Synovectomy

Open surgical arthroscopic synovectomy reduces replacement-therapy-resistant disease and repetitive hemarthresis of a single joint. This procedure removes inflamed tissue and joint blood vessels. 

CXCL12 Serum ELISA Elevated levels in RA and OA, significant reduction after synovectomy. 166, 197... 

Kanbe K, Takemura T, Takeuchi K, Chen Q, Takagishi K, Inoue K. Synovectomy reduces stromal-cell-derived factor-1 (SDF-1) which is involved in the destruction of cartilage in osteoarthritis and rheumatoid arthritis. J Bone Joint Surg Br 2004 86(2) 296-300. 

Various methods for incorporating radioactive rhenium into suitable particles have been introduced. The earliest example is the use of 186Re-labeled sulfur colloid for radiation synovectomy. Commercial preparations for this application have been available for many years (CIS, France, 1987 catalog). 186Re-sulfur colloid has been used for endocavi-tary irradiation of cystic craniopharyngiomas, where irradiation of surrounding tissue is a risk that must be avoided [155]. 

Hydroxyapatite particles can be used for radiation synovectomy by exploiting the strong binding of rhenium diphosphonate complexes to the surface of hydroxyapatite (vide supra). The same 186Re-HEDP preparations as for bone palliative therapy are used. When injected into joints, these particles (mean diameter 25 pm, maximum diameter 45 pm) remain within the joint to the extent of at least 95% for several days in arthritic rabbits and rats [156], More recently, microspheres have been labeled with 188Re for this purpose [156a,b],... 

Surgical removal of the inflamed synovial membrane (synovectomy) frequently provides long-term relief If feasible, this approach is preferred because all pharmacotherapeutic measures entail significant adverse effects. 

Radiation synovectomy involves therapy of rheumatic synovitis in knees inflicted with rheumatoid arthritis. Treatment involves the use of Dy-165 FMHA (270 mCi) or Ho-166 FMHA(lOmCi). 

Osmic acid is injected into joints for chemical synovectomy and is associated with local pain, effusions, and fever skin necrosis is less frequent (1). Nerve damage and abnormal urinary findings (hematuria, proteinuria, and leukocyturia) can occur (SEDA-12, 94). A potentially dangerous drug, it certainly should not be given to young patients. 

Shortkroff S, Mahmood A, Sledge C B et al 1992 Studies on holmium-166-labelled hydroxyapatite a new agent for radiation synovectomy. Journal of Nuclear Medicine 33 937... 

There is a long standing connection between arthritis treatment and osmium (2). Osmium tetroxide has been used on a limited basis for the treatment of arthritis in humans, principally in Europe, for about 30 years. Osmium tetroxide treatment is not used in the United States and is controversial everywhere. In theory, the treatment makes use of the toxicity of osmium tetroxide to achieve a "chemical synovectomy". Detractors believe that the damage to joint tissues inherent in the procedure exacts a price too high for the method to be generally acceptable. Still, the small but persistent literature which has developed over the years provides a growing list of apparent successes. 

For a period of 1 to 3 days following osmarin injection the dogs exhibited evidence of increased discomfort in the treated joint. A similar period of increased discomfort was noted when normal rabbit joints were treated with osmarin, but was not seen in either normal or arthritic osmarin treated joints of pigs. The authors do not attirbute this short period of discomfort to the physical trauma of the injection. More likely explanations could be that osmarins cause a temporary decrease in synovial fluid viscosity, or that the discomfort is due to a type of chemical synovectomy which was previously noted in the rabbits. 

Chinol M, Vallabhajosula S, Goldsmith SJ, Klein MJ, Deutsch KF, Chinen LK, Brodack JW, Deutsch EA, Watson BA, Tofe AJ (1993) Chemistry and biological behavior of samarium-153 and rhenium-186-labeled hydroxylapatite particles Potential radiopharmaceuticals for radiation synovectomy. J Nucl... 

Valliant, J. R, P. Schaffer, J. F. Britten, A. Davison, A. G. Jones, and J. C. Yanch. 2000. The synthesis of cortico-steroid-carborane esters for the treatment of rheumatoid arthritis via boron neutron capture synovectomy. Tetrahedron Lett. Al 1355-1358. 

Sojan S, Bartholomeusz D (2005) Cutaneous radiation necrosis as a complication of yttrium-90 synovectomy. Hell J Nucl Med 8 58-59... 

Dunn AL, Manco-Johnson M, Busch MT, Balark KL, Abshire TC (2005) Leukemia and P32 radionuclide synovectomy for hemophilic arthropathy. J Thromb Hae-most 3 1541-1542... 

Chadzopoulos D, Badiavas K (2005) Complications in Y radiation synovectomy. Hell J Nucl Med 8 134 author reply 134... 

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