Treatment Of Inflammatory Joint Disease

One of the main reasons for joint pain and effusion is an inflammation of the synovial membrane either caused by an autoimmune response in case of rheumatoid arthritis, chronic reactive arthritis, and arthritis in other immunoarthritic rheumatoid disorders or caused by mechanical stress and abrasion of cartilage and or bone in case of osteoarthritis. Treatment of inflammatory joints therefore depends on the type of the underlying disease and is based on systemic drug therapy and local joint...

Contraindications

An absolute contraindication for radiation synovectomy is pregnancy. Routine pregnancy testing should be performed prior to treatment in women of childbear-ing age. Patients who are actively lactating or nursing also should not undergo radionuclide joint treatment. After radiation synovectomy, pregnancy should be avoided by effective contraception for four to six months (Table 5). Radiation synovectomy is also contraindicated in septic arthritis and synovial cyst rupture. Local skin or tissue...

Patient Preparation And Treatment Procedure

Prior to treatment, the indication for radiation synovectomy should be carefully reviewed both by the referring physician and the nuclear medicine specialist (Table 4). This includes a detailed treatment and drug history (e.g., a previous intra-articular steroid injection may reduce or even normalize the uptake pattern on the blood-pool images as well as mask typical local findings such as swelling and effusion) and a physical examination to exclude other joint damage causes (see...

Pathophysiology of Ankylosing Spondylitis

The first description of two patients suffering from complete inflammatory anky-losis of the spine and peripheral joints was presented by Adolf Struempell in 1884, followed by reports by Wladimir von Bechterew and Pierre Marie (6). The etiology of this rheumatoid-inflammatory disease is still unknown. Owing to the frequent association with the human leukocyte antigen HLA-B27 in more than 90 of all AS patients, a genetic predisposition is highly assumed. However, only 10 of all HLA-B27-positive...

References

Local therapy of rheumatic diseases. Wien Z Inn Med 1952 33 351-363. 2. Delbarre F, Cayla J, Menkes C, et al. Synoviorthesis with radioisotopes. Presse Med 1968 76 1045-1050. 3. Hollander JL, Brown EM Jr, Jessar RA, Brown CY. Hydrocortisone and cortisone injected into arthritic joints comparative effects of and use of hydrocortisone as a local antiarthritic agent. J Am Med Assoc 1951 147 1629-1635. 4. Barrueco JL, Gazquez A, Redondo E, Regodon S. Changes in the...

Indications For Radiation Synovectomy And Success Rates

Although approved indications differ in various countries, radiation synovectomy in general is applicable for local therapy of synovitis and is therefore suitable for patients with different types of inflammatory joint disease. Indications always should be set based on a joint collaboration of the nuclear medicine specialist and the rheumatologist or orthopedic surgeon or any other clinician involved in the patient's treatment. Commonly applied indications are listed in Table 3. As treatment...