Efficacy of radiosynovectomy in the treatment of chronic knee synovitis: Systematic review and meta-analysis

Introduction: Knee joints are commonly involved with various inflammatory and non- inflammatory rheumatic diseases. Radiosynovectomy is being used as a local therapeutic option to alleviate pain and swelling in involved joints. The present study evaluated the effectiveness of radiosynovectomy for treatment of chronic knee synovitis. Methods: Through a search of Medline and SCOPUS with (Radiosynovectomy or radio-synovectomy or "radio synovectomy" or "radiation synovectomy" or radiosynoviorthesis or radio-synoviorthesis or synoviorthesis or "radiochemical synovectomy" or "radioisotope synovectomy") and (Re-188 or Y-90 or Sm-153 or P-32) as key words, 9 RCTs were enrolled in the analysis. Results: The outcomes of interest were odds ratio and risk difference of improvement in the radiosynovectomy group compared to the control group. Odds ratio and risk difference for Sm-153 plus corticosteroid subgroup was 1.959[0.571- 6.725, P=0.285] and 14.9% [-17.1%-47%, P=0.362] respectively. The subgroup of Y-90 plus corticosteroids showed pooled odds ratio and risk difference of 2.366[0.779-7.188, P=0.129] and 23.9% [-1.7%-49.4%, P=0.67] and in the subgroup Y-90 alone were 0.851[0.356-2.036, P=0.717] and -2.3% [-23.3%-18.7%, P=0.829], respectively. Conclusion: Combination of Y-90 colloid or Sm-153 with corticosteroids in radiosynovectomy have higher response rate compared to each of radioisotope or corticosteroid therapy alone.