phosphorus-radioisotopes and Arthritis--Rheumatoid

Topics: Arthritis, Rheumatoid; Calcium Radioisotopes; Femur; Hip Joint; Humans; Methods; Osteoarthritis; Phosphorus Radioisotopes; Radionuclide Imaging; Strontium Radioisotopes

Topics: Arthritis, Rheumatoid; Erbium; Gold Colloid, Radioactive; Gold Radioisotopes; Humans; Injections, Intra-Articular; Phosphorus Radioisotopes; Radioisotopes; Synovitis; Yttrium

To determine the efficacy of Phosphorus-32 radiation synovectomy in the treatment of patients with severe rheumatoid arthritis (RA) unresponsive to systematic or local medical therapy.. Twenty-three knees in 16 patients with severe chronic RA were prospectively treated by intra-articular installation of Phosphorus-32 and evaluated at 1, 3, 6, and 12 months. The Western Ontario and McMaster Universities Arthritis index (WOMAC), visual analog scale (VAS), Health Assessment Questionnaire (HAQ), pain scale, and grade of joint effusion and tenderness were assessed. At the 12-month time interval, the treated knees were classified into four categories: excellent response (no symptoms), good response (significant reduction of symptoms), moderate response (slight decrease), and poor response (no change or worsening).. Excellent response or good response was observed in 13/23 (56.5%) of the treated knees, moderate response in 2/23 (8.7%) of the treated knees, and poor response in 8/23 (34.8%) of the treated knees. The grades of effusion and tenderness were significantly decreased one-month posttreatment (P< 0.05); however, these changes did not persist at other time intervals (P > 0.05). There was a significant improvement in the HAQ, WOMAC, VAS, and pain scores at all time points compared with baseline, including at the 12-month time interval (P < 0.05).. Phosphorus-32 radiosynovectomy is an effective therapeutic treatment for patients with RA of the knee unresponsive to conventional pharmacotherapy.

Topics: Adult; Aged; Arthritis, Rheumatoid; Chronic Disease; Female; Humans; Male; Middle Aged; Phosphorus Radioisotopes; Prospective Studies; Synovectomy; Treatment Failure

Radiosynovectomy (RSO) is widely used in rheumatoid arthritis (RA). Commercially available radiopharmaceuticals are costly, and therefore new agents may be of interest. Radiocolloids labelled with less costly and more accessible radionuclides are of interest to developing countries. We investigated the efficacy of different formulations in RA.. In a multicentre effort, a cohort of 99 RA patients with knee involvement underwent RSO. Sixty-eight patients were treated with 184 ± 4 MBq Y-90 silicate (Y-90), 15 patients with 53 ± 11 MBq P-32 colloid (P-32), and 16 patients with 451 ± 110 MBq of Re-188 tin colloid (Re-188). Corticosteroid group (CSG) consisting of 46 patients received an intra-articular instillation of 20-40 mg triamcinolone. Pain response was evaluated by a 10-step visual analogue scale (VAS) before, 1 month, 3 months, 6 months and 12 months following the procedure.. In the RSO group (n = 99), pain relief by VAS from 6 ± 2 before to 5 ± 3, 4 ± 2, 3 ± 2 and 4 ± 2 at 1, 3, 6, 12 months after RSO was documented (Y-90 group: 6 ± 2 to 3 ± 2; P-32: 5 ± 2 to 3 ± 2, Re-188: 7 ± 2 to 4 ± 2 before vs. 6 months after therapy, respectively). The CSG VAS values were 6 ± 2 before and 5 ± 2, 4 ± 3, 5 ± 2 and 6 ± 2 at 1, 3, 6 and 12 months after corticosteroid instillation, respectively. Pain relief achieved with the three radiocolloid formulations did not differ significantly (P > 0.1). Pain relief at 12 months was more durable in RSO compared to CSG, P < 0.05. At 3 months, pain relief (>2 steps) was reported by 86% of RSO versus 67% of CSG, at 6 months 72 versus 46% and at 12 months 46 versus 21%. Side effects, i.e. swelling or transient pain increase, were recorded in 16% of patients but resolved within 1 month.. Therapeutic efficacy of RSO for RA of the knee applying either P-32, Re-188 or Y-90 provides comparable results. Pain relief by RSO is longer lasting as compared to corticosteroid instillation.

Topics: Adrenal Cortex Hormones; Adult; Aged; Arthritis, Rheumatoid; Colloids; Female; Humans; Instillation, Drug; Knee Joint; Male; Middle Aged; Pain; Phosphorus Radioisotopes; Radiosurgery; Rhenium; Synovial Membrane; Triamcinolone; Yttrium Radioisotopes

The aim of this study was to assess the effects of treatment with our locally produced P-32 colloidal suspension on knee synovitic inflammations of hemophilic and rheumatoid arthritis (RA) patients, as well as to compare results with chemical synovectomy or corticoid intra-articular injections and evaluate the cost-benefit ratio.. Thirty-six hemophilic male patients, 4-28 years of age and sent by the Hemophilic Foundation (Buenos Aires, Argentina), were enrolled for knee radiosynovectomy (RS) with P-32 colloid (26 patients), or the antibiotic rifampicin with the cooperation of orthopaedists (10 patients). Parents' informed consent was obtained. The following procedures were performed: routine blood tests, X-ray, ultrasound, a 3-phase bone scan, plus monthly methylene diphosphonate (MDP) controls. Patients were included in this study only if several knee episodes had occurred. Exclusion criteria included bone destruction and big Baker's cyst. Twelve RA patients were included, with similar selection criteria: 6 RA patients received P-32 therapy, and the other 6 patients intra-articular corticoids. Clinical, blind evaluation (state of joint involvement, pain, motility, requirements of antihemophilic factors, corticoids, or analgesics) was registered in follow-up charts. If required, joint aspiration was carried out. Intra-articular instillation of saline plus flushing was done before the needle was withdrawn. P- 32 Bremsstrahlung emission was used in the gamma camera for early and late imaging to confirm the absence of leakage. For intra-articular chemical injections therapy, 4 MBq of Tc-99m MAA (macroaggregates) was used. Immobilization and relative rest for 72 hours followed the procedures.. There were neither local or systemic effects, nor leakage during P-32 treatment. Intra-articular rifampicin and corticoids procedures required frequent injections. Comparison of regions of interest (ROIs) in treated knees during soft-tissue scintigraphies in pre- and post-third MDP control showed knee improvement. The follow-up evaluation demonstrated an increase in joint motion, diminished volume, and less requirement and frequency of the use of antihemophilic factors (AHF) in 80% of the radiosynovectomies (21 of 26), thus lowering health costs. Five female RA patients (5 of 6) had decreased joint swelling and pains, resulting in increased joint motion.. Radiosynovectomy in RA showed a 3-month pain palliative effect. One intra-articular knee radiosynoviorthesis in haemophilic patients provides a more than 3- month relief of symptoms after treatment with locally produced P-32 (11 patients). This turned out to be a safe, economic alternative procedure in emerging nations where the availability of AHF is difficult and expensive.

Topics: Adolescent; Adult; Arthritis, Rheumatoid; Child; Child, Preschool; Colloids; Follow-Up Studies; Hemophilia A; Humans; Knee; Male; Middle Aged; Phosphorus Radioisotopes; Synovitis

Absorbed dose profiles are presented for radionuclides of frequent or potential use in radiation synovectomy, an intraarticular technique aimed at treating rheumatoid arthritis through direct and highly selective irradiation of inflamed synovium. The radionuclides investigated were 198Au, 165Dy, 32P, 186Re, 90Y, and 166Ho. These profiles reveal the absorbed dose imparted per unit activity of injected radionuclide (Gy/mCi) as a function of penetration distance (mm) to major components of the arthritic synovial joint. Their usefulness is twofold: they can be employed to select the radionuclide best suited to achieving the proper depth of penetration in tissue (approximating the thickness of the inflamed synovium) and to determine, a priori, the necessary dose of radioactivity (delivering an absorbed dose sufficient to effectively treat all the diseased tissue). The extent of radiation of other synovial joint components, such as bone and articular cartilage, and how the advancing rheumatoid arthritis can be expected to alter the extent and pattern of absorbed dose penetration in the joint are also discussed.

Topics: Arthritis, Rheumatoid; Bone and Bones; Cartilage, Articular; Computer Simulation; Dose-Response Relationship, Radiation; Dysprosium; Gold Radioisotopes; Holmium; Humans; Phosphorus Radioisotopes; Radiation Dosage; Radioisotopes; Radiotherapy, Computer-Assisted; Rhenium; Synovial Membrane; Yttrium Radioisotopes

Topics: Adult; Aged; Arthritis; Arthritis, Rheumatoid; Chronic Disease; Female; Humans; Injections, Intra-Articular; Knee Joint; Male; Middle Aged; Phosphorus Radioisotopes

Basis, indications and results of the endolymphatic therapy with radionuclides, of the selective therapy with radiophosphorus and radiostrontium and of the intraarticular and endocavitary therapy with radiocolloids are described. Future scientific engagement and intensive basic research in radionuclide therapy is required. However, because of the expected therapeutic profit the efforts seem to be justified.

Topics: Adolescent; Adult; Aged; Arthritis, Rheumatoid; Child; Child, Preschool; Female; Gold Colloid, Radioactive; Humans; Infant; Iodine Radioisotopes; Male; Middle Aged; Neoplasms; Peritoneal Neoplasms; Phosphorus Radioisotopes; Polycythemia Vera; Radioisotopes; Radiotherapy; Radiotherapy Dosage

Topics: Adult; Aged; Agranulocytosis; Arthritis, Rheumatoid; Blood Volume; Cell Survival; Felty Syndrome; Female; Half-Life; Humans; Isoflurophate; Leukocyte Count; Male; Middle Aged; Muramidase; Neutropenia; Phosphorus Radioisotopes; Splenectomy

Topics: Adipose Tissue; Adult; Agammaglobulinemia; Arteritis; Arthritis, Rheumatoid; Autopsy; Blood Platelet Disorders; Bronchopneumonia; Chlorambucil; Chronic Disease; Colon; Dexamethasone; Female; Hematopoiesis; Humans; Lung; Lung Diseases, Obstructive; Lymph Nodes; Lymphoma, Non-Hodgkin; Necrosis; Panniculitis, Nodular Nonsuppurative; Phosphorus Radioisotopes

Topics: Arthritis, Rheumatoid; Humans; Injections, Intra-Articular; Knee Joint; Phosphorus Radioisotopes; Synovial Membrane

Topics: Arthritis; Arthritis, Rheumatoid; Humans; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Rheumatic Fever