Caballero Motta Liz R, Anzola Alfaro Ana M, Janta Iustina, Molina Collada Juan, Henao Yulieth Katherine, Pérez Pascual Rebeca, Álvaro-Gracia José María, Nieto-González Juan Carlos
Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo 46, 28007 Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, SpainInstituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
Ther Adv Musculoskelet Dis. 2021 Nov 25;13:1759720X211055309. doi: 10.1177/1759720X211055309. eCollection 2021.
Radiosynovectomy can be an effective treatment for difficult-to-treat monoarthritis resistant to systemic and local standard therapy. The objective of our study was to determine predictors of good response to radiosynovectomy in routine care and give an overview of this underused technique.
Retrospective observational study of all the patients who underwent radiosynovectomy during a 6-year inclusion period. All the procedures were ultrasound guided and the radiopharmaceutical used was chosen according to joint size. The patient was considered to have an effective response to radiosynovectomy if the attending physician reported a positive outcome and there was no need to increase local and or systemic treatment due to arthritis in the affected joint during the next 12 months following the procedure.
We included 67 patients who underwent radiosynovectomy in the knee (73.1%), wrist (16.4%), and elbow (10.5%). Overall, 44 (65.7%) procedures were considered effective. In the multivariate analysis, infiltration of wrists (odds ratio = 0.192; confidence interval = 0.046-0.79) and pigmented villonodular synovitis (odds ratio = 0.13; confidence interval = 0.021-0.82) were independently associated with a noneffective response. No patients experienced complications associated with radiosynovectomy during follow-up.
Infiltrations of wrists with joint damage seem less likely to have a response to radiosynovectomy. In pigmented villonodular synovitis, radiosynovectomy as an adjuvant therapy for relapse might not be effective when performed more than 6 months after surgery. Overall, radiosynovectomy is an effective and safe treatment for persistent monoarthritis.
放射性滑膜切除术可作为治疗对全身及局部标准治疗耐药的难治性单关节炎的有效方法。我们研究的目的是确定常规治疗中放射性滑膜切除术良好反应的预测因素，并概述这种未得到充分应用的技术。
对纳入期6年内接受放射性滑膜切除术的所有患者进行回顾性观察研究。所有手术均在超声引导下进行，所用放射性药物根据关节大小选择。如果主治医生报告结果为阳性，且在手术后接下来的12个月内受累关节因关节炎无需增加局部和/或全身治疗，则认为患者对放射性滑膜切除术有有效反应。
我们纳入了67例接受放射性滑膜切除术的患者，其中膝关节手术占73.1%，腕关节手术占16.4%，肘关节手术占10.5%。总体而言，44例（65.7%）手术被认为有效。多变量分析显示，腕关节受累（比值比=0.192；置信区间=0.046-0.79）和色素沉着绒毛结节性滑膜炎（比值比=0.13；置信区间=0.021-0.82）与无效反应独立相关。随访期间无患者发生与放射性滑膜切除术相关的并发症。
伴有关节损伤的腕关节受累似乎对放射性滑膜切除术反应较小。在色素沉着绒毛结节性滑膜炎中，放射性滑膜切除术作为复发的辅助治疗，在手术后6个月以上进行可能无效。总体而言，放射性滑膜切除术是治疗持续性单关节炎的一种有效且安全的方法。
