Effects of radiosynovectomy with p-32 colloid therapy in hemophilia and rheumatoid arthritis.
OBJECTIVE
The aim of this study was to assess the effects of treatment with our locally produced P-32 colloidal suspension on knee synovitic inflammations of hemophilic and rheumatoid arthritis (RA) patients, as well as to compare results with chemical synovectomy or corticoid intra-articular injections and evaluate the cost-benefit ratio.


METHODS
Thirty-six hemophilic male patients, 4-28 years of age and sent by the Hemophilic Foundation (Buenos Aires, Argentina), were enrolled for knee radiosynovectomy (RS) with P-32 colloid (26 patients), or the antibiotic rifampicin with the cooperation of orthopaedists (10 patients). Parents' informed consent was obtained. The following procedures were performed: routine blood tests, X-ray, ultrasound, a 3-phase bone scan, plus monthly methylene diphosphonate (MDP) controls. Patients were included in this study only if several knee episodes had occurred. Exclusion criteria included bone destruction and big Baker's cyst. Twelve RA patients were included, with similar selection criteria: 6 RA patients received P-32 therapy, and the other 6 patients intra-articular corticoids. Clinical, blind evaluation (state of joint involvement, pain, motility, requirements of antihemophilic factors, corticoids, or analgesics) was registered in follow-up charts. If required, joint aspiration was carried out. Intra-articular instillation of saline plus flushing was done before the needle was withdrawn. P- 32 Bremsstrahlung emission was used in the gamma camera for early and late imaging to confirm the absence of leakage. For intra-articular chemical injections therapy, 4 MBq of Tc-99m MAA (macroaggregates) was used. Immobilization and relative rest for 72 hours followed the procedures.


RESULTS
There were neither local or systemic effects, nor leakage during P-32 treatment. Intra-articular rifampicin and corticoids procedures required frequent injections. Comparison of regions of interest (ROIs) in treated knees during soft-tissue scintigraphies in pre- and post-third MDP control showed knee improvement. The follow-up evaluation demonstrated an increase in joint motion, diminished volume, and less requirement and frequency of the use of antihemophilic factors (AHF) in 80% of the radiosynovectomies (21 of 26), thus lowering health costs. Five female RA patients (5 of 6) had decreased joint swelling and pains, resulting in increased joint motion.


CONCLUSIONS
Radiosynovectomy in RA showed a 3-month pain palliative effect. One intra-articular knee radiosynoviorthesis in haemophilic patients provides a more than 3- month relief of symptoms after treatment with locally produced P-32 (11 patients). This turned out to be a safe, economic alternative procedure in emerging nations where the availability of AHF is difficult and expensive.
Centro de Medicina Nuclear, Comision Nacional de Energía Atómica Argentina, Buenos Aires, IAEA, Argentina. soroa@cnea.gov.ar
Victoria Ester
VE
Soroa
Mańa
M
del Huerto Velázquez Espeche
Carlos
C
Giannone
Horacio
H
Caviglia
Gustavo
G
Galatros
Daniel
D
Fernández
Marcos
M
Méndez
Gustavo Guillermo
GG
Naswetter
Jorge Osvaldo
JO
Nicolini
D000293:Adolescent; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003102:Colloids / Q000008:administration & dosage; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D007717:Knee / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010761:Phosphorus Radioisotopes / Q000627:therapeutic use; D013585:Synovitis / Q000150:complications / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery*
D003102:Colloids; D010761:Phosphorus Radioisotopes