Efficacy of radiosynovectomy in the treatment of chronic knee synovitis: Systematic review and meta-analysis

Document Type : Systematic Review/Meta-analysis


1 Nuclear Medicine Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Thyroid Center, Institute of Radiology, Nuclear Medicine and Radiotherapy, Bottrop, Germany

3 Rheumatic Diseases Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: Knee joints are commonly involved with various inflammatory and non- inflammatory rheumatic diseases. Radiosynovectomy is being used as a local therapeutic option to alleviate pain and swelling in involved joints. The present study evaluated the effectiveness of radiosynovectomy for treatment of chronic knee synovitis.
Methods: Through a search of Medline and SCOPUS with (Radiosynovectomy OR radio-synovectomy OR "radio synovectomy" OR "radiation synovectomy" OR radiosynoviorthesis OR radio-synoviorthesis OR synoviorthesis OR "radiochemical synovectomy" OR "radioisotope synovectomy") AND (Re-188 OR Y-90 OR Sm-153 OR P-32) as key words, 9 RCTs were enrolled in the analysis.
Results: The outcomes of interest were odds ratio and risk difference of improvement in the radiosynovectomy group compared to the control group. Odds ratio and risk difference for Sm-153 plus corticosteroid subgroup was 1.959[0.571-6.725, P=0.285] and 14.9% [-17.1%-47%, P=0.362] respectively. The subgroup of Y-90 plus corticosteroids showed pooled odds ratio and risk difference of 2.366[0.779-7.188, P=0.129] and 23.9% [-1.7%-49.4%, P=0.67] and in the subgroup Y-90 alone were 0.851[0.356-2.036, P=0.717] and -2.3% [-23.3%-18.7%, P=0.829], respectively.

Conclusion: Combination of Y-90 colloid or Sm-153 with corticosteroids in radiosynovectomy have higher response rate compared to each of radioisotope or corticosteroid therapy alone.


Main Subjects

Liepe K. Efficacy of radiosynovectomy in rheumatoid arthritis. Rheumatol Int. 2012 Oct;32(10):3219-24.
Bain LS, Balch HW, Wetherly JM, Yeadon A. Intraarticular triamcinolone hexacetonide: double-blind comparison with methylprednisolone. Br J Clin Pract. 1972 Dec;26(12):559-61.
Nissilä M, Isomäki H, Koota K, Larsen A, Raunio K. Osmic acid in rheumatoid synovitis. A controlled study. Scand J Rheumatol. 1977;6(2):111-2.
McEwen C. Multicenter evaluation of synovectomy in the treatment of rheumatoid arthritis. Report of results at the end of five years. J Rheumatol. 1988;15(5):765-9.
Jensen CM, Poulsen S, Ostergren M, Hansen KH. Early and late synovectomy of the knee in rheumatoid arthritis. Scand J Rheumatol. 1991;20(2):127-31.
Schneider P, Farahati J, Reiners C. Radiosynovectomy in rheumatology, orthopedics, and hemophilia. J Nucl Med. 2005 Jan;46 Suppl 1:48S-54S.
Fellinger K, Schmid J. Local therapy of rheumatic diseases. Wien Z Inn Med. 1952 Sep;33(9):351-63.
Deutsch E, Brodack JW, Deutsch KF. Radiation synovectomy revisited. Eur J Nucl Med. 1993 Nov;20(11):1113-27.
Jones G. Yttrium synovectomy: a meta-analysis of the literature. Aust N Z J Med. 1993 Jun;23(3):272-5.
Heuft-Dorenbosch LL, de Vet HC, van der Linden S. Yttrium radiosynoviorthesis in the treatment of knee arthritis in rheumatoid arthritis: a systematic review. Ann Rheum Dis. 2000 Aug;59(8):583-6.
Kresnik E, Mikosch P, Gallowitsch HJ, Jesenko R, Just H, Kogler D, Gasser J, Heinisch M, Unterweger O, Kumnig G, Gomez I, Lind P. Clinical outcome of radiosynoviorthesis: a meta-analysis including 2190 treated joints. Nucl Med Commun. 2002 Jul;23(7):683-8.
van der Zant FM, Boer RO, Moolenburgh JD, Jahangier ZN, Bijlsma JW, Jacobs JW. Radiation synovectomy with (90)Yttrium, (186)Rhenium and (169)Erbium: a systematic literature review with meta-analyses. Clin Exp Rheumatol. 2009 Jan-Feb;27(1):130-9.
Bridgman JF, Bruckner F, Bleehen NM. Radioactive yttrium in the treatment of rheumatoid knee effusions. Preliminary evaluation. Ann Rheum Dis. 1971 Mar;30(2):180-2.
Gumpel JM, Roles NC. A controlled trial of intra-articular radiocolloids versus surgical synovectomy in persistent synovitis. Lancet. 1975 Mar 1;1(7905):488-9.
Nissilä M, Anttila P, Hämäläinen M, Jalava S. Comparison of chemical, radiation and surgical synovectomy for knee joint synovitis. Scand J Rheumatol. 1978;7(4):225-8.
Doherty M, Dieppe PA. Effect of intra-articular yttrium-90 on chronic pyrophosphate arthropathy of the knee. Lancet. 1981 Dec 5;2(8258):1243-6.
Sheppeard H, Aldin A, Ward DJ. Osmic acid versus yttrium-90 in rheumatoid synovitis of the knee. Scand J Rheumatol. 1981;10(3):234-6.
Grant EN, Bellamy N, Fryday-Field K Disney T, Driedger A, Hobby K. Double-blind randomized controlled trial and six-year open follow-up of yttrium-90 radiosynovectomy versus triamcinolone hexacetonide in persistent rheumatoid knee synovitis. Inflammopharm. 1992 Sep;1(3):231-8.
O'Duffy EK, Clunie GP, Lui D, Edwards JC, Ell PJ. Double blind glucocorticoid controlled trial of samarium-153 particulate hydroxyapatite radiation synovectomy for chronic knee synovitis. Ann Rheum Dis. 1999 Sep;58(9):554-8.
Jahangier ZN, Jacobs JW, Lafeber FP, Moolenburgh JD, Swen WA, Bruyn GA, Griep EN, ter Borg EJ, Bijlsma JW. Is radiation synovectomy for arthritis of the knee more effective than intraarticular treatment with glucocorticoids? Results of an eighteen-month, randomized, double-blind, placebo-controlled, crossover trial. Arthritis Rheum. 2005 Nov;52(11):3391-402.
Dos Santos MF, Furtado RN, Konai MS, Castiglioni ML, Marchetti RR, Silva CP, Natour J. Effectiveness of radiation synovectomy with Yttrium-90 and Samarium-153 particulate hydroxyapatite in rheumatoid arthritis patients with knee synovitis: a controlled, randomized, double-blinded trial. Clin Rheumatol. 2011 Jan;30(1):77-85.
Das B. Role of radiosynovectomy in the treatment of rheumatoid arthritis and hemophilic arthropathies. Biomed Imaging Interv J. 2007 Oct;3(4):e45.
U─čur O, Gedik GK, Atilla B, Rubello D. Radiosynovectomy: current status in the management of arthritic conditions. Nucl Med Commun. 2008 Sep;29(9):755-8.
Clunie G, Fischer M; EANM. EANM procedure guidelines for radiosynovectomy. Eur J Nucl Med Mol Imaging. 2003 Mar;30(3):BP12-6.
Caldwell JR. Intra-articular corticosteroids. Guide to selection and indications for use. Drugs. 1996 Oct;52(4):507-14.