ab1904

The effect of radiation synovectomy in patients with persistent arthritis: A prospective study

Z.N. Jahangier¹, J.D. Moolenburgh², J.W.G. Jacobs¹, H. Serdijn³, J.W.J. Bijlsma¹

¹Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht; Departments of ²Rheumatology and of ³Nuclear Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands

ABSTRACT
Objective
To investigate and compare the effects of radiation synovectomy of various joints in a rheumatological practice.

Methods
Consecutive patients referred for radiation synovectomy to Medical Center Alkmaar from 1993 till 1996 were analyzed (n = 138). Patients had to have persistent arthritis despite at least two intra-articular glucocorticoid injections with 20 mg triamcinolone hexacetonide. The knees were treated with 185 MBq Yttrium-90; shoulders, elbows, wrists, hips and talocrural joints received 185 MBq Rhenium-186 and meta-carpophalangeal joints and proximal interphalangeal joints 37 MBq Erbium-169. The radionuclide injection was followed by injection of 20 mg triamcinolone in order to prevent flare-up of synovitis (due to chemical irritation) and needle-track burn. The clinical effect was assessed by evaluating VAS pain (0-10 point scale), functional disability, tenderness and swelling of the treated joint and patient's and physician's global assessments of the effect of therapy (each on a 4-point scale).

Results
The overall success rate for radiation synovectomy one year after treatment was 70% with a significant improvement in the variables VAS pain, functional disability and joint tenderness and swelling, when compared to baseline values (p < 0.000001). Moderate to considerable satisfaction of patients and physicians one year after treatment was found for > 50% of cases. Wrists and shoulders were the joints with highest success rate of treatment, followed by the elbows. Lowest success rates were found for hips and ankles. In RA treatment was effective in 76% of cases whereas patients with OA exhibited a success rate of 50%. In RA all treated joints, except the ankles, exhibited a success rate of ³ 75%. No short-term clinical adverse side effects were noted.

Conclusion
Radiation synovectomy seems to be a successful treatment for persistent arthritis when other therapeutic modalities have failed.

Key words
Radiosynovio-orthesis, radiation, synovectomy, synoviolysis, arthritis, therapy, yttrium, radionuclide.

Please address correspondence to: Zalima N. Jahangier, MD, Department of Rheumatology and Clinical Immunology, F 02.127, University Medical Center, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
E-mail: Z.N.Jahangier@digd.azu.nl