THE DEVELOPMENT OF RADIATION SYNOVECTOMY IN ARTHRITIS

放射性滑膜切除术对炎症的功能性消融 关节内短程给药后的滑膜， 发射贝塔的放射性同位素。这种同位素被络合成一个 颗粒载体，以延缓和减少泄漏 减少关节的辐射，从而减少全身的辐射照射。 我们开发了一种用于放射滑膜切除术的新试剂- 镝-165-氢氧化铁大聚集体(165Dy-FHMA)-和 在过去的六年里一直在临床试验中使用。 在112个(85%)的类风湿膝关节中，有95个(85%)表现出明显的 治疗一年后改善。放射性泄漏 从治疗的关节已经不到注射剂量的1%。 我们建议进行165Dy-FHMA的前瞻性试验，以证实 在我们之前的非对照研究中显示了这种有效性。 预期这些研究会有良好的结果，以及 认识到165Dy的不切实际的半衰期，我们建议 开发适合在以下领域使用的新代理 毗邻反应堆，极大地扩展了这一技术的可用性 心理治疗。 其他各种组合的同位素和载体系统将 在抗原诱导的关节炎的动物模型中进行研究。 潜在的同位素包括Re 188和Y-90；载体 包括FHMA、硫胶和亲脂性络合物。 除了对膝关节类风湿性关节炎有效之外 (可能还有其他关节)，我们在 膝关节血友病和色素沉着绒毛结节 滑膜炎表明很有可能 放射性滑膜切除术对这些疾病也是有用的。 客观评价残留物的治疗效果 有问题；为了解决这个问题，我们建议继续我们的 ~(111)In扫描的临床应用研究 炎症反应的客观和定量指标 滑膜组织。

Radiation synovectomy produces functional ablation of inflamed synovium following intra-articular administration of short-range, beta-emitting radioisotopes. The isotope is complexed to a particulate carrier in order to delay and decrease leakage rom the joint, thereby reducing the total body radiation exposure. We have developed a new agent for radiation synovectomy - dysprosium-165-ferric hydroxide macroaggregates (165Dy-FHMA) - and have been using it in clinical trials over the past six years. Ninety-five of 112 (85%) rheumatoid knees showed significant improvement one year after treatment. Leakage of radioactivity from the treated joint has been less than 1% of the injected dose. We propose to conduct a prospective trial of 165Dy-FHMA to confirm the efficacy indicated in our previous uncontrolled studies. Anticipating a favorable outcome from these studies, and recognizing the impractical half life of 165Dy, we propose to develop new agents that will be appropriate for use in areas not adjacent to a reactor, greatly extending the availability of this therapy. Other isotopes and carrier systems, in various combinations, will be investigated in the animal model of antigen-induced arthritis. Potential isotopes include rhenium 188 and yttrium-90; carriers include FHMA, sulfur colloids and lipophilic complexes. In addition to its usefulness in rheumatoid arthritis of the knee (and potentially other joints), our preliminary studies in hemophilic arthropathy of the knee and pigmented villonodular synovitis indicate a high degree of probability that radiation synovectomy will be useful in these disorders as well. Objective evaluation of the efficacy of treatment remains problematic; to address this problem, we propose to continue our investigation of indium-111 scanning as a clinically useful, objective and quantitative indicator of inflammation in the synovial tissues.