ab22605

¹⁶⁹erbium-citrate synoviorthesis after failure of local corticosteroid injections to treat rheumatoid arthritis-affected finger joints

A. Kahan¹, G. Mödder², C.J. Menkes¹, P. Verrier¹, J.-Y. Devaux⁴, A. Bonmartin⁵, Y. De Rycke⁶, L. Manil⁶, F. Chossat⁷, J. Tebib³

¹Paris V University, Rheumatology A Department, Hôpital Cochin, AP Ð HP, Paris, France; ²Nuclear Medicine, Max Planck Institute, Köln-Marsdorf, Germany; ³Rheumatology Department, Centre Hospitalier Lyon-Sud, Lyon; ⁴Paris V University, Nuclear Medicine Department, Hôpital Cochin, AP - HP, Paris; ⁵Nuclear Medicine Department, Centre Hospitalier Lyon-Sud, Lyon; ⁶Consultants for Schering - CIS bio international, Gif-sur-Yvette; ⁷Schering - CIS bio international, Gif-sur-Yvette, France.

ABSTRACT
Objectives
Intra-articular injection of ¹⁶⁹Erbium-citrate (¹⁶⁹Er-citrate; radiosynoviorthesis or radiosynovectomy) is an effective local treatment of rheumatic joint diseases. However, its efficacy in corticosteroid-resistant rheumatoid arthritis-affected joints has not been clearly demonstrated.

Methods
A double-blind, randomised, placebo-controlled, international multicentre study was conducted in patients with rheumatoid arthritis with recent (£ 24 months) ineffective corticosteroid injection(s) into their finger joint(s). Eighty-five finger joints of 44 patients were randomised to receive a single injection of placebo (NaCl 0.9%) or ¹⁶⁹Er-citrate. Results of evaluation 6 months later were available for 82 joints (46 metacarpophalangeal and 36 proximal interphalangeal joints) of 42 patients: 39 ¹⁶⁹Er-citrate-injected joints and 43 placebo-injected joints. Efficacy was assessed using a rating scale for joint pain, swelling and mobility.

Results
Intent-to-treat analysis of the results of the 82 joints showed a significant effect of ¹⁶⁹Er-citrate compared to placebo for the principal criteria decreased pain or swelling (95 vs 79%; p = 0.038) and decreased pain and swelling (79 vs 47%; p = 0.0024) and for the secondary criteria decreased pain (92 vs 72%; p = 0.017), decreased swelling (82 vs 53%; p = 0.0065) and increased mobility (64 vs 42%; p = 0.036). Per-protocol analysis, excluding 18 joints of patients who markedly changed their usual systemic treatment for arthritis, gave similar percentages of improvement but statistical significance was lower owing the reduced power of the statistical tests.

Conclusion
These results confirm the clinical efficacy of ¹⁶⁹Er-citrate synoviorthesis of rheumatoid arthritis-diseased finger joints after recent failure of intra-articular corticotherapy.

Key words
Radiosynoviorthesis, erbium, rheumatoid arthritis.

Please address correspondence to: Professeur André Kahan, Hôpital Cochin, Service de Rhumatologie A, 27 rue du Faubourg Saint Jacques, 75014 Paris, France.
E-mail: andre.kahan@cch.ap-hop-paris.fr