RADIOSYNOVECTOMYS CLINICAL-APPLICATIONS AND COST-EFFECTIVENESS - A REVIEW

It is apparent that from the work of the authors and many others, incl uding the work of Rivard, Sledge, Zuckerman, among others, that radios ynovectomy has an important role to play in providing effective treatm ent of affected joints associated with rheumatoid arthritis and other forms of arthritis as well as the hemophiliac joint. The treatment off ers relief from the effects of recurrent joint effusion with an approx imately 60% to 66% favorable response and from recurrent hemarthrosis in the hemophiliac joint with an approximately 75% to 80% favorable re sponse. The impact of providing radiosynovectomy as an alternative to surgical synovectomy is seen, where postoperative side effects such as joint stiffness are avoided, improved quality of life is repeatedly d ocumented, and the cost savings in health care dollars, particularly e vident in the hemophiliac joint in this relatively small population, a re potentially enormous. With almost two million people in the United States suffering from rheumatoid arthritis, the potential savings in h ealth care dollars is also enormous. As with any use of in vivo radiop harmaceuticals, the potential for radiation-induced damage exists. How ever, with a 25 plus year record of use, more optimally configured rad iopharmaceuticals, and the addition of maneuvers to minimize potential joint leakage, the risk of radiation induced damage appears to be min imal. It appears as though radiosynovectomy is an effective as well as cost-effective alternative to surgical synovectomy and is becoming th e procedure of choice particularly in the hemophiliac patient with rec urrent hemarthrosis and synovitis who has failed medical therapy. It i s also the procedure of choice in patients for whom surgery is contrai ndicated because of the presence of clotting factor inhibitors. Copyri ght (C) 1997 by W.B. Saunders Company.