Radionuclide Syvonectomy

LucyP

I've been advised to have a Radionuclide Syvonectomy procedure for my knee to help with my RA. It seems a good idea as had reactions to Methotrexate and am not keen to go back onto drugs as its only one joint affected.

It appears to be a radio-active chemical (Y-90) is injected into the knee (similar to a steroid injection) and then you have a cast so you do not move the knee for 3 days to ensure the chemicals do not travel. This will then kill the synovial lining of the knee joint. This then (hopefully) ensures that the swelling goes and then the lining cannot attack itself to keep swelling. Which sounds great....just worried if there are other side effects of not having a lining in the knee or negatives?

I'm struggling to find anything other than scholar articles online. Any advice would be great.

helpline_team

Hi Lucyp

Thank you for your post to Helplines. I'm not sure how much help we can offer from a Helplines point of view. This is a very specialised procedure they are suggesting, so our general information would not be detailed enough. The onus is on the consultant to find you enough information that's helpful - so do go back to them if you don't have enough to base your informed decision on.

If you wanted some other views you might decide to consult another rheumatologist to see if they have input to offer you.

I just wonder about your reaction to the methotrexate - was it your desire not to consider other treatments or did the rheumatologist go straight for this procedure? What proportion of people who have one joint affected, continue to have just one joint affected? Will they continue to monitor you and offer treatment if your levels go up? The better news is that there a lot of drug options out there, so will always be options to consider. I realise that these decisions are big and very personal though.

Finally a good way to hear about experiences will be to post on our Living with arthritis Forum - but everyone's experiences are different so you have to take it all with a pinch of salt.

You are most welcome to ring us at Helplines if you'd like to talk over what's on your mind. There's no pressure to make up your mind.

I hope some of this will be of help.

Kind regards

Guy

dreamdaisy

Hi, I'm not a member of Helplines, just a forum user. I had something similar done many years ago when I had just one affected knee joint, it was repeated when the other knee joined in. Despite the best of intentions from the rheumatologist my psoriatic arthritis ignored the intrusion and carried on regardless. It was done in the oncology ward and I was kept in isolation for 24 hours; I was told to keep away from children for six weeks because I was over the norm for natural radiation - at the time I was a self employed tutor for dyslexics so that affected my income. I was already on crutches (still am) so that wasn't a bother. I don't know of anyone else who has had this done but, if you decide to go ahead with it, I hope it helps. I wish you well. DD

LucyP

Hi,

I had a reaction to methotrexate - problems with breathing etc and was in hospital for 10 days so no desire to have that again! Also kept being ill when i was on it as had no immune system. I'm sort of against drugs as its only one joint that's effective and not keen on pumping my body with them for just my knee. I'll learn to live with the intermittent swelling and stiffness. The rheumatoid factor never shows anything up but as my sister has RA since she was 3 they've always said that's what I've got, although I only started to have problems about 15 years ago when I twisted it at school.

I'm happy to try the treatment and if it doesn't work then I've not lost anything by trying - just need to walk through if there are any side effects of not having a joint lining?

Thanks for you reply though, I have booked an appointment with my consultant tomorrow to discuss this further.

Thanks DD - I've been told to avoid children for 7 days so will be working from home rather than the office - but as the weathers due to be cold that's fine by me! Did you find you had any problems with the knee with there being no lining?

dreamdaisy

You are in a very different position to me, I started nineteen years ago with one affected joint, by the time this was done on my knee both were affected and it was supposed to slow the progression of the PsA in that knee. Nice theory . I'm now bone-on-bone throughout both joints - I don't think the lack of synovium altered anything for the positive. Any form of arthritis is degenerative and progressive so anything we can do to at least slow the progression has to be a good thing - I think I was too far gone when it was done! I'm now up to around forty affected joints and, thanks to the cold weather, can today feel every single one of them. If you go ahead I hope you find at least some benefit for a while (or even longer) but it's not going to alter the fact that your immune system is over-active and needs suppressing to slow down the progression.

I am currently coping with the first nasty infection I've had since early last year. I take a triple therapy to suppress disease activity and am assiduous with hand washing, anti-bac wipes and hand gel. All of us with an auto-immune on here are immuno-suppressed on one way or another and generally cope with it well. Have you tried anything apart from methotrexate? DD