Effectiveness of radiation synovectomy with samarium-153 particulate hydroxyapatite in rheumatoid arthritis patients with knee synovitis: a controlled randomized double-blind trial.
OBJECTIVE
The aim of the present study was to investigate the effectiveness of Samarium(153)-particulate hydroxyapatite radiation synovectomy in rheumatoid arthritis patients with chronic knee synovitis.


METHODS
Fifty-eight rheumatoid arthritis patients (60 knees) with chronic knee synovitis participated in a controlled double-blinded trial. Patients were randomized to receive either an intra-articular injection with 40 mg triamcinolone hexacetonide alone (TH group) or 40 mg triamcinolone hexacetonide combined with 15 mCi Samarium(153)-particulate hydroxyapatite (Sm/TH group). Blinded examination at baseline (T0) and at 1 (T1), 4 (T4), 12 (T12), 32 (T32), and 48 (T48) weeks post-intervention were performed on all patients and included a visual analog scale for joint pain and swelling as well as data on morning stiffness, flexion, extension, knee circumference, Likert scale of improvement, percentage of improvement, SF-36 generic quality of life questionnaire, Stanford Health Assessment Questionnaire (HAQ), Lequesne index, use of non-steroidal anti-inflammatory drugs or oral corticosteroids, events and adverse effects, calls to the physician, and hospital visits.


RESULTS
The sample was homogeneous at baseline, and there were no withdrawals. Improvement was observed in both groups in relation to T0, but no statistically significant differences between groups were observed regarding all variables at the time points studied. The Sm/TH group exhibited more adverse effects at T1 (p<0.05), but these were mild and transitory. No severe adverse effects were reported during follow-up.


CONCLUSIONS
Intra-articular injection of Samarium(153)-particulate hydroxyapatite (15 mCi) with 40 mg of triamcinolone hexacetonide is not superior to triamcinolone hexacetonide alone for the treatment of knee synovitis in patients with rheumatoid arthritis at 1 y of follow-up.
Santos
Marla Francisca dos
MF
Division of Rheumatology, Universidade Federal de São Paulo, Escola Paulista de Medicina (UNIFESP) - São Paulo/SP, Brazil.
Furtado
Rita Nely Vilar
RN
Konai
Monique Sayuri
MS
Castiglioni
Mario Luiz Vieira
ML
Marchetti
Renata Rosa
RR
Natour
Jamil
J
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000532:radiotherapy*; D002908:Chronic Disease; D004338:Drug Combinations; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006882:Hydroxyapatites / Q000008:administration & dosage / Q000009:adverse effects*; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011868:Radioisotopes / Q000009:adverse effects* / Q000627:therapeutic use; D012493:Samarium / Q000008:administration & dosage / Q000009:adverse effects*; D013585:Synovitis / Q000188:drug therapy / Q000532:radiotherapy*; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D006882:Hydroxyapatites; D011868:Radioisotopes; C091049:samarium hydroxyapatite; D012493:Samarium; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide