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Title: 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
Authors: Santos, Marla Francisca dos [UNIFESP]
Vilar Furtado, Rita Nely [UNIFESP]
Konai, Monique Sayuri [UNIFESP]
Vieira Castiglioni, Mario Luiz [UNIFESP]
Marchetti, Renata Rosa [UNIFESP]
Goncalves Silva, Constancia Pagano [UNIFESP]
Natour, Jamil [UNIFESP]
Universidade Federal de São Paulo (UNIFESP)
Keywords: Intra-articular injection
Radiation synovectomy
Rheumatoid arthritis
Issue Date: 1-Jan-2011
Publisher: Springer
Citation: Clinical Rheumatology. London: Springer London Ltd, v. 30, n. 1, p. 77-85, 2011.
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.
ISSN: 0770-3198
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