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.

Abstract

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.

• Authors: Marla Francisca Dos Santos, Rita Nely Vilar Furtado, Monique Sayuri Konai, Mario Luiz Vieira Castiglioni, Renata Rosa Marchetti, Constancia Pagano Gonçalves Silva, Jamil Natour
• Journal: Clinical rheumatology (Clin Rheumatol) Vol. 30 Issue 1 Pg. 77-85 (Jan 2011) ISSN: 1434-9949 [Electronic] Germany
• PMID: 21120562 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Radioisotopes
• Yttrium Radioisotopes
• Samarium
• Durapatite
• Triamcinolone Acetonide
• triamcinolone hexacetonide

Topics

• Arthritis, Rheumatoid (metabolism)
• Chronic Disease
• Double-Blind Method
• Durapatite (chemistry)
• Female
• Humans
• Knee Joint (metabolism)
• Male
• Middle Aged
• Radioisotopes (pharmacology)
• Samarium (pharmacology)
• Surveys and Questionnaires
• Synovitis (metabolism, pathology)
• Triamcinolone Acetonide (analogs & derivatives, pharmacology)
• Yttrium Radioisotopes (pharmacology)