Extra-articular tissue radiation may be caused by:
Injection of the radiopharmaceutical outside the synovial cavity;
Leakage of the radiopharmaceutical through the injection site;
Drainage of the radiopharmaceutical via the lymphatic system.
Acute side effects are rare. Joint inflammation might worsen and could last for several days and sometimes accompanied by fever. ESR could increase and leukocytosis could occur. Long term side effects have not been described in the literature, even though this treatment has been in use for more than 60 years.