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Title: Radionuclide therapy for arthritic knees

Abstract

A new radionuclide therapeutic approach for rheumatoid arthritis of the knee is described. This therapy combines a short-lived radionuclide with a carrier whose physical and chemical characteristics aid retention of the radioactive particles within the joint. Joining a radionuclide to a particulate carrier had not been explored previously as a potential method for inhibiting radiation leakage. The treatment couples the rare earth element dysprosium 165 to ferric hydroxide in macroaggregate form (size range: 3 to 10 ..mu..m). After the relatively inert iron complex penetrates the synovium, it causes cell death. Macrophages and phagocytes clear away the cellular debris, essentially eliminating the synovium.

Authors:
Publication Date:
OSTI Identifier:
5833287
Resource Type:
Journal Article
Resource Relation:
Journal Name: JAMA, J. Am. Med. Assoc.; (United States); Journal Volume: 253:6
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; DYSPROSIUM 165; TISSUE DISTRIBUTION; UPTAKE; RHEUMATIC DISEASES; RADIOTHERAPY; BONE JOINTS; COMPARATIVE EVALUATIONS; PATIENTS; RADIATION DOSES; RADIATION PROTECTION; RADIOPHARMACEUTICALS; BETA DECAY RADIOISOTOPES; BETA-MINUS DECAY RADIOISOTOPES; BODY; DISEASES; DISTRIBUTION; DOSES; DRUGS; DYSPROSIUM ISOTOPES; EVEN-ODD NUCLEI; INTERMEDIATE MASS NUCLEI; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; LABELLED COMPOUNDS; MEDICINE; NUCLEAR MEDICINE; NUCLEI; ORGANS; RADIOISOTOPES; RADIOLOGY; RARE EARTH ISOTOPES; RARE EARTH NUCLEI; SKELETAL DISEASES; SKELETON; THERAPY; 550604* - Medicine- Unsealed Radionuclides in Therapy- (1980-)

