MR evaluation of radiation synovectomy of the knee by means of intra-articular injection of holmium-166-chitosan complex in patients with rheumatoid arthritis: results at 4-month follow-up.
OBJECTIVE
To determine whether MRI is able to demonstrate the effect of radiation synovectomy after the intra-articular injection of holmium-166-chitosan complex for the treatment of rheumatoid arthritis of the knee.


METHODS
Fourteen patients aged 36-59 years were treated with 10-20 mCi of holmium-166-chitosan complex. A criterion for inclusion in this study was the absence of observable improvement after 3- or more months of treatment of the knee with disease-modifying anti-rheumatic drugs. MR images were acquired both prior to and 4-months after treatment. Clinical evaluation included the use of visual analog scales to assess pain, and the circumference of the knee and its range of motion were also determined. MR evaluation included measurement of the volume of synovial enhancement and wall thickness, the amount of joint effusion, and quantifiable scoring of bone erosion, bone edema and lymph nodes.


RESULTS
Visual analog scale readings decreased significantly after radiation synovectomy (p < 0.05). MRI showed that joint effusion decreased significantly (p < 0.05), and that the volume of synovial enhancement tended to decrease, but to an insignificant extent (p = 0.107).


CONCLUSIONS
The decreased joint effusion noted at 4-month follow-up resulted from radiation synovectomy of the rheumatoid knee by means of intra-articular injection of holmium-166-chitosan complex.
Lee
Sang Hoon
SH
Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Korea. jss@yumc.yonsei.ac.kr
Suh
Jin Suck
JS
Kim
Ho Seok
HS
Lee
Jong Doo
JD
Song
Jungsik
J
Lee
Soo Kon
SK
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000532:radiotherapy*; D002686:Chitin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D048271:Chitosan; D005260:Female; D005500:Follow-Up Studies; D006695:Holmium / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011868:Radioisotopes / Q000627:therapeutic use; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D013583:Synovial Membrane / Q000528:radiation effects*; D013997:Time Factors
D011868:Radioisotopes; D019275:Radiopharmaceuticals; D002686:Chitin; D048271:Chitosan; D006695:Holmium