Effectiveness of radiation synovectomy with Yttrium-90 and Samarium-153 particulate hydroxyapatite in rheumatoid arthritis patients with knee synovitis: a controlled, randomized, double-blinded trial.
The aim of the present study was to investigate the long-term effectiveness of and tolerance to Yttrium-90 and Samarium-153-particulate hydroxyapatite radiation synovectomy in patients with rheumatoid arthritis (RA) and chronic knee synovitis. Eight-four patients (90 knees) with chronic knee synovitis and RA (according to the American College of Rheumatology criteria) participated in a controlled, double-blinded trial. Patients were randomized to receive an intra-articular injection with either 5 mCi Yttrium-90 plus 40 mg of triamcinolone hexacetonide (Y/TH Group), 15 mCi Samarium-153 hydroxyapatite plus 40 mg of triamcinolone hexacetonide (Sm/TH Group), or 40 mg triamcinolone hexacetonide alone (Control Group). Blinded examination at baseline, 1, 4, 12, 32, and 48 weeks post-intervention included a visual analog scale for joint pain and swelling, morning stiffness, range of motion, knee circumference, Likert scale, percentage of improvement, Stanford Health Assessment Questionnaire, Lequesne index, use of non-steroidal anti-inflammatory drugs and corticosteroids, events and adverse effects, calls to the physician, and hospital visits. There were three withdrawals prior to the injections. Regarding the pain, there was a significantly better response in the Y/TH Group versus the Sm/TH Group at T1 (p = 0.025) and versus TH alone at T48 (p = 0.026). The Sm/TH group had more adverse effects (p = 0.042), but these were mild and transitory. For the pain parameter alone, Yttrium-90 radiosynovectomy associated to TH proved superior to Samarium-153 hydroxyapatite radiosynovectomy associated to TH at T1 and to synovectomy with TH at T48. No other statistically significant inter-group differences were detected.
Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil.
Marla Francisca
MF
Dos Santos
Rita Nely Vilar
RN
Furtado
Monique Sayuri
MS
Konai
Mario Luiz Vieira
ML
Castiglioni
Renata Rosa
RR
Marchetti
Constancia Pagano Gonçalves
CP
Silva
Jamil
J
Natour
D001172:Arthritis, Rheumatoid / Q000378:metabolism*; D002908:Chronic Disease; D004311:Double-Blind Method; D017886:Durapatite / Q000737:chemistry*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011868:Radioisotopes / Q000494:pharmacology*; D012493:Samarium / Q000494:pharmacology*; D011795:Surveys and Questionnaires; D013585:Synovitis / Q000378:metabolism* / Q000473:pathology; D014222:Triamcinolone Acetonide / Q000031:analogs & derivatives / Q000494:pharmacology; D015021:Yttrium Radioisotopes / Q000494:pharmacology*
D011868:Radioisotopes; D015021:Yttrium Radioisotopes; D012493:Samarium; D017886:Durapatite; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide