Clinical effect of radiation synovectomy of the upper extremity joints: a randomised, double-blind, placebo-controlled study.
OBJECTIVE
To compare the clinical efficacy of radiosynoviorthesis (RSO) with intra-articular radionuclide plus glucocorticoid (GC) injection (group A) with that of placebo plus GC injection (group B) for the treatment of persistent synovitis in joints of the upper extremity.


METHODS
At baseline and at 6 and 12 months after intra-articular injection, six clinical parameters were scored. Changes in clinical values over time were summed to provide a change composite index (CCI), ranging from 0 (no effect) to 12 (maximal effect). A CCI > or =6 was considered to indicate successful treatment. Differences in response rate and CCI between groups A and B were examined. Regression analyses were performed to explore whether baseline variables could predict therapeutic effect.


RESULTS
Sixty-eight joints in 44 patients were treated. Six months after intra-articular injection, response rates (CCI > or =6) were 69% (25/36) in group A and 29% (9/31) in group B (p=0.001). The mean CCIs +/- standard deviation at 6 months were 6.7+/-3.2 for group A and 3.3+/-3.8 for group B (p=0.001). At 12 months the response rates were 69% (25/36) in group A and 32% (8/25) in group B (p=0.004). The mean CCIs at 12 months were 6.8+/-3.3 for group A and 4.2+/-4.7 for group B (p= 0.046). None of the baseline variables predicted the therapeutic effect.


CONCLUSIONS
RSO (radionuclide plus GC) of upper extremity joints with immobilisation for 72 h shows a significantly better response rate than placebo plus GC in patients with persistent synovitis after at least one failed outpatient intra-articular GC injection.
van der Zant
F M
FM
Department of Nuclear Medicine, Hospital Medical Center Alkmaar, Willhelminalaan 12, 1815 JD, Alkmaar, The Netherlands. f.zant@mca.nl
Jahangier
Z N
ZN
Moolenburgh
J D
JD
Swen
W A A
WA
Boer
R O
RO
Jacobs
J W G
JW
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D018771:Arthralgia / Q000517:prevention & control / Q000628:therapy*; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004871:Erbium / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D015990:Placebo Effect; D011868:Radioisotopes / Q000008:administration & dosage*; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012211:Rhenium / Q000008:administration & dosage*; D013585:Synovitis / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage*; D034941:Upper Extremity
D000893:Anti-Inflammatory Agents; D011868:Radioisotopes; D019275:Radiopharmaceuticals; D014221:Triamcinolone; D012211:Rhenium; D004871:Erbium