FRI0640-HPR USEFULNESS OF ISOTOPIC RADIOSYNOVIORTESIS IN RHEUMATIC DISEASES WITH CHRONIC REFRACTORY SYNOVITIS.
Authors: J. Anino-Fernández, A. I. Rebollo Giménez, M. A. Ramírez Huaranga, D. Castro
Journal: Annals of the Rheumatic Diseases (2020)

Background: Radioactive synoviortesis consists of the intra-articular injection of particles from a radioisotopic colloidal suspension, to achieve the selective destruction of the synovial membrane, respecting the cartilage and bone Objectives: To describe the experience of performing isotopic radiosynoviortesis (RSO) as an alternative technique to the traditional procedures in the treatment of chronic synovitis refractory in patients of our health area and to define the pathologies, clinical improvement and safety in patients treated with the above described method. Methods: Observational, descriptive and cross-sectional study by reviewing radiosynoviortesis performed in patients with chronic arthritis refractory between 2005 and 2019 at the General University Hospital of Ciudad Real and comparing to common treatments, which normally consist of corticosteroids, disease-modifying drugs, biological therapy, nonsteroidal anti-inflammatory drugs and opioids. The study group involved 65 patients aged 37 to 75 years that had been diagnosed of rheumatic diseases such as rheumatoid arthritis, spondyloarthropathy, gout, osteoarthritis, villonodular synovitis, lupus and undifferentiated arthritis. Once medical records were reviewed, and prior to the procedure, the following information was registered into a database: age, sex, pathology, treatment received, infiltrations, affected joint, mobility, radiographic stage, laboratory parameters (VSG and PCR), Health Assessment Questionnaire (HAQ) and visual analog pain scale (VAS). After 6 months of treatment, clinical improvement provided by radiosynoviortesis was evaluated and a second database was created by collecting the following data: physical examination, HAQ, laboratory parameters (VSG and PCR), VAS, mobility and subjective perception of the patient. In addition, short-term complications were also recorded. After 6 months of radiosynoviortesis treatment, clinical improvement was established as a consequence of the following parameters: absence of inflammation on physical examination, improvement of inflammation reactants in comparison to the beginning of the procedure –assuming a decrease of ≥2 mm in ESR and ≥O, 2 mg / dl in CPR as such–, enhancement of HAQ –decrease of ≥ 0.25 compared to the beginning of the treatment–, EVA improvement determined by a reduction of &gt; 25% in relation to the initial value and increase of mobility. Additionally, the subjective perception of the patient was also considered as evidence of the. clinical improvement. Results: on the sixth month of treatment, 58.4 % of the individuals perceived a good clinical improvement, which was qualified as excellent by 6.2% of them. 56.9% of patients also presented pain reduction in the VAS scale, together with a decrease in joint swelling in 66% of the cases and an enhanced joint mobility in 69.2% of them. No side effects appeared due to treatment. An improvement in HAQ was observed in 67.7% of the observations and inflammation parameters (both ESR and CRP) were reduced in 64.6% of the subjects. The pathologies in which the technique has been most frequently prescribed are villonodular synovitis (27.7%) and rheumatoid arthritis (20%). Conclusion: Isotopic radiosynoviortesis is a useful and safe therapeutic alternative, that leads to a clinical improvement demonstrated by a reduction of pain and inflammation and increased mobility in those patients with chronic synovitis refractory. Compared to usual treatments, currently available data supports the effectiveness and safety of radiosynoviortesis as an alternative therapy for these patients References: [1] Margit Szentesi, Zoltán Nagy, Pal Géher, István Papp. A prospective observational study on the long-term results of 90Yttrium citrate radiosynoviorthesis of synovitis in osteoarthritis of the knee joint. Eur J Nucl Med Mol Imaging (2019) 46:1633–1641 [2] Zwolak R, Majdan M.Contemporary use of radiosynoviorthesis in chronic polyarthrtitis.Wiad Lek. 2017;70(3 pt 2):677-684. Disclosure of Interests: None declared