to stay off work?
When you leave the hospital you are advised to keep your knees at rest for another day, so it is best if you wait for about 3 days after the injection before you return to work.
Will I need to see a doctor after the treatment?
Yes. You will see your doctor some weeks after the treatment, so he/she can see how the treatment has worked for you.
Further information
If you have further questions, please do not hesitate to call us.
Tricia Cornell, Senior Rheumatology Practitioner, 01202 442849 or Lars Jansson, Head of Nuclear Medicine, 01202 442650
References
This information has been produced by:
Head of Department:
Mr L Jansson
Date Produced: February 2007
Review Date: February 2008
Responsible Clinician: Dr TD Goode, Consultant Oncologist