Citation Formats

Doepel, L.K.. Radionuclide therapy for arthritic knees. United States: N. p., 1985. Web. doi:10.1001/jama.1985.03350300022003.
Doepel, L.K.. Radionuclide therapy for arthritic knees. United States. doi:10.1001/jama.1985.03350300022003.
Doepel, L.K.. 1985. "Radionuclide therapy for arthritic knees". United States. doi:10.1001/jama.1985.03350300022003.
@article{osti_5833287,
title = {Radionuclide therapy for arthritic knees},
author = {Doepel, L.K.},
abstractNote = {A new radionuclide therapeutic approach for rheumatoid arthritis of the knee is described. This therapy combines a short-lived radionuclide with a carrier whose physical and chemical characteristics aid retention of the radioactive particles within the joint. Joining a radionuclide to a particulate carrier had not been explored previously as a potential method for inhibiting radiation leakage. The treatment couples the rare earth element dysprosium 165 to ferric hydroxide in macroaggregate form (size range: 3 to 10 ..mu..m). After the relatively inert iron complex penetrates the synovium, it causes cell death. Macrophages and phagocytes clear away the cellular debris, essentially eliminating the synovium.},
doi = {10.1001/jama.1985.03350300022003},
journal = {JAMA, J. Am. Med. Assoc.; (United States)},
number = ,
volume = 253:6,
place = {United States},
year = 1985,
month = 2
}
  • Patients with arthritic complaints are seen frequently by podiatrists, who must establish a differential diagnosis. When combined with the patient's history, physical examination, joint aspiration, laboratory data, and radiographs, bone and joint scans provide a sensitive and objective means of arriving at an accurate diagnosis.
  • Pathologic reactions in the tissues of knees of rabbits following intra- articular introduction of colloidal ThO/sub 2/ (Thorotrast) were studied. Two ml of Thorotrast were injected into each of the right knees of adult male rabbits; in some the right femoral articular cartilages were irritated 24 hr earlier by inserting a needle into the articular cavity and scrntching the anterior surface of the articular cartilage. The animals were killed at intervals of 12, 200, 250, and 270 days following injection of ThO/sub 2/. Macroscopic examination showed collections of the foreign material in the thickened, hypertrophied synovial lining of the injectedmore » knees. Lymph glands situated on the lumbar portion of the vertebral column were enlarged and contained ThO/sub 2/ particles. Microscopic examination of tissues removed l2 days after injection revealed ThO/ sub 2/ particles engulfed to the greatest extent by the outer layer of cells of the synovium and by the cells lining the intra-articular tendons. All of the right knee specimens removed after a 200-day interval showed hyperplasia of synovial membrane, with formation of villi. The ThO/sub 2/ particles were situated in clumps, usually engulfed by giant cells, deep in the subsynovial stratum. The outer or surface cells lining of the synovium contained only sparse amounts of foreign material. Collections of ThO/sub 2/ were seen also in subsynovial tissues in the fibers of intra-articular tendons and interstitial loose connective tissue of contiguous muscle fibers. Focal necrosis, calcification, and foreign-body giant cells were encountered in the capsular tissues and in the intraarticular tendon fibers. When articular cartilage was traumatized prior to the injection, ThO/sub 2/ was found in the young reparative connective tissue lining the fibrocartilaginous tissue in the surgically produced defects. Normally, cells in the articular cartilage do not act as macrophages; however, some cells in the contiguous synovial lining did take up some of the foreign substance. The results show that ThO/sub 2/ was rapidly taken up by the outer layer of synovial cells and transported to the subsynovial layer. A hyperplastic and hypertrophic villous type of synovitis was produced, which simulated to some degree the histologic architecture found in nonspecific villous synovitis in man. The newly formed lining cells covering the fibrocartilaginous connective tissue, which appeared in the defects of the femoral articular cartilage, were able to retain the radioopaque and radioactive foreign material, but the original articular cartilage cells did not retain the foreign particles. (BBB)« less
  • Because of failure to fully respond to an initial intraarticular injection of dysprosium 165-ferric hydroxide macroaggregates, 17 patients with seropositive rheumatoid arthritis underwent repeat radiation synovectomy using this agent. Of the 13 patients who were evaluated 1 year later, 54% (7 knees) had good results, 31% (4 knees) had fair results, and 15% (2 knees) had poor results. The initial lack of significant benefit from radiation synovectomy did not appear to preclude a favorable response to a second injection.
  • The clearance rates of free iodide and of radioiodinated serum albumin were measured in the knee and wrist joints of 9 normal adult dogs. Iodide clearance from the knee was 3 times greater than that from the wrist. In contrast, radioiodinated serum albumin clearance from the knee was only slightly greater than that from the wrist. Interpreted as respective indices of effective synovial plasma flow and lymphatic drainage, these values indicate that the filtration fraction is normally greater in microvessels of the wrist than in those of the knee. These findings complement the results of companion studies of Starling forcesmore » that indicate a higher pressure microvascular bed in the wrist than in the knee.« less
  • Purpose: Accurate measurement of the three-dimensional (3D) rigid body and surface kinematics of the natural human knee is essential for many clinical applications. Existing techniques are limited either in their accuracy or lack more realistic experimental evaluation of the measurement errors. The purposes of the study were to develop a volumetric model-based 2D to 3D registration method, called the weighted edge-matching score (WEMS) method, for measuring natural knee kinematics with single-plane fluoroscopy to determine experimentally the measurement errors and to compare its performance with that of pattern intensity (PI) and gradient difference (GD) methods. Methods: The WEMS method gives highermore » priority to matching of longer edges of the digitally reconstructed radiograph and fluoroscopic images. The measurement errors of the methods were evaluated based on a human cadaveric knee at 11 flexion positions. Results: The accuracy of the WEMS method was determined experimentally to be less than 0.77 mm for the in-plane translations, 3.06 mm for out-of-plane translation, and 1.13 deg. for all rotations, which is better than that of the PI and GD methods. Conclusions: A new volumetric model-based 2D to 3D registration method has been developed for measuring 3D in vivo kinematics of natural knee joints with single-plane fluoroscopy. With the equipment used in the current study, the accuracy of the WEMS method is considered acceptable for the measurement of the 3D kinematics of the natural knee in clinical applications.« less