Radiosynoviorthesis with rhenium-186 in rheumatoid arthritis: a prospective study of three treatment regimens.
The aim of this study was to evaluate the efficiency of radiation synovectomy with rhenium-186 in rheumatoid arthritis. In this prospective, randomized trial we compared three different treatment regimens for shoulder, elbow, wrist, hip and ankle joints: group 1, injection of rhenium-186; group 2, injection of rhenium-186 in combination with triamcinolone hexacetonide; group 3, injection of triamcinolone hexacetonide alone. Each treatment group included 50 joints. Patients included in the study had to fulfil the following criteria: (1) they had to have a diagnosis of rheumatoid arthritis (ARA criteria 1988), (2) their disease-modifying drug had to be methotrexate, started at least 6 months prior to injection therapy and given for the entire study time, (3) their nonsteroidal anti-inflammatory drug had to be diclofenac given at a dose of 150 mg/day or less and (4) they were also given prednisolone at a dose of 7.5 mg/day or less. After 3 years of follow-up, 79 joints met these criteria, i.e. 71 joints were excluded from the study: 26 joints because the patients changed the disease-modifying drug (12 joints from group 1, 4 joints from group 2 and 10 joints from group 3); 45 joints because of recurrent synovitis and second-stage treatment (21 joints from group 1, 5 joints from group 2 and 19 joints from group 3). During the follow-up period, joints were assessed for pain, synovitis, joint motion and stage of radiological destruction. Best clinical results and slowest progression in radiological destruction were achieved with the combined injection of rhenium-186 and triamcinolone hexacetonide. Therefore, we recommend this treatment for articulosynovitis with the exception of severe forms, the latter because of the effective penetration range of rhenium-186.
Göbel
D
D
Department of Orthopaedic Surgery, University Hospital of Goettingen, Germany. goebel-dr-dietmar@t-online.de
Gratz
S
S
von Rothkirch
T
T
Becker
W
W
Willert
H G
HG
D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D010147:Pain Measurement; D018579:Patient Selection; D011239:Prednisolone / Q000008:administration & dosage; D011446:Prospective Studies; D011868:Radioisotopes / Q000627:therapeutic use*; D016059:Range of Motion, Articular / Q000187:drug effects / Q000528:radiation effects; D012008:Recurrence; D012211:Rhenium / Q000627:therapeutic use*; D013585:Synovitis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*
D000893:Anti-Inflammatory Agents; D011868:Radioisotopes; D012211:Rhenium; D011239:Prednisolone; D014222:Triamcinolone Acetonide; D008727:Methotrexate