Clinical efficacy of radiation synovectomy in digital joint osteoarthritis

Purpose: Purpose. Radiation synovectomy was developed for local treatment of rheumatoid arthritis. In this study, the long-term efficacy of radiation synovectomy was retrospectively evaluated in patients with osteoarthritis ( activated arthrosis) of the digital joints using an algofunctional score. Methods: Fifty-three digital joints in 29 patients ( mean age 64.8 years) were treated by intra-articular injection of Er-169 citrate. All joints were painful despite pharmacotherapy and showed an elevated blood pool pattern in a pretherapeutic three-phase bone scan, indicative for local synovitis. The patients were asked to classify their complaints with respect to different daily manual activities on a ten-step pain scale from 1 ( total disability) to 10 ( lack of any impairment) prior to and after treatment, with a mean follow-up of 41 months. Local signs of osteoarthritis such as joint swelling or pain were additionally evaluated and were scored from progression of complaints to excellent improvement based on patient self-evaluation. Results: All patients reported a pronounced improvement in their manual activities. The mean total score of 4.73 +/- 0.58 for all activities prior to treatment increased significantly to 6.79 +/- 0.47 after radiation synovectomy ( p< 0.05). The best results were obtained in the thumb base joints, whereas distal interphalangeal joints were frequently resistant to therapy. Conclusion: Radiation synovectomy is highly effective in digital joint osteoarthritis with concomitant local synovitis.