RE: Radiation Synovectomy

["Barry Siegel" <siegelb@mirlink.wustl.edu>]

You might wish to see the following review article.  There are no
radiopharmaceuticals currently approved by the FDA for radiation synovectomy
in the United States.

AU  - Deutsch E
AU  - Brodack JW
AU  - Deutsch KF
IN  - Mallinckrodt Medical, Inc., St. Louis, MO 63134.
TI  - Radiation synovectomy revisited. [Review]
SO  - Eur J Nucl Med 1993 Nov;20(11):1113-27
AB  - Radiation synovectomy is a potential weapon in the therapeutic
      armamentarium of nuclear medicine. It is an attractive alternative
      to surgical or chemical synovectomy for the treatment of rheumatoid
      arthritis. In this article the clinical results obtained with
      radiation synovectomy from the 1950s through 1992 are summarized and
      reviewed. Even after taking into account the paucity of
      well-controlled trials and rigorous clinical follow-up, it is clear
      that radiation synovectomy is efficacious in controlling the
      symptoms of rheumatoid arthritis. However, the procedure is not
      widely used because of concerns about leakage of radioactivity from
      the treated joint, and the resulting high doses that can be
      delivered to nontarget organs. New approaches to the preparation of
      radiolabeled particles for use in radiation synovectomy promise to
      minimize this leakage and thus allow the full potential of this
      important radiotherapy to be realized. [References: 118]

Barry A. Siegel, M.D.
Division of Nuclear Medicine
Mallinckrodt Institute of Radiology
510 S. Kingshighway Blvd.
St. Louis, MO 63110
PHONE:  (314) 362-2809
FAX:  (314) 362-2806
INTERNET:  siegelb@mirlink.wustl.edu
_______________________________________________________________________________
From: radsafe@romulus.ehs.uiuc.edu on 22 Mar 1996  05:41
Subject: Re: Radiation Synovectomy
To: Multiple recipients of list


> One of our physicians has posed a question. 
> Radiation Synovectomy is the intracavitary use of isotopes 
> in the knee or other joints for therapeutic reasons. The
> Nuclear Medicine textbook I have available describes this
> as a routine clinical procedure, using colloidal gold-198.
> 
> Better isotopes for this therapy exist, specifically P-32 
> and Y-90. The question is, what is the regulatory status
> of the use of these isotopes for radiation synovectomy. 
> Does the FDA consider this to be approved for routine use, and
> if so, who markets the radiopharmaceuticals?
> 
*****
REPLY
*****

A more important question would be:  What is the cliniical efficacy 
of the procedure using any of these radiopharmaceuticals?  

I doubt there is any.


David Adcock, MD, MPH
University of South Carolina