Changes in articular synovial lining volume measured by magnetic resonance in a randomized, double-blind, controlled trial of intra-articular samarium-153 particulate hydroxyapatite for chronic knee synovitis.
OBJECTIVE
Magnetic resonance techniques have recently been investigated as tools with which to monitor inflammatory joint disease. Our aim was to use a contrast-enhanced T1-weighted protocol to monitor the short-term changes in knee synovial lining volume in a double-blind, randomized, controlled trial of intra-articular samarium-153 particulate hydroxyapatite (Sm-153 PHYP).


METHODS
Twenty-four out-patients with chronic knee synovitis, from a cohort who had been recruited to a long-term clinical efficacy trial, were recruited for this study. Patients received either intra-articular Sm-153 PHYP combined with 40 mg triamcinolone hexacetonide or 40 mg intra-articular triamcinolone hexacetonide alone. Synovial lining volumes were calculated from three-dimensional T1-weighted contrast-enhanced images made before and after contrast enhancement with thresholding and pixel counting, immediately before and 3 months after treatment.


RESULTS
Paired pre- and post-treatment magnetic resonance data were obtained for 18/24 (75%) patients. There was no significant difference in mean pre-treatment synovial volume between the two treatment groups (139 vs 127 ml). A mean reduction in synovial lining volume was detected in the Sm-153 PHYP/steroid-treated group (139 to 110 ml, P = 0.07) and in the steroid-treated group (127 to 58 ml, P < 0.001). The reduction was significantly greater in the steroid-treated group (-61% vs -23%, P < 0.05).


CONCLUSIONS
Short-term changes in articular synovial lining in response to intra-articular treatment for chronic synovitis may be monitored by magnetic resonance imaging. After 3 months, a greater mean reduction in synovial lining volume had occurred in response to intra-articular steroid alone compared to combined Sm-153 PHYP/steroid injection.
Clunie
G P
GP
Rheumatology Research Unit, University College London, UK.
Wilkinson
I D
ID
Lui
D
D
Hall-Craggs
M A
MA
Paley
M N
MN
Edwards
J C
JC
Ell
P J
PJ
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006882:Hydroxyapatites / Q000008:administration & dosage*; D007717:Knee / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012493:Samarium / Q000008:administration & dosage*; D013583:Synovial Membrane / Q000000981:diagnostic imaging / Q000473:pathology; D013585:Synovitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000031:analogs & derivatives
D000893:Anti-Inflammatory Agents; D006882:Hydroxyapatites; C091049:samarium hydroxyapatite; D012493:Samarium; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide